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Children, COVID19 and Multisystem Inflammatory Syndrome – The What’s What

Children, COVID19 and Multisystem Inflammatory Syndrome - The What’s What

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Parents around the world, including Sri Lanka, have been concerned about Multisystem Inflammatory Syndrome or MIS-C appearing in children who have been diagnosed with COVID19. In this article, we break down what’s known, what remains unknown and the steps to take if you suspect your child could be suffering from MIS-C.

What is MIS-C?

MIS-C is a condition where different parts of the body can become inflamed including the heart, lungs, brain, eyes, kidneys or gastrointestinal tract. 

It appears in children who have had or been around someone who has been diagnosed with COVID19. It’s considered to be a potentially serious condition, developing as a delayed complication of COVID19. Data shows that it usually develops two to six weeks after children have recovered from the virus. It can even develop in those children who were asymptomatic to COVID19. 

What are the symptoms of MIS-C?

Call your regular paediatrician or an on-demand paediatrician or family doctor at anytime on the oDoc app if your child is experiencing:

  • A fever and any of the following symptoms:
    • Abdominal pain
    • Bloodshot eyes
    • Chest tightness/pain
    • Diarrhoea
    • Extra fatigue or feeling unusually weak or dizzy
    • Headache
    • Low blood pressure
    • Neck pain
    • Rash 
    • Vomiting

If your child is showing any of the following signs, please seek emergency care immediately

  • Difficulty in breathing
  • Continuous pain or pressure in the chest
  • Inability to stay awake or alert
  • Pale, grey or blue coloured skin, lips or nail bed

This is not an exhaustive list of symptoms, please call a medical professional immediately if any other signs or symptoms appear that are severe or concerning to you. 

Please call 1990 for the Suwa Seriya ambulance service.

Can MIS-C be treated?

Doctors will conduct diagnostics tests on your child to look for inflammation and other signs of disease. Once diagnosed, doctors will closely monitor your child and use a variety of medications to reduce inflammation and protect the affected organs. 

It is vital to seek medical care at the earliest indication of MIS-C. 

What are the unknowns?

There are still a lot of questions out there such as why do some recovered children develop MIS-C and others do not? What health factors could contribute to MIS-C? 

Scientists are working hard to answer these questions and we will update this blog as and when new research is published. 

And finally…

The best way to protect your child from MIS-C is to protect your household from COVID19, this includes:

  • Getting all adults in the household vaccinated at the first opportunity to do so
  • Continuing to mask when interacting with others from different households
  • Washing hands often with soap and water
  • Conducting play dates within a social bubble and in an outdoor environment

If you are concerned about COVID19 or MIS-C and would like medical advice, please consult a pediatrician or family doctor on the oDoc app. Click here to download the app.

Sources

  1. For Parents: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19, CDC.gov website (2021)

  2. Multisystem Inflammatory Syndrome in Children (MIS-C), Boston Children’s Hospital (2021)

  3. MIS-C and COVID-19: Rare Inflammatory Syndrome in Kids and Teens, Johns Hopkins Medicine (2021)

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Long COVID: What we know so far

Long COVID: What we know so far

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Since May 1st, over 300,000 cases of COVID-19 been diagnosed in Sri Lanka. We are mostly familiar with the short term symptoms of the disease (e.g. fever, cough, sore throat, runny nose to name a few). Most have recovered but ca. 8,700 persons have died at the time of writing. Some have seen symptoms persist for a longer period, a condition globally known as long COVID. In this article, we break down what we know so far about long COVID.

What is long COVID?

The UK’s National Health Service describes long COVID as having symptoms that continue for more than 12 weeks after initial diagnosis which cannot be attributed to another illness.

The UK COVID Symptom study found that 1 in 7 adults experienced symptoms for longer than 4 weeks and 1 in 20 adults experienced symptoms beyond the 8 week mark.

long COVID

What are the common symptoms of long COVID?

