Jan 29, 2021
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The distance is over. Is there a risk of increasing diseases among children?

Anyone can become infected with COVID-19, but there are persistent rumors that it affects children much less. Is this true? talked to about how protected the young body is from coronavirus, as well as about other “children’s” details of the pandemic. Doctor of Medical Sciences, Chief Researcher of the National Medical Research Center for Children’s Health, Professor of the Russian National Research Medical University named after V.I. Pirogova Viley Bulgakova.

Vilya Akhtyamovna Bulgakova, Doctor of Medical Sciences., Chief Researcher at the National Medical Research Center for Children's Health, Professor at the Russian National Research Medical University named after I.I.  Pirogov
Vilya Akhtyamovna Bulgakova, Doctor of Medical Sciences., Chief Researcher at the National Medical Research Center for Children’s Health, Professor at the Russian National Research Medical University named after I.I. Pirogov. Photo: From personal archive

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Natalya Kosyakova, Vilya Akhtyamovna, now all the children from a distance have returned to their desks. The risk of contracting ARVI increases. How can you assess the epidemic situation in this regard?

Bulgakov’s villa: This question, of course, worries parents, doctors and teachers. In principle, winter is a season of high incidence of ARVI and influenza, and now there is also a pandemic of a new coronavirus infection in the yard. But although the epidemiological situation is still serious, it does not exceed the threshold values. In particular, in Moscow, children have already been able to return to school.

The season of increased respiratory morbidity, which usually begins in September, is precisely due to the fact that children return to educational institutions, and this is overcrowding. In addition, when cold weather sets in, pathogens of respiratory diseases are especially activated. And according to any data – from the district polyclinic site to the WHO, on average, during the season, it is children who are also carriers of infections 3 times more likely to get these diseases.

True, this school year, the season of respiratory diseases was leveled by quarantine measures. By the way, excellent monitoring work on the epidemiological situation is carried out and published by not only Rospotrebnadzor, but also the N.I. Smorodintsev in St. Petersburg – all information is in the public domain on their resources.

– How does children’s immunity work? How does it differ from the immunity of adults? How can it help the child’s body in the fight against viruses?

– Children’s immunity is not as strong as in adults, it reaches the adult level by about 14-16 years. And in the fall, innate immunity, in particular, the protective function of the mucous membranes, usually also decreases. Together, a number of micro-reasons contribute to this – cold, dry indoor air, the same crowding. And anatomical and physiological characteristics of children play a big role here.

But at the same time, both the innate and acquired ability of the child’s body to activate various body systems helps to successfully cope with the infection, unless, of course, the child suffers from concomitant or chronic diseases and if he does not face social problems: when, for example, there is a nutritional deficiency – everything is much more complicated.

The child’s immune system matures gradually, and there is an opinion, including among pediatricians, that if children suffer from ARVI often and the disease is mild, then this is a kind of natural stimulant to strengthen the immune system. But for children with the problems I have named, everything is different – they have an increasing tendency not only to the most common respiratory infections, but also to serious complications. If ARVI is an inflammatory process of the upper respiratory tract, then with a deeper penetration of the infection into the body, there is a risk of getting pneumonia or other serious ailment. In pediatrics, such cases (up to hospitalization and even resuscitation measures) are more frequent than in a similar situation in adult patients.

Is the virus not afraid of the child?

– Is the coronavirus really not as dangerous for children as for adults?

– The question is still open. After all, we are used to the fact that children get ARVI more often than adults, and pediatricians at the beginning of the COVID-19 epidemic in Russia prepared for the worst. But very quickly, an understanding came – both from our own experience and according to foreign medical publications – that for the first time an incredible situation emerged when adults fell seriously ill and died, and the children remained practically out of the infectious process. Children get sick less often than adults with a new coronavirus infection, and if they do get sick, it is mild and practically asymptomatic. Although, say, both abroad and in our country there have been cases of even hospitalization of children with COVID-19. …

Based on my own practice, I can say that the overwhelming majority of children were asymptomatic or mildly ill – unlike adults in their families. Cases of the disease in severe form are extremely few, although they are. More seriously ill teenagers over 15 years old and babies under 3 years old who have serious health problems.

