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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 Medical Education Minister K Sudhakar on Thursday paid a surprise visit to the C V Raman Hospital in Bengaluru and urged the administration to follow COVID-19 guidelines properly. He also took stock of the hospital's preparedness to fight the deadly virus.

The minister noticed a number of flaws and warned the hospital to go strictly by the guidelines. He saw that despite 15 high-flow oxygen beds lay vacant, only two patients were admitted. He then asked the hospital to send asymptomatic and mildly symptomatic patients to COVID-19 care centres so that beds were available to those who need these.

"Doctors' profession is a noble one and in a situation like this everyone should perform their duty with utmost humanity and compassion. During this crisis, we should all be kind and empathetic," the minister said. He also ordered the suspension of two officials for not following the guidelines and not giving the right treatment to patients.

He noticed that the hospital lab collected less number of swabs and instructed them to collect a minimum of 500 swabs per day. Pointing out the under-utilised beds and ICUs, he observed that because of such negligence by officials, the government is being blamed despite working day and night for the past four-five months.
During this visit, the minister also interacted with the patients through video call and enquired about the services provided to them by the hospital.

"Surprise visits will continue. I will be in touch with every lab and get the right number of tests done on a daily basis," the minister said while speaking to the media.

He also urged the people who have recovered from COVID-19 to donate their plasma to save other lives, adding that donors will receive a reward of Rs 5000 as a token of appreciation.