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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.

Washington, Feb 22: US President Donald Trump will raise the issue of religious freedom with Prime Minister Narendra Modi during his visit to India next week, the White House said on Friday, noting that the US has great respect for India's democratic traditions and institutions.

"President Trump will talk about our shared tradition of democracy and religious freedom both in his public remarks and then certainly in private. He will raise these issues, particularly the religious freedom issue, which is extremely important to this administration," a senior official told reporters in a conference call.

The official was responding to a question on whether the president was planning to speak to Modi on the Citizenship (Amendment) Act or the National Register of Citizens.

"We do have this shared commitment to upholding our universal values, the rule of law. We have great respect for India's democratic traditions and institutions, and we will continue to encourage India to uphold those traditions," the official said, requesting anonymity.

"And we are concerned with some of the issues that you have raised," the senior administration official said, in response to the question on CAA and NRC.

"I think the President will talk about these issues in his meetings with Prime Minister Modi and note that the world is looking to India to continue to uphold its democratic traditions, respect for religious minorities," the official said.

"Of course, it's in the Indian constitution -- religious freedom, respect for religious minorities, and equal treatment of all religions. So this is something that is important to the president and I'm sure it will come up," said the official.

Pointing out that India has a strong democratic foundation, the official said India is a country rich in religious, linguistic, and cultural diversity.

"In fact, it's the birthplace of four major world religions," the official noted.