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May 12: Children suffering from non-respiratory disease symptoms like diarrhea and fever, or those with a history of exposure to the novel coronavirus, should be suspected of having COVID-19, a new study says.

According to the research, published in the journal Frontiers in Pediatrics, gastrointestinal symptoms first suffered by some children hints at potential infection with SARS-CoV-2 through the digestive tract.

"This case series is the first report to describe the clinical features of COVID-19 with non-respiratory symptoms as the first manifestation in children," the scientists from Tongji Hospital in China wrote in the study.

They explained that the gastrointestinal symptoms could be arising since the type of receptors in lung cells targeted by the virus can also be found in the intestines.

Most children are only mildly affected by COVID-19, and the few severe cases often have underlying health issues, the researchers said.

"It is easy to miss its diagnosis in the early stage, when a child has non-respiratory symptoms, or suffers from another illness," said study co-author Wenbin Li, who works at the Department of Pediatrics, Tongji Hospital.

"Based on our experience of dealing with COVID-19, in regions where this virus is epidemic, children suffering from digestive tract symptoms, especially with fever and/or a history of exposure to this disease, should be suspected of being infected with this virus," Li said.

In the study, the scientists described the clinical features of children admitted to hospital with non-respiratory symptoms, who were subsequently diagnosed with pneumonia and COVID-19.

"These children were seeking medical advice in the emergency department for unrelated problems, for example, one had a kidney stone, another a head trauma," Li said.

The study noted that all the children had pneumonia, which was confirmed by chest X-ray scan before or soon after admission.

These children were then confirmed to have COVID-19.

While their COVID-19 symptoms were initially mild or relatively hidden before their hospital admission, four out of the five cases had digestive tract symptoms as the first manifestation of this disease, the researchers said.

Li hopes that doctors will use the findings to quickly diagnose and isolate patients with similar symptoms, which may aid early treatment and reduce transmission.

According to the researchers, the children's gastrointestinal symptoms, which have also been recorded in adult patients, could be an additional route of infection.

"The gastrointestinal symptoms experienced by these children may be related to the distribution of receptors and the transmission pathway associated with COVID-19 infection in humans," Li explained.

Since the virus infects people via the ACE2 receptor, which can be found in certain cells in the lungs as well as the intestines, COVID-19 might infect patients not only through the respiratory tract in the form of air droplets, but also through the digestive tract by contact or fecal-oral transmission, the study noted.

While COVID-19 tests can occasionally produce false positive readings, Li said all the five children assessed in the study were infected with the disease.

However, he cautioned that more research is needed to confirm their findings.

"We report five cases of COVID-19 in children showing non-respiratory symptoms as the first manifestation after admission to hospital. The incidence and clinical features of similar cases needs further study in more patients," he said.

Bengaluru, May 15: With lockdown-3 coming to an end in a couple of days, Karnataka Chief Minister B S Yediyurappa on Friday expressed confidence about the Centre announcing relaxation to "many things" after May 17.

"After May 17, the government of India is going to relax so many things, let us wait for it," he said in response to a question from reporters here. "According to me they (centre) will relax everything.... maybe for things like five-star hotels and others they may not give permission for the time being, but for other things they are going to give permission. Let's wait and see."

The nationwide lockdown was initially imposed from March 25 to April 14, then extended to May 3 and again to May 17 to prevent the spread of the novel coronavirus. Karnataka Tourism Minister C T Ravi on Wednesday had hinted at the state government permitting the opening of gyms, fitness centres and golf courses, also certain hotels for local tourism purpose after May 17, when the third phase of the COVID-19 induced lockdown comes to an end.

The Muzrai department (in charge of the administration of temples) was also planning to have a Standard Operating Procedure (SOP) in place, that needs to be followed at temples once they are opened for the public, officials have said. They said the opening of temples for the public is however subject to the MHA (Ministry of Home Affairs) guidelines.

During the recent video conferencing Prime Minister Narendra Modi had with Chief Ministers of various states, Yediyurappa had proposed doing away with district wise colour-coding and instead advocated strict cordoning of containment zones to control the spread of the pandemic.

He had pitched for resuming all economic activities in stand-alone establishments while continuing the restrictions on malls, cinema halls, dining facilities and establishments with centrally controlled air-conditioning. The CM had suggested that 50 to 100 meters around known clusters be declared as containment zones and commercial activities, including public transport, to be allowed in non- containment zones.