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Anales de la Facultad de Ciencias Médicas (Asunción)

versión impresa ISSN 1816-8949

An. Fac. Cienc. Méd. (Asunción) vol.54 no.1 Asunción abr. 2021

https://doi.org/10.18004/anales/2021.054.01.13 

Articles

COVID-19 pandemic: a pediatrician’s reflections

Oscar Ignacio Doldán1  2 
http://orcid.org/0000-0003-4289-1078

1Universidad Nacional de Asunción, Facultad de Ciencias Médicas. San Lorenzo, Paraguay.

2Sociedad Paraguaya de Pediatría, Tribunal de Certificación Pediátrica. Asunción, Paraguay


COVID-19 is the greatest health crisis of our generation and the second pandemic of the 21st century declared by the World Health Organization (WHO) after the H1N1 occurred in 2009 -although the latter had much less global impact.

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) significantly altered the whole world, giving rise to different “pandemics” in many areas of our daily lives, both in children and in adults. I will refer -in my capacity as pediatrician-to the impact our children are suffering, which also is changing our life routine as we knew it before the irruption of this unpredictable illness, with the following edges of a "vicious hexagon":

1. The Health Pandemic:

This disease is the product of the genetic mutation of the Coronaviridae family respiratory virus, which by altering its partial nucleotide sequences of RNA, behaves like an "unknown" virus not only for the human being's immune system but also for the medical community, which had had to learn on a daily basis the management of a new disease with continuous trials and errors. Illustrating this situation someone said it accurately: "It is like performing a play on stage, while the screenplay is still being written."

The clinical picture is predominantly characterized by fever, respiratory symptoms, anosmia and ageusia. Particularly in children, it could present on certain occasions extra-respiratory signs, e.g., gastrointestinal form followed by other less common indications such as cardiovascular, neurological, and cutaneous manifestations.

Recent evidence suggests that the pediatric age group has not suffered the worst consequences of the new coronavirus, i.e., children infected with Covid-19 present milder manifestations of the disease or the signs appear asymptomatically. However, children are capable of spreading the virus to other people, becoming important vectors of it.

The coronavirus enters host cells via the angiotensin-converting enzyme 2 (ACE2) receptor. The concentration of ACE2 in human tissue cells would indicate the potential risk of recognition by the virus and hence the susceptibility to infection. Then, it binds to the proteins in the capsid through the glycoproteins found in the virus envelope and develops in the host-depending on the viral load and/or underlying diseases that make it more vulnerable-an unpredictable response that ranges from 80% asymptomatic, 15% with various symptoms, and 5% very critical with management in intensive care units.

Fortunately, it is postulated that children still have these receptors immature; therefore, the entry of the virus is hindered, unlike what happens with other germs such as influenza, RSV, adenovirus, among others.

Certain children, however, can become critically ill, developing in some cases the multisystem inflammatory syndrome due to COVID-19 or "MIS-C", manifesting complex symptoms, eventually several weeks after being infected. The clinical picture requires admission to the intensive care unit with a general favorable prognosis. This syndrome has commonalities with other pediatric inflammatory conditions, such as the Kawasaki disease, the bacterial toxic shock syndrome, and the macrophage activation syndrome (MAS). The etiopathogenesis of the MIS-C is still undetermined. However, preferentially it affects young infants and children with certain underlying conditions such as asthma or chronic lung diseases, diabetes, genetic conditions, neurological or metabolic conditions, complex congenital heart disease, immunosuppressed, obesity, among other co-morbidities.

2. The Educational Pandemic

Millions of children and young people around the world did not go to school in the past 12 months since the health emergency was declared due to the dangerous pandemic.

Basic education is the foundation of the child's neurodevelopment. Children at school acquire not only knowledge but also the ideal scenario in which they socialize with their peers, developing values such as generosity, solidarity, tolerance, respect, sharing their experiences, goods, and even food.

Additionally, with alarming frequency, when school activity is suspended, some basic services such as food and nutrition programs are indirectly interrupted, exposing our infants to greater vulnerability since during the time they are not in school, they cannot receive those services so necessary for their growth.

On the other hand, schools "shield" children against different risks such as exploitation, violence, mistreatment, sexual abuse (often with the despicable consequence of an early pregnancy), and child labor.

3. The Economic Pandemic

The repercussion of the “economic pandemic” has aggravated the poverty of many people, either because a relative gets sick or dies, with the consequential costs of expensive prescriptions and medical care, or because of having to take care of a sick relative, or due to the loss of one or more jobs within the inner circle. As to the children-whose attendance have already been interrupted for an indefinite and prolonged period of time-these factors constitute a serious risk of school dropouts increasing.

