March 30, 2020

The total cases of Covid-19 globally is 697,244 and the total number of deaths is 33,257.The disease started in the Hubei Province of Wuhan in China but has torn through the entire world, with more than 200 countries and territories having seen at least one case. In Africa, 47 countries have confirmed 4981 patients with 135 deaths. (These figures change daily). In Uganda, 33 cases have been confirmed, and of these 2 are children, one aged 8 months and the other 10 years. 

The disease presents with flu like symptoms such as cough, fever and a dry cough but some patients have reported irritation in the eyes, mild diarrhea and joint pains. The disease is usually mild in children below the age of 10 years and carries a low mortality rate. The disease is more severe in persons 30 years and older particularly those with underlying debilitating health problems. 

In a retrospective study conducted in Wuhan young children were more at risk of serious illness than older children were. The proportion of severe and critical cases was 10.6 % for children younger than 1 year, 7.3% for those 1 to 5, 4.2% for those 6 to 10, 4.1% for those 11 to 15, and 3.0% for those 16 to 18. "Only one child died, and most cases were mild, with much fewer severe and critical cases (5.9%) than adult patients (18.5%)," according to their findings. 

Despite that finding, investigators said that children of all ages and both sexes were clearly at risk due to the coronavirus. "Although clinical manifestations of children's CoVID-19 cases were generally less severe than those of adult patients, young children, particularly infants, were vulnerable to infection," they wrote.

The authors write that the less severe presentation may be attributed to less exposure or sensitivity to CoVID-19, different immune response mechanisms, or higher levels of antibodies to viruses than in adults due to broader exposures to respiratory infections in winter.

In Africa, where children are allowed to get exposed to various microbiomes and presumably have an expanded load of gut microbiota, they are expected to have a more robust immune system. Children  could be a potential driver of the CoVID-19 since they may be asymptomatic careers. This risk makes a good argument for social distancing and removal of children from crowded situations like schools in order to contribute to flattening of the curve. 

The risk of congenital spread of the coronavirus may be extremely rare but it still exists. The current concern remains with children who have underlying conditions who are likely to have severe disease if they get infected with CoVID-19. 

As the world continues to struggle with controlling the CoVID-19 pandemic, the gains made in improving the health of children should not be lost. We should ensure that every child is born safely and reaches their fifth birthday through availing them with clean water, food, shelter, freely available vaccines and education. Older children should be protected to reach their second decade of life, which is their adolescence. Adolescents should be supported to grow into healthy and responsible adults. 

During the lockdown and social distancing to stop the CoVID-19 pandemic, we must care for the physical, mental and emotional health of our children and adolescents. We must encourage them to continue with school activities, engage in physical exercise and stay safe by practicing maximum levels of hygiene like hand washing and adequate sleep. 

*Dr. Sabrina Bakeera-Kitaka is a Paediatrician at Mulago National Referral Hospital and a Senior Lecturer in the Department of Paediatrics, Makerere College of Health Sciences, Makerere University, Kampala, Uganda.