There are over 200 symptoms that have been reported that affect various organs in the body from the brain to the skin. Symptoms vary from person to person.

Most common symptoms include:

  • Extreme fatigue
  • Brain fog (problems with memory or concentration)
  • Joint pain
  • Changes to taste or smell
  • Shortness of breath, heart palpitations and chest tightness

Other symptoms range from hallucinations, insomnia, hearing and sight changes, gastrointestinal problems to changes in periods and skin conditions².

Those that experience long COVID have described it as “a storm. One day you can have zero symptoms … then it will just go crazy and as quickly as it hits you it can go.”³

What makes some people prone to long COVID whilst others recover quickly?

The science is still out on exactly why some people suffer for longer. Persons experiencing long COVID are not thought to be infectious but one theory is that the body continues to respond to small amounts of the virus that remains in the body & become reactivated. Another theory is that the infection causes some people’s bodies to go into overdrive, attacking its own tissues.

The COVID symptom study¹ had also found that those who experienced a milder version of COVID19 are more prone to long COVID over an extended period of time.

There is evidence that the following categories of people may be more prone than others:

  • Women
  • Older adults
  • People with pre-existing asthma
  • People who had a wider range of symptoms during their initial illness

Can children get long COVID?

A recent study by King’s College London found that for most children, COVID tends to be a mild, short illness. The 1,500 subject study reported that the average duration of symptoms for a child is six days and fewer than 1 in 50 children are unwell after eight weeks.

How long does it take to recover from long COVID?

Recovery estimates vary but most people with long-COVID are able to live life as relatively normal. However, It is important to get healthcare advice from a trusted professional, listen to your body and rest as much as possible when symptoms flare up.

Are there any treatments available?

Large studies are underway to better understand the nature of this secondary condition. As the 216m persons infected with COVID around the world recover, their experiences help shed light on the disease.

Whilst there are no specific treatments available, the focus is on managing symptoms and enabling a slow return to normal activity.

Nutrient rich foods rich with vitamins & minerals that support the immune system are deemed beneficial and experts encourage patients to eat a holistic, well rounded diet.

Worried you may be suffering from long COVID?

If you are experiencing any new or worsening symptoms, especially 4-8 weeks post your initial COVID-19 diagnosis, speak to a doctor on oDoc. Your doctor will discuss your symptoms and if necessary, order clinical tests to rule out other causes. They will provide guidance on how to best manage your symptoms.

If you are worried or anxious about COVID19 or long COVID, speak to a mental health professional on oDoc.

Click here to download the oDoc app to your mobile device.

Sources:

  • COVID Symptom Study, 2020 How long does COVID-19 last? ZOE COVID Study, UK
  • Davis, H et al., (2021) Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. The Lancet
  • Guardian, UK., 2020, Lingering and painful: the long and unclear road to coronavirus recovery.
  • COVID Symptom Study, (2020) Do children get long COVID? ZOE Covid Study, UK
  • Molteni et al., (2021).,Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2., The Lancet
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Long COVID: What we know so far

Since May 1st, over 300,000 cases of COVID-19 been diagnosed in Sri Lanka. We are mostly familiar with the short term symptoms of the disease (e.g. fever, cough, sore throat, runny nose to name a few). Most have recovered but ca. 8,700 persons have died at the time of writing.

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The harsh truth: Children are getting COVID

The harsh truth: Children are getting COVID

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As of 9th August 2021, 45,000 children have contracted COVID-19 in Sri Lanka, with around 20,000 under 10 years of age. Some children have had high fever and other severe symptoms that require treatment at hospitals, with Lady Ridgeway Children’s Hospital stating that they have run out of capacity treating COVID infected children.

If you’re a parent or anyone who has young nieces, nephews or cousins, the last thing you want to think about is having these little ones in hospitals, struggling in any sort of way.


What are the long-term effects of children contracting COVID?

