Children and COVID

There is an increasing number of children presenting to the emergency section of Princess Margaret Hospital (PMH) with COVID-19 symptoms, including a COVID-positive infant who was recently admitted to hospital with diabetic ketoacidosis.

And several cases of multisystem inflammatory syndrome (MIS-C) associated with COVID-19 – a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs – have been diagnosed in children since the start of the pandemic in The Bahamas.

This was revealed in interviews with Perspective by Consultant General Pediatrician at PMH Accident and Emergency Dr. Charelle Lockhart, and New Providence-based pediatrician Dr. Tamarra Moss.

Lockhart disclosed, “We are seeing a lot of [pediatric] cases that we consider PUIs, which are persons under investigation, and I can tell you that not all of them are actually being tested.

“We have some parents that have been refusing for their kids to be tested, so that is proving to be a bit of an issue for us, but we still treat them as a PUI, which means we gown up and see them in the front of the hospital where we see all the other PUIs.

“In terms of numbers [of pediatric admissions], I cannot tell you how many for the third wave, but in total so far there have been 16 admissions, four of them have been pretty sick with symptoms suggestive of the multisystem inflammatory syndrome.

“Thankfully, they have all recovered well. One surprising one that we had recently within the last two weeks was an infant that had COVID and something very rare that we don’t see a lot in that age population, which is diabetic ketoacidosis. That was both surprising and disturbing.”

Diabetic ketoacidosis (DKA) is a life-threatening condition that affects those with diabetes, and occurs when the body begins to break down fat at a rapid rate.

The liver processes the fat into a fuel called ketones, which causes the blood to become acidic.

When questioned on whether the infant’s condition was thought to be COVID induced, Lockhart pointed out that the condition can be triggered by factors including infection, adding, “We do not know. We can only speculate and say anecdotally.

“But we have had a lot of [pediatric] diabetics come in, in diabetic ketoacidosis. Now, whether that is due to them not taking their medication properly, or if it was induced by an infectious process like COVID, it’s hard to tell, but a few of them that come in with DKA were COVID-positive.”

Lockhart further disclosed that children who have had to be admitted to hospital during the course of the pandemic have had symptoms including an “unrelenting” fever, and gastrointestinal symptoms such as diarrhea and vomiting.

Preliminary studies point to a potential link between COVID-19 and the development of DKA, but more research is necessary.

Lockhart said some parents resist having their children tested for COVID-19 because they do not want their children to go through the process of being nasal swabbed, and opined that some might be in denial about their child’s potential COVID infection, or might be unwilling to take time from work or keep their child home from school if the test is positive.

She explained, “We try to counsel the parents as best as possible to convince them to get their kids tested because that is really the only thing that’s going to convince them to isolate themselves.

“So the problem is, they are not isolating and they are moving about the community either in denial or whatever it is, so our recommendation is they isolate, and certainty if they present with a fever, that they be 24 hours fever-free before they even think about going to school.

“I think that we are unfortunately not testing enough, so we just don’t know where it is and how far the spread is. That is really nerve-racking for all of us as pediatricians because kids are being exposed all the time from adults who are not necessarily doing what they should be doing, and then they are going to go into the schools.”

Lockhart said based on her understanding, some COVID cases in schools are being identified through parents who are honest enough to contact a school to advise of their own COVID status.

COVID-19 testing for children who present to PMH is free according to Lockhart; therefore, there is no cost-factor impacting a parent’s refusal to have his or her child tested.

She noted, “I think it is important enough that before you send your kid back to school, you should make sure that you are not exposing a whole school or a classroom to COVID-19.”

But how does a parent decide whether one’s child should be tested for COVID-19?

We put this question to Lockhart, who advised, “There are so many viruses that can cause these same symptoms, especially in children, that I would say it’s very difficult to look for those symptoms in children.

“What I look for personally [are] symptoms in parents or close contacts. If you as an adult person tell me you have a temperature of 101 [degrees], as far as I am concerned, you have COVID.

“If the child has a fever or gastrointestinal (GI) symptoms, I start asking ‘have you had relatives that just came from the States’, ‘does anybody else in the house have a fever or GI symptoms’, because I find that that points me to it closer than looking at what kids have, since it is common for them to have these symptoms, especially in Spring time.”

Pregnant women “shocked” at COVID-19 status

Current protocols dictate that all mothers who are being admitted for delivery must have a COVID-19 test performed, and according to pediatrician Dr. Tamarra Moss, mothers who test positive are often shocked at the results, and are consequently concerned about the health of their baby.

Moss added, “For mothers who test positive, they are shocked because many of them would have been completely asymptomatic, and so they are in disbelief and their next thought goes to how is this going to affect my baby, and is my baby going to be okay.”

Moss disclosed, “Our track record is good thus far in that we have not yet seen any vertical transmissions from mother to baby, and so that speaks to the fact, from our perspective, that there has not been any evidence of transplacental COVID infections.

“So we are able to assure moms in that way.”

Newborns of COVID-positive mothers are tested within 24 to 48 hours of birth, according to Moss, and their mothers are permitted to nurse with their babies provided the mother wears a mask while breastfeeding.

COVID-19 adolescents Moss has seen have presented with symptoms including low grade fever, general malaise, fatigue and slight cough or nasal congestion.

She meantime affirms the observations of her colleague physicians that the third wave is dealing a harder blow to younger adults than in the previous waves.

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