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Kochi, Jan 21: Eight tourists from Kerala were found dead in a resort at Daman in Makwanpur district of Nepal, reports said. The dead include a couple and four minor children.

The deceased were identified as Praveen Kumar Nair (39), Saranya (34), Ranjith Kumar T.B (39), Indu Ranjith (34), Sreebhadra (9), Abhinav Soorya (9), Abhi Nair (7) and Vaishnav Ranjith (2).

The deceased are from Chengottukonam in Thiruvananthapuram and Kundamangalam in Kozhikode. Praveen, a travel enthusiast hailing from Chengottukonam, went on the Nepal trip with his wife, three children and friends from Kochi, last week.

 “They were using a gas heater in the room. Suffocation might have caused their death,” said superintendent of police Sushil Singh Rathore of the District Police Office in Makwanpur, news agencies reported.

According to newspaper reports here, the deaths occurred at a resort named Everest Panorama. They were airlifted to HAMS hospital where they were pronounced dead on arrival, superintendent of police Sushil Singh Rathaur said.

They were part of a group of 15 people travelling from Kerala to Pokhara, a popular mountain tourist destination, The Himalayan Times reported.

They were on their way back home and stayed at Everest Panorama resort in Daman in Makawanpur district on Monday night.

The tourists are suspected to have died of asphyxiation after turning on the gas heater and shutting all the windows to keep warm.  Hotel staff opened the room using duplicate keys as there was no response from the rooms when the other members of the group went to check on them.

According to the manager of the resort, the guests stayed in a room and turned on a gas heater to keep themselves warm. Although they had booked a total of four suites, eight of them stayed in a room, the manager said, adding that all the windows and the door of the room were bolted from inside.

“All arrangements have been made to bring the bodies to Kerala at the earliest. The Union government is coordinating with the Indian Embassy in Nepal. A doctor from the Indian embassy will be present during the post mortem. Other members of the group are being brought to Kathmandu by road,” said Union minister V Muraleedharan.

Chief minister Pinarayi Vijayan said that NORKA will coordinate with Nepal authorities to bring dead bodies.

 “Embassy officials are at the government hospital where a post mortem is being done. Formalities will be completed at the earliest and arrangements are in place to bring dead bodies by Wednesday evening. State government is in constant contact with Nepal authorities,” said Kadakampally Surendran, tourism minister.

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.