Even if children do contract COVID and have healthy enough immune systems to fight off the virus, the long-term effects post-COVID, known as long COVID, should not be taken lightly. Similar to adults with long COVID, children can suffer devastating neurological, physical and psychological issues that can disrupt their schooling, sleep, extracurricular activities and other aspects of life. Symptoms such as fatigue, headaches, brain fog, memory and concentration difficulties, sleep disturbances, ongoing change in smell and taste can creep up even after the child has recovered from COVID.

“The potential impact is huge,” said Dr. Avindra Nath, chief of infections of the nervous system at the National Institute of Neurological Disorders and Stroke who spoke to The New York Times. “I mean, they’re in their formative years. Once you start falling behind, it’s very hard because the kids lose their own self-confidence too. It’s a downward spiral.”

How can you protect the children in your household?

The problem is that young children or teens cannot be vaccinated at this moment. The best solution right now to keep them safe is to get yourself and everyone in your household vaccinated right now if eligible.

Children are at home these days so there is no chance they are contracting the virus from other children. They are most likely getting the virus from their parents or grandparents and others in their household. With the extremely contagious and transmissible Delta variant, if one person in the household contracts COVID, it is highly likely that everyone else in that household, including the children, will get the virus as well.

Studies have shown that vaccinating older adults has decreased the number of COVID-19 cases in young children. A clear example of this was in Israel, where COVID-19 cases in children declined rapidly when adults got vaccinated in large numbers earlier this year.

But don’t vaccinated adults still pass on the virus?

Yes, but vaccinated people are much less likely to get infected with COVID-19, therefore are less likely to pass on the virus to others. Even if they do get infected, vaccinated people clear the virus much faster with a significantly shorter infectious period than the unvaccinated, hence making them much less contagious.


What more can you do to protect the children in your household?

Teach your children the importance of wearing masks over nose & mouth, good hygiene and physical distancing whenever outside the home. It’s a sad reality to subject our kids to this new world but with all these precautions in place, hopefully we can move onto a newer world where our kids can go back to schools and be with their friends safely!

If you have questions about the vaccines and are still on the fence on getting a vaccine, please consult with a doctor on oDoc today.

Sources:

  • The Best Way to Keep Your Kids Safe From Delta, The Atlantic
  • Kids Struggle With Long COVID, The New York Times
  • Lady Ridgeway Runs Out of Capacity, Daily Mirror
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Long COVID: What we know so far

Since May 1st, over 300,000 cases of COVID-19 been diagnosed in Sri Lanka. We are mostly familiar with the short term symptoms of the disease (e.g. fever, cough, sore throat, runny nose to name a few). Most have recovered but ca. 8,700 persons have died at the time of writing.

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Breaking down the Delta Variant

Breaking down the Delta Variant

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It seems we hear of a news report of a newly discovered Delta COVID19 case in Sri Lanka almost on a daily basis. Resulting in the question, what is the delta variant and what does that mean for us?

For our more in-depth blog on variants, please click here

Short read: It is highly transmissible and has caused more hospitalisations than the Alpha variant in the UK (and India, though the data isn’t as neatly available), especially in young people and the unvaccinated. It is found to be more resistant to the Pfizer and AstraZeneca vaccine responses especially after only one dose but continues to provide 80-90% protection after two doses against symptomatic disease. A widespread of this variant in Sri Lanka could overburden an already overwhelmed medical system. Until vaccines can be rolled out to the majority of the population, adhering to strict COVID19 protocols by businesses and individuals is our only avenue for protection. 

Want more details? Read on!

The Delta variant (B.1617.2) was first sequenced in India post its recent COVID wave of March 2021. The variant was classified as a variant of concern by the WHO alongside the Alpha variant (B.1.1.7) first discovered in Britain, the Beta variant (South Africa) and the Gamme variant (Brazil). Variants of concern are those that are considered highly transmissible, highly infectious and/or deadly.

So what do we know about this newest variant on the block?

Image source: Dr. Eric Topol

How transmissible is it?

