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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: The Secondary School Leaving Certificate (SSLC) examinations in Karnataka concluded on Friday with an overall average of about 98 per cent attendance amid the coronavirus scare. Chief Minister B S Yediyurappa congratulated the lakhs of students who appeared for the crucial exercise braving the coronavirus pandemic situation.

An average of about 98 per cent of 8.5 lakh odd enrolled students took the exams which began on June 25, after the government stuck to its decision to go ahead with them despite rising coronavirus cases but laid down a string of safety measures, including face masks and maintaining distancing by seating only one student a bench.

Examinations for all main subjects had been completed and alternative subjects such as music would take place on Saturday, Education department officials said.

"I heartily congratulate students who faced the examination even during the coronavirus pandemic," Mr Yediyurappa tweeted.

Expressing happiness over the successful completion of the examination, he greeted state Primary and Secondary Education Minister S Suresh Kumar, officers and employees of education department, health department, police and transport personnel.

"The exam is a proof that anything can be made possible if all the government departments work in tandem," Mr Kumar tweeted.

Later addressing a press conference, he said on Friday 98.10 per cent attendance was recorded compared to 98.76 for the same paper last year.

"Credit goes to children. First day, parents were scared and students were sceptical and there was a big challenge before us. But the children appearing for the exam instilled confidence. They came with masks, sanitisers and were careful about maintaining social distancing. Our children have set an example for others to follow," Mr Kumar said.

Lauding the students, parents and the government staff who made the exam possible ignoring the virus scare, Medical Education Minister Dr K Sudhakar said Karnataka has set an example by successfully conducting the examination.

The Karnataka Secondary Education Examination Board, which conducted the examination, faced various challenges. While protecting students from coronavirus infection was the top priority, transportation, security and convincing the parents to allow their children to take up the exam were the other factors it encountered.

According to sources in the department, the education officers had directed authorities of all the schools to call the parents and students to make sure that they appear for the examinations.

The Central Board of Secondary Education (CBSE) and boards of various neighbouring states either gave general promotion or decided to give marks to the students based on their performance in the earlier tests conducted by the schools.

The exams were conducted at a time when there was a sudden spurt in coronavirus cases in Karnataka, especially Bengaluru. Expressing apprehension, former chief minister and JD(S) leader H D Kumaraswamy had appealed to the government to postpone the examination but the government went ahead with its decision.

Bengaluru, Jun 12: The Central government has identified Karnataka's Udupi and Yadgir among the "emerging districts of concern" for COVID-19 in the country. Confirming the development, a top official of the state health department said, "they (centre) had reviewed these two districts a few days back...there was a sudden spurt of cases due to Maharashtra returnees turning positive." Sources said union cabinet secretary Rajiv Gauba, during a recent video conference with state chief secretaries and health secretaries, had shared his thoughts on the issue.

According to the information shared, districts with more than 400 cases, half of which was reported post-May 18 lockdown relaxation, have been identified as "emerging districts of concern." They are concentrated in the seven states/union territories of Maharashtra, Rajasthan, Tamil Nadu, West Bengal, Karnataka, Jammu and Kashmir and Haryana. "Udupi and Yadgir from Karnataka, along with Gurugram in Haryana and Kolhapur in Maharashtra have 90 per cent of the cases recorded after May 18," they said.

As on June 11 evening, Udupi had a total of 969 positive cases, out of which 619 are active, while 735 positive cases have been reported in Yadgir, out of which 626 are active. The two districts had reported a total of only 11 cases each as on May 18. While Udupi till last evening had seen 349 discharges, it was 108 in Yadgir.

Both districts have reported one COVID related fatality so far. As of June 11 evening, cumulatively 6,245 COVID-19 positive cases were confirmed in the state, which included 72 deaths and 2,976 discharges.