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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 18: Karnataka chief minister B S Yediyurappa today announced lockdown relaxations from tomorrow (May 19) across the state. As per new guidelines public transport services will start operations outside COVID-19 containment zones in the state. 

 “To facilitate easy movements of citizens, services of the BMTC, KSRTC, NEKRTC and NWKRTC will start from Tuesday morning, except in containment zones. Even private buses can ply,” Yediyurappa said, after discussing the Centre's Lockdown 4.0 guidelines with his Cabinet colleagues and officials. 

“The only condition is that only 30 people should travel in one bus so as to ensure social distancing,” the CM said. 

He also clarified that bus fares will not be hiked. “I know there will be losses incurred. The government will bear the losses,” he said. 

Auto rickshaws, taxis and maxi cabs (six-passenger vehicles) will also be allowed to operate. “Auto rickshaws and taxis will have a driver and two passengers. Maxi cabs will have a driver and three passengers,” Yediyurappa said. 

All parks in the state will be open 7 am to 9 am and 5 pm to 7 pm. 

Starting Tuesday, all shops except malls and theatres can open. “This includes salons,” the CM said. 

All relaxation will cease to exist every Sunday, the CM said. “Every Sunday will be a complete lockdown. There’ll be no shops and the movement of people. It’ll be a complete rest day,” he said. 

The existing curfew from 7 pm to 7 am will continue on all days, which means public transport services will not be allowed during this time. 

Trains will run within the state, but interstate trains will not be allowed till May 31, the CM said. 

It is mandatory for citizens to wear masks in public. “Not wearing a mask will be penalised,” Yediyurappa said. 

On the classification of zones, Yediyurappa said the government's main focus was containment zones. “We're particular about containment zones. In the Karwar district, for example, Bhatkal will be a containment zone and no other taluk will have restrictions,” he said. 

However, the government will review the relaxation based on how things pan out. “States have been given the freedom, so we can withdraw or modify as necessary,” he said.