Pulmonologist Iulia Simina about affecting children in case of SARS CoV-2 infection

Sibiu news, 19.01.2021

Dr. Iulia Simina, pulmonologist and pediatrician at the Sibiu Pneumoftiziology Hospital, offers explanations on the degree of damage to children if they have been infected with the SARS-CoV-2 virus.

”PRECAUTIONS FOR REOPENING SCHOOLS

With the progress made in vaccination in our country, we are in the situation, long awaited by all, both parents and children, to start school again.
Looking around us at what has happened in other countries, with the gradual reopening of schools and kindergartens, it is natural for us, as parents, to go through periods of worry about this stage in our children’s lives.

In order to help parents, we consider necessary some explanations regarding the evolution of SARS CoV-2 virus infection in children and also regarding the epidemiological impact generated by the infection at this age group in the community, but also in society in general. To date, most studies have shown a low number of cases of SARS CoV-2 infection in children, ranging from 3% to 7% of all confirmed cases of COVID-19. Of the total confirmed cases in children, over 60% were over 10 years old, with an average age of 11 years. Although much fewer, cases of infants diagnosed with SARS CoV-2 virus infection were more severe, requiring hospitalization in intensive care units.

The existence of a small number of cases of children infected with the SARS CoV-2 virus has led to the emergence of hypotheses to support this low incidence.

A first hypothesis would be that in the lungs of children there are fewer receptors for angiotensin convertase 2 (ACE-2) than in the lungs of adults, molecules that have an increased affinity for coronavirus and that facilitate the access of this virus in cells. .

A second hypothesis would be that the large number of vaccines given to the child, from the first days of birth, would be a real “training” for his immune system. The strongest stimulant effects on children’s immune systems seem to have the measles vaccine and the BCG vaccine (against tuberculosis). The decrease in the post-vaccination effect after about 10 years after vaccination could explain, in a way, the increase in the number of cases of COVID-19 infection over the age of 10 years.

There are, therefore, various causes that determine the less severe evolution of SARS CoV-2 virus infection in children, but which can also lead to an underestimation of the number of infected cases in this age group. If we add to this the fact that there have been several studies performed on asymptomatic children or those with mild forms of the disease, which have shown the existence, in fact, of high viral loads in the upper respiratory tract, we are not wrong if we refer to this age group as a major source of the spread of the virus.

Under these conditions, reopening of schools can be a problem, both in the case of symptomatic children who have recently undergone SARS CoV-2 virus infection (infection documented by the positive result of RT-PCR SARS CoV-2 or by the rapid Atg SARS CoV-2 2), as well as, in particular, in the case of asymptomatic children, contacts (especially intra-home), with an adult / child family member diagnosed with COVID-19 infection (being asymptomatic, most of the time, they are not tested and not receive no treatment).

These categories will be a real reservoir of infection with the new coronavirus, especially since they often do not comply with the rules of social distancing and hygiene.

Another aspect, less known and studied so far in children with COVID-19 infection is the sequelae (especially lung) secondary to this infection.

Therefore, the Sibiu Pneumoftiziology Hospital, through consultations carried out in the Children’s Pneumology office, comes to the aid of young patients who have been infected with the new coronavirus and who have been declared cured (having at least 14 days from the detection of COVID-19 infection by specific tests) and those who have been in contact with a person diagnosed with SARS CoV-2 virus infection (who have completed the 14-day quarantine period).
The evaluation performed through the Children’s Pneumology office within the TB Dispensary will consist of a clinical consultation and spirometry. If necessary, these investigations can be supplemented with blood tests and / or chest x-rays.
A referral note from the child’s family doctor is required for the consultation, which may include the date of detection of COVID-19 infection or the date of the beginning of the quarantine period. These data are necessary because the evaluation is addressed to those children who have left the period of maximum contagion. Symptomatic cases confirmed with SARS CoV-2 virus infection and asymptomatic contacts still in the quarantine period will follow the same circuits as before (contact the family doctor by telephone and, if necessary, call an ambulance to consultation in the emergency service, within the Pediatric Hospital).
Also, in order to respect the social distance and limit the spread of the infection, it is necessary to make a prior telephone appointment at the telephone numbers 0269 210 979 and 0771 544 108.
We specify that currently, the Children’s Pneumology office is operating in Pavilion 2 of the Pneumophthisiology Hospital, at Aleea Filozofilor no. 3–5, after the TB Dispensary building (located in Morilor Street, no. 57) was rehabilitated. .
We look forward to seeing you and wish you every success at school!