Children ARE being affected by Covid-19...A thread.

I've seen a lot of debate about how children are/ aren't affected by Covid-19 and therefore how it is sensible/ insane that they can't return to school/ play with friends & family etc.

I decided to do some reading!

I'm a children's Physiotherapist at a London hospital. I treat children on the High Dependency Unit for a range of respiratory conditions and have just completed a literature review on Covid & Paeds as part of a project.

I thought I would synthesise what I've learnt and share it for others to read, critique and reflect on.

Incidences of Covid-19 continue to rise with 14,735,331 confirmed cases worldwide, as of today. In the UK we have had 254,120 confirmed cases and 45,312 tragic deaths.

Here are the UK confirmed cases by age:

Here are the UK Covid-19 mortality cases by age:

Note the bars are too small to even read;

1y> = 2 tragic deaths.
1-14y = 4 tragic deaths.

So children don't get ill as a result of Covid-19?

Wrong.

Children who have proven or likely exposure to Covid-19 infected adults are becoming unwell with symptoms that are similar to Kawasaki Disease (KD) and Paediatric Multisystem Inflammatory Sysndrome (PIMS).

KD is quite rare in the UK and Europe at 16 cases per 100,000 children, compared to Japan where it is 264 cases per 100,000.

Since the beginning of the Pandemic we have seen as much as a 30-fold increase in cases across Europe...

It's a 'vasculitis of childhood' meaning it causes inflammation and associated damage to the blood vessels in children - if untreated it can cause coronary artery dilation, aneurism and ultimately death via myocardial infarction (heart attack) or internal bleeding.

There isn't a single diagnostic test. The child must have a fever > 5d as well as 4/5 of the following:

- Bilateral Conjunctivitis
- Rash
- Hand or foot oedema
- Changes to mucosa
- Cervical Lymphadenopathy >1.5cm

However... it's not that simple.

Not every child presents as above.

Some symptoms are in line with PIMS, which has seen a similar rise in cases since the Pandemic.

PIMS presents as: (WHO)

- Fever > 3 days + 2 of the following:

- Bilateral Conjunctivitis
- Rash
- Changes to mucosa
- Evidence of coagulopathy

There is quite a lot of overlap between KD and PIMS with many children presenting with symptoms of both, but not meeting the exact criteria for diagnosis.

Fortunately if identified and treated early there are few prolonged effects of either.

If untreated then the child may be at risk of cardiac impairment into adulthood, such as:

- Impaired Left Ventricle Ejection Fraction
- Effusions
- Valve Regurgitation
- Coronary Artery inflammation and aneurism.

This is why early recognition is so important.

Obviously this isn't all-encompassing, but provides a little bit of insight and context into how children are affected by the Pandemic.

It also makes me question how the children will be affected by their PIMS/ KD.

There is little known about the rehab needs of these patients and how we best serve them as therapists.

Do children under 2 regress milestones or demonstrate delayed development?

Do the older children have a reduced exercise tolerance?

What does this mean for their health?

From here I will investigate the long term effects of children affected by Covid/ PIMS/ KD to identify any rehab needs.

I'm not sure what we'll find, but if we can improve outcomes even slightly it will be a success.

Thanks for reading! Refs below.

Refs:
https://tinyurl.com/y4a7xrjd 
https://tinyurl.com/rnjqnnh 
https://tinyurl.com/y4dbcy52 
https://tinyurl.com/yyz5eowz 
https://tinyurl.com/y3xfdnce 
https://tinyurl.com/y286kmqs 

@ChelWestTherapy @physiotalk @thecsp @thecspstudents @ASPHphysio @CSPLondon @TheAPCP