Both we and our foreign colleagues began to associate a small number of diseases among children with vaccine prevention within the framework of the national calendar. However, so far these are all hypotheses that have not been confirmed or refuted. Perhaps due to vaccination against other infections, the innate link of the immune system is activated, which also provides protection against this infection.

Another version says: because children often get sick with ARVI, it is easier for their trained body defense mechanisms to put up barriers against a new coronavirus infection.

Another reason is anatomical. Coronavirus enters the body by connecting with ACE2 receptors in cells, and in children, unlike adults, there are still few of these receptors in the upper respiratory tract, that is, there is nothing to connect with. Although, according to the same hypothesis, children have enough such receptors in the cells of the intestine – therefore, intestinal syndrome is observed. In fact, there are about a dozen hypotheses today.

– If the child is still ill – what are the consequences?

– Pediatricians are now worried about whether complications will appear in those who were sick easily, as a time bomb. So far, too little time has passed since the beginning of the epidemic for us to give an answer to it, although scientists are collecting data. We will receive an answer when we have accumulated information and complete comprehensive research is carried out.

The fact is that preliminary data both in our country and abroad indicate that in adults (this cannot yet be extended to children), the so-called postcoid syndrome manifests itself. For months, he “gives out” various pathological situations, and not only respiratory. Our Ministry of Health even issued a document on the additional medical examination of citizens who have had severe forms of COVID-19.

With regard to children, the answer will be, but over time. If we take the non-medical consequences, then we can say that anxiety accompanied, especially adolescents, from the very beginning of the disease: fear of their own illness, and fear for relatives, and fears about the outcome of the disease. All this caused an accompanying problem – a psychological one. It is worth noting a radical change in lifestyle – this also entails psychological problems.

Given the complications of a somatic nature, I support the opinion of colleagues who work in hospitals and have more experience working with children with an unfavorable background in the course of ARVI (including not only the respiratory system, but also the nervous system): the disease should not be allowed to take its course and justify it by “training” immunity. It has already been proven that diseases of the cardiovascular system in adults very often have roots in childhood against the background of frequent SARS.

Don’t forget about prevention

– Can a child get infected with COVID-19? What preventive measures could you recommend, based on the research of domestic scientists?

– Preventive measures can and should be carried out by everyone – both children and adults, because we live next to each other. We have a lot of experience in this area, but in the new situation we did everything by touch – both in treatment and in prevention, because whatever you say, but COVID-19 is not a kind of flu.

General epidemiological knowledge exists to ensure personal and public safety. First of all, it is hygiene and understanding that after visiting public places, without washing your hands, it is not necessary to touch the mouth, nose and eyes, through the mucous membranes of which the infection enters the body. Everyone is also aware of social distancing. A mask can protect against droplets containing the virus, which can stay in the air for 4 to 15 minutes (this was proved not even by doctors, but by engineers). Children, however, do not wear masks – it is difficult for them both mentally and anatomically.

Prevention is, of course, vaccination. I mean the calendar vaccine prophylaxis, which should not be suspended in any case. And vaccination against coronavirus does not apply to children, because the efficacy and safety of the vaccine must be fully understood. Therefore, other – proven – measures are required.

If we talk about drug prevention, then we are usually talking about immunomodulators. This is a fairly wide group of drugs of both natural and plant origin, these are synthetic products too. We give preference to those of them, the effect of which has been well studied. For example, azoxime bromide, which is called polyoxidonium on the market. Numerous studies have shown that the use of the drug actually promotes the activation of immune agents in the fight against the pathogen. Now there are already studies on the effectiveness of its use by health workers as a preventive measure against infection with the new coronavirus that causes COVID-19.

In relation to children, immunomodulators can be used primarily for those who have a tendency to frequent ARVI or who already have an initial stage of development of one of the chronic respiratory diseases. But I want to remind you that any drugs, including immunomodulators, can be used exclusively as directed by a doctor. Even vitamins cannot be used uncontrollably.

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