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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.

Istanbul: Mosques in Turkey reopened on Friday for mass prayers after more than two months as the government further eased strict restrictions to stop the spread of the new coronavirus.

Turkey has been shifting since May to a "new normal" by easing lockdown measures and opening shopping malls, barbershops and hair salons.

President Recep Tayyip Erdogan has said many other sites -- restaurants and cafes as well as libraries, parks and beaches -- will reopen from Monday.

Hundreds of worshippers wearing protective masks performed mass prayers outside Istanbul's historic Blue Mosque for the first time since mosques were shut down in March.

In the Ottoman-era Fatih mosque, worshippers prayed both inside and outside, with the municipality handing out disinfectants and disposable carpets.

"I have waited a lot for this, I have prayed a lot. I can say it's like a new birth, thanks to God, he has brought us back here," he said.

Another worshipper, Asum Tekif, 50, said: "It has a been a long time... we missed the mosques."

Turkey, a country of 83 million, has so far recorded 4,489 coronavirus-related deaths and 162,120 confirmed cases.

Prayers in Hagia Sophia

Muslim clerics on Friday recited prayers in the Hagia Sophia, the world famous Istanbul landmark which is now a museum after serving as a church and a mosque.

The prayers were held to celebrate the anniversary of the conquest of Constantinople, today's Istanbul, by the Ottomans in 1453.

"It is very important to commemorate the 567th anniversary of the conquest ... through prayers in the Hagia Sophia," said President Recep Tayyip Erdogan, who attended the ceremony via videoconference.

The stunning edifice was first built as a church in the sixth century under the Byzantine Empire as the centrepiece of its capital Constantinople.

After the Ottoman conquest, it was converted into a mosque before being turned into a museum during the rule of Mustafa Kemal Ataturk, the founder of modern Turkey, in the 1930s.

But there have been hints about reconverting the Hagia Sophia into a mosque. Last year, Erdogan himself mooted the possibility of turning Hagia Sofia museum into a mosque.

Such calls have sparked anger among Christians and raised tensions with neighbouring Greece.

In 2015, a Muslim cleric recited the Koran in the Hagia Sophia for the first time in 85 years to mark the opening of an exhibition.

After Friday prayers at the Blue Mosque, a small group of Muslim worshippers shouted: "Let the chains break and let the Hagia Sophia open".

The group was later dispersed by the police who stopped them from protesting near Hagia Sophia that sits immediately opposite the Blue Mosque.

Newsroom, June 5: The union health ministry has announced new rules for shopping malls which have been permitted to open from June 8, except those falling in containment zones.

The guidelines will come into effect from Monday and cinema halls, gaming arcades and children play areas in these establishments will remain closed.

Here is the complete list of standard operating procedures issued by the ministry to be followed in shopping malls to contain the spread of COVID-19.

•   Thermal screening of all visitors mandatory at entry point, along with compulsory hand hygiene. Only asymptomatic visitors will be allowed to enter the shopping mall .

•  It will be mandatory for all visitors as well as workers to wear face masks at all times inside the mall. 

•  Posters and audio-visual media on preventive measures about COVID-19 should be displayed prominently.

•  Visitor entry to shopping malls should be allowed in a staggered manner and adequate manpower be deployed by mall management for ensuring social distancing norms.

•  All employees who are at higher risk like elderly, pregnant women and those having underlying medical conditions should take extra precautions. They should preferably not be exposed to any front-line work requiring direct contact with the public.

•   Proper crowd management in the parking lots and outside the premises – duly following social distancing norms shall be ensured. Preferably, separate entry and exits for visitors, workers and goods/supplies shall be organised.

•   The staff for home deliveries should be screened thermally by the shopping mall authorities prior to allowing home deliveries and required precautions while handling supplies, inventories and goods in the shopping mall must be ensured.

•   Physical distancing of a minimum of 6 feet, when queuing up for entry and inside the shopping mall should be maintained as far as feasible while the number of customers inside the shop should be kept at a minimum, so as to maintain the physical distancing norms.

•   The number of people in the elevators should be restricted and use of escalators with one person on alternate steps should be encouraged.

•   Number of people in the elevators shall be restricted, duly maintaining social distancing norms. Use of escalators with one person on alternate steps may be encouraged.

•   Effective and frequent sanitation within the premises shall be maintained with particular focus on lavatories, drinking and hand washing stations/areas

•   Cleaning and regular disinfection of frequently touched surfaces  to be made mandatory in all malls in common areas as well as inside shops, elevators, escalators etc.

•   In the food-courts, adequate crowd and queue management is to be ensured and not more than 50 per cent of seating capacity should be permitted.

•   Food court staff should wear mask and hand gloves and take other required precautionary measures, the seating arrangement should ensure adequate social distancing between patrons as far as feasible and tables should be sanitized each time a customer leaves.

•   Gaming arcades, children play areas and cinema halls inside shopping malls shall remain closed.

•   Spitting should be strictly prohibited and installation and use of Aarogya Setu App shall be advised to all.

•   The ministry advised persons aged above 65, those having comorbidities, pregnant women and children below the age of 10  to stay at home, except for essential and health purposes.