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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.

New Delhi, Mar 29: "What corona? My children are hungry, they have walked from Gurugram with me do you think corona is what I fear?," Yogesh Gangwar who is salesman in a cloth showroom said as he wiped his tears.

Many others regret for not leaving the city early on.

"God knows when we will reach our hometown. My family was telling me to leave work early in March and get back, but I avoided suggestions and now I am stranded here," Babu Ram who hails from Rampur and works at a plastic recycling factory here in Mundka told media.

Migrant labourers were forced to walk as the public transport were closed and borders were sealed due to the lockdown.

"There is no food to eat, I cannot pay rent of room without my daily wages so I decided to walk with my family from Narela to here. I just hope I get a bus soon," Revati, who works as construction labour said as she fed her three-year-old with pieces of bread that one of the policemen at Anand Vihar gave her.

However, when Yogi Adityanath-led BJP government in Uttar Pradesh decided to deploy around 1,000 buses to help these workers reach their respective hometowns, thousands of them reached Anand Vihar ISBT with a hope to catch one of these buses.

The Delhi government also announced that 100 buses have been deployed to help those trying to reach to their homes in other states on foot.

In order to avoid the spread of the virus, the police asked the people to stand in three queues and also asked the people to de-board the overcrowded buses.

Earlier, budget passenger carrier SpiceJet had offered its aircraft to operate few flights from Delhi and Mumbai to Patna to take migrant labourers, particularly from Bihar, who have got stuck in various parts of the country due to COVID-19 related lockdown.