WHO’s Dr Mike Ryan described the Delta variant as “faster, fitter and will pick off the more vulnerable more efficiently than the previous variants”. The variant is the fastest spreading one in the UK and has prompted medical professionals to estimate that it is around 60-70% more transmissible than the Alpha variant. 

Tracked data shows that COVID cases have grown 75% week over week in May in the UK (mostly amongst young people and the unvaccinated). 

Why is more transmissible more dangerous?

To quote Zeynep Tufecki on a New York Times op-ed:

“Increased transmissibility is an exponential threat. If a virus that could previously infect three people on average can now infect four, it looks like a small increase. Yet if you start with just two infected people in both scenarios, just 10 iterations later, the former will have caused about 40,000 cases while the latter will be more than 524,000, a nearly 13-fold difference.”

What are its symptoms?

Even in the early throes of the Indian third wave, reports of different COVID19 symptoms began to circulate amongst social media. 

Updated COVID19 symptoms as per the CDC now include:

  • Fatigue
  • Muscle or body aches
  • Headache
  • Sore throat
  • Congestion or runny nose
  • Diarrhoea
  • Nausea and vomiting

How does it affect hospitalisations and the death rate?

A Public Health Scotland study found that the risk of hospital admissions was almost doubled with Delta vs. Alpha. 

Amongst those vaccinated with Pfizer or AstraZeneca, the Public Health England study reported that those with one dose of vaccine were 75% less likely to be hospitalised and those with both doses are 94% less likely to be hospitalised when compared to the unvaccinated population.

How does it respond to vaccines? 

A report published by Public Health England indicated that the variant is moderately resistant to vaccines, especially just the first dose. A single dose of AZ or Pfizer reduced a person’s risk of developing symptomatic illness by 30% (vs. 50% for the Alpha variant). A second dose of AZ increased protection to 60% (compared to 66% for Alpha). Two doses of Pfizer were 88% protective against the variant (compared to 93% against Alpha). 

No studies are available about the Sputnik or Sinopharm response to the new variant.

How can we stay safe?

Whilst richer countries look to rapid deployment of vaccines to counteract the rising Delta cases, Sri Lanka – with limited access to vaccines – must rely on the tried and tested COVID19 safety precautions:

  • Limiting physical gatherings (especially, AC & indoors)
  • Masking indoors & outdoors (over nose & mouth, when around those that are not of the same household)
  • Washing hands with soap
  • Sanitising high touch surfaces

As the third wave has taken us to the brink of medical capacity, any spread of the Delta variant in Sri Lanka could have serious ramifications to public health, but also to the overburdened medical system.

We encourage all Sri Lankans to get vaccinated, to stay home and follow COVID19 protocols to the utmost of your abilities. 

If you are experiencing any COVID19 symptoms or would like to speak with a doctor about your general health, download the oDoc app here

If the uptick of cases and variants are causing your mental health to suffer, speak to a psychologist on the oDoc app safely from your home.

Sources

  1. Stowe, J. et al. Effectiveness of COVID-19 vaccines against hospital admission with the Delta (B.1.617.2) variant., Preprint at https://go.nature.com/3gnqwxr (2021)
  2. Sheik, Z et al. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness., The Lancet: 397: 2461-262 (2021)
  3. WHO says delta is the fastest and fittest Covid variant and will ‘pick off’ most vulnerable, CNBC (2021)
  4. UK reports 6,238 daily Covid cases amid fears over Delta variant infectiousness, The Guardian (2021)
  5. Tufecki, Z., Covid’s Deadliest Phase May Be Here Soon, The New York Times (2021)
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Long COVID: What we know so far

Since May 1st, over 300,000 cases of COVID-19 been diagnosed in Sri Lanka. We are mostly familiar with the short term symptoms of the disease (e.g. fever, cough, sore throat, runny nose to name a few). Most have recovered but ca. 8,700 persons have died at the time of writing.

