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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, Jul 16: Karnataka chief minister BS Yediyurappa on Tuesday said he would request Prime Minister Narendra Modi for more relaxations, as he made it clear that Covid-19 lockdown measures were not required in the state anymore.

"The lockdown is not required for Karnataka, we will request for more relaxations," Yediyurappa said in response to a question about video conferencing with the Prime Minister.

Speaking to reporters here, he said, "I will request him (PM) to make way for- people to lead a normal life and for the improvement in the economic situation."

Several services such as metro, theatres, gyms, swimming pools, bars among others continue to remain restricted under unlock 1.0 that is currently in place.

Modi is scheduled to hold a video conference with chief ministers of various states on Tuesday and Wednesday. Yediyurappa is scheduled to take part in the video conferencing on Wednesday.

The chief minister, who took part in the special pooja organised at Shankar Math here to pray for the control of Covid-19, said, the government was making all efforts to control the spread.

"We are taking strong measures and all of us should fight this together," he said, as he highlighted that the government has released the financial assistance amount that was announced for farmers, and was ensuring that it reaches them.

The current physical distancing guidelines provided by the World Health Organisation (WHO) and by the US Centers for Disease Control and Prevention (CDC) may not be adequate to curb the coronavirus spread, according to a research which says the gas cloud from a cough or sneeze may help virus particles travel up to 8 metres. The research, published in the Journal of the American Medical Association, noted that the the current guidelines issued by the WHO and CDC are based on outdated models from the 1930s of how gas clouds from a cough, sneeze, or exhalation spread.

Study author, MIT associate professor Lydia Bourouiba, warned that droplets of all sizes can travel 23 to 27 feet, or 7-8 metres, carrying the pathogen.

According to Bourouiba, the current guidelines are based on "arbitrary" assumptions of droplet size, "overly simplified", and "may limit the effectiveness of the proposed interventions" against the deadly pandemic.

 She explained that the old guidelines assume droplets to be one of two categories, small or large, taking short-range semi-ballistic trajectories when a person exhales, coughs, or sneezes.

However based on more recent discoveries, the MIT scientist said, sneezes and coughs are made of a puff cloud that carries ambient air, transporting within it clusters of droplets of a wide range of sizes.

Bourouiba warned that this puff cloud, with ambient air entrapped in it, can offer the droplets moisture and warmth that can prevent it from evaporation in the outer environment.

"The locally moist and warm atmosphere within the turbulent gas cloud allows the contained droplets to evade evaporation for much longer than occurs with isolated droplets," she said.

"Under these conditions, the lifetime of a droplet could be considerably extended by a factor of up to 1000, from a fraction of a second to minutes," the researcher explained in the study.

The MIT scientist, who has researched the dynamics of coughs and sneezes for years, added that these droplets settle along the trajectory of a cough or sneeze contaminating surfaces, with their residues staying suspended in the air for hours.

"Even when maximum containment policies were enforced, the rapid international spread of COVID-19 suggests that using arbitrary droplet size cutoffs may not accurately reflect what actually occurs with respiratory emissions, possibly contributing to the ineffectiveness of some procedures used to limit the spread of respiratory disease," Bourouiba wrote in the study