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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.

New Delhi, Apr 19: The government on Sunday prohibited the sale of non-essential items through e-commerce platforms during the ongoing lockdown, four days after allowing such companies to sale mobile phones, refrigerators and ready-made garments.

Union Home Secretary Ajay Bhalla issued an order excluding the non-essential items from sale by the e-commerce companies from the consolidated revised guidelines, which listed the exemption given to the services and people from the purview of the lockdown.

The order said the following clause -- "E-commerce companies. Vehicles used by e-commerce operators will be allowed to ply with necessary permissions" -- is excluded from the guidelines.

The previous order had said such items were allowed for sale through e-commerce platforms from April 20.

However, the reason for reversing the order is not known immediately.

Thiruvananthapuram, Mar 31: The Kerala government

on Tuesday rejected concerns of community spread of novel coronavirus in the state in the wake of the second death of a patient here who had no travel history or reported contact with any infected person.

Setting aside the concern, Health Minister K K Shylaja said the deceased man, a native of nearby Pothancode, was already suffering from several other health issues including high blood pressure.

The 68-yearold man died at the government medical college here, taking the total number of COVID-19 deaths in Kerala to two, the government said.

"We have got information that the deceased man had come in contact with some persons arrived from the Gulf. As he was very sick and was not in a position to speak, we could not collect details from him directly," she told reporters here.

"So we had to collect such details from his relatives now. As per preliminary assessment, it was a case of contact spread. So, as of now, there is no need to get panic about the community spread," she said

The possibility of death was high among patients, aged above 60 years and suffering from other diseases like heart ailments or diabetics, she said.

"That's why we are giving strict directions to the elderly people to remain in homes and avoid contact with infected persons, " the minister said.

However, the minister directed those came in contact with the deceased person to remain in self-quarantine and inform the authorities if they developed any infection symptoms.

In both the coronavirus deaths in the state, the deceased persons were aged and were suffering from other diseases, she added.