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Understanding the dynamics – breastfeeding, pregnancy and COVID vaccines

Understanding the dynamics - breastfeeding, pregnancy and COVID vaccines

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As Sri Lanka rolls out its vaccination program, the questions have shifted from “Which vaccine should I get?” to “Should pregnant and breastfeeding women get vaccinated?” 

The answer in short: Yes, everyone should get vaccinated when offered the chance.

For a more detailed answer on how the vaccine affects pregnant and lactating women, read more below.

Breastfeeding and vaccinations 🤱🏾

Women who have recently given birth or are still breastfeeding should get the vaccine. 

Initially, the clinical trials for the COVID-19 vaccines currently in use did not include women who were breastfeeding. So, there was no clinical data on the safety of vaccines in lactating women, effects of the vaccine in breastmilk production and the consequences on the baby. However, now according to the WHO and new research, lactating women can receive a COVID-19 vaccine.

Recent reports have shown that breastfeeding women who have received COVID-19 vaccines have antibodies that pass on to the baby via breast milk, helping in protecting the baby. 

 A study conducted in Israel with thePfizer-BioNTech vaccine, with 84 breastfeeding women, showed that IgA antibody (the first line of defence when exposed to an infection) secretion was present as early as 2 weeks after vaccination in the breast milk. This was followed by a spike in IgG antibody (important for remembering the virus to prevent future infections) 1 week after the second dose in the breast milk. This suggests a potential protective effect against infection in the infant as these antibodies are passed on to them via the milk. No mother or infant experienced any serious adverse event during the study period.

More data is needed to understand what protection these antibodies provide to the baby. Even though the studies on breastfeeding and vaccinations are not advanced, the present data shows no indication of harm to the mother or child.

Pregnancy and vaccinations 🤰🏾

As with many other vaccines, the effects of the COVID-19 vaccines on pregnant women have not been studied extensively yet. However, health professionals assess the risks of COVID19 vs. the COVID vaccine when deciding whether pregnant women should receive the vaccine. 

Pregnant women with any of the following conditions are at a higher risk of contracting severe COVID than women who are not pregnant: 

  • have underlying health conditions (for example diabetes, high blood pressure or asthma)
  • are overweight
  • are aged 35 years or over

Preliminary findings in a study conducted in the US on the effects of mRNA vaccine in pregnant women did not show obvious safety signals among pregnant women who received mRNA Covid-19 vaccines compared to the control group.

It must be noted that injection-site pain was reported more frequently among pregnant women than among non-pregnant women, whereas other side effects such as headache, chills, and fever were reported less frequently. However, a more detailed and longitudinal study is needed to understand the full impact of vaccination on pregnant women. 

We already know pregnant women are at a higher risk of getting severe COVID and also at a higher risk of delivering a baby prematurely. So in a country like Sri Lanka, where the transmission rate is high, the benefits of getting the vaccine far outweigh the risks. 

Fertility and vaccinations 🌸

Women who are planning to get pregnant in the near future can absolutely take the vaccine. There is no evidence of COVID vaccines affecting fertility or the chances of getting pregnant. So get your vaccine when it becomes available to you. 

If you want more detailed information on getting vaccinated you can speak to one of our on-demand GPs at any time via the oDoc app. If you or your loved ones are showing any COVID symptoms please consult a doctor via oDoc immediately or use the oDoc COVID symptom checker to understand what you should do next.

Sources

  1. Perl, S. H., Uzan-Yulzari, A., Klainer, H., Asiskovich, L., Youngster, M., Rinott, E., & Youngster, I. (2021). SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women.
  2. Vaccination Considerations for People Pregnant or Breastfeeding. (2021, June 16). Centers for Disease Control and Prevention. 
  3. Public Health Scotland. (2021, June 18). Pregnancy, breastfeeding and the coronavirus vaccine. The Coronavirus (COVID-19) Vaccine. 
  4. WHO. (2021, June 4). Episode #41 – Vaccines, pregnancy, menstruation, lactation and fertility. World Health Organisation.
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