4. The Psychological Pandemic

On this view, the “square circle” locks children who are already exposed to fear and anxiety transmitted by their parents’ stress, who often find themselves in the powerlessness of not being able to satisfy their basic needs, putting their well-being and development at serious risk, especially in younger children.

Indeed, for children, it is essential to interact with peers and friends of the same age. Lockdowns at homes severely impede their socialization and the development of the playful sense, almost a physiological necessity for their psyche integrity. Therefore, psychosomatic manifestations appear such as headaches, irritability and even anxiety outbreaks and/or depression, to which are added side effects such as a greater sedentary lifestyle that leads to obesity, ophthalmological and postural alterations as the effects of prolonged exposures of computer screens.

5. The Informational Pandemic: Infodemic or Infoxication

Infodemic means an excessive amount of information about a problem that affects the planet. This term derives from the union between two words: information and epidemic. Infoxication, in turn, comes from the union of the terms information and intoxication (mental).

During the previous pandemics, the scarcity of scientific information was the common denominator, which prevented sharing the best way to manage the disease in a timely manner. Paradoxically, today we are dealing with the opposite phenomenon: excessive information (frequently contradictory or false) that mainly confuses the community more, creating the possibility of deleterious effects on health.

Disinformation-deliberately inaccurate or unreliable- spreads rapidly via social media, which is a perfect breeding ground for inexperienced general public and even health experts.

Before this avalanche of information and miraculous panaceas that offer the prevention or cure of this horrendous disease, currently only four medications have "survived" as useful: oxygen, dexamethasone, heparin, and remdesivir (still questioned by some physicians.) Everything else is involved in endless debates, even recognizing that in this strange pathology we are learning every day and what is accepted as true today, tomorrow may not be and vice versa. A special segment deserves the "antivaccine" group, which with its perverse preaching may cause immeasurable damage to the worthy goal of immunizing the majority of the human population.

6. The Moral Pandemic

Along with the aforementioned “pandemics”, the most detrimental -for corroding the entire social fabric- is the corruption of rulers, politicians, businessmen and profiteers, who profit miserably from this unfortunate situation at the cost of the own affected people’s lives. Against this scourge, there is still no "vaccine" which will free us from its egregious immorality.

My Point of View

While we are waiting for the majority of the world's population to be protected with the long-awaited immunizations, the most useful “vaccines” are still social distancing, hand washing and the proper use of face masks.

Social conscience and the herd immunity will be the keys for reducing the possibility that the coronavirus will continue to take valuable lives and that we will definitely return to normality.

REFERENCIAS BIBLIOGRAFICAS

1. Organización Mundial de la Salud. Línea del tiempo. 2020 https://www.who.int/es/news-room/detail/27-04-2020-who-timeline---covid-19. [ Links ]

2. Tolosa A. Coronavirus SARS-CoV-2: estructura, mecanismo de infección y células afectadas. 2020. https://genotipia.com/genetica_medica_news/coronavirus-estructura-infeccion-celulas/Links ]

3. Morel Ayala Z, Buongermini AE, Martínez de Cuéllar C, Zacur de Jiménez M, Ramírez Pastore L, Lezcano MC, Greco J, Meza Brítez R. Manifestaciones Extra pulmonares de la infección por SARS-CoV-2 en Pediatría. Revisión. Anales de la Facultad de Ciencias Médicas (Asunción), 2020; 53(2), 87-104. [ Links ]

4. Cai X, Ma Y, Li S, Chen Y, Rong Z, Li W. Clinical Characteristics of 5 COVID-19 Cases With Non-respiratory Symptoms as the First Manifestation in Children. Front Pediatr. 2020 May 12; 8:258. [ Links ]

5. Martínez Hernández JA, Medeiros M. Infección por SARS-CoV-2 en pediatría y sus implicaciones en el trasplante renal. 2020. https://www.medigraphic.com/pdfs/trasplantes/rmt-2020/rmts202h.pdfLinks ]

6. Pediatric Intensive Care Society. PICS statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease. April 27, 2020. Available at:https://picsociety.uk/wpcontent/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdfLinks ]

7. Padgett H. Tres formas en las que el coronavirus afecta a los niños y las niñas. 2020. https://plan-international.es/blog/2020/03/tres-formas-en-las-que-el-coronavirus-afecta-los-ninos-y-las-ninas. [ Links ]

8. Chaccour C, Vilasanjuan R. Infodemia: ¿Cómo ha afectado la epidemia de desinformación a la respuesta frente a la COVID-19?. 2020. https://www.isglobal.org/-/infodemia-como-ha-contribuido-la-epidemia-de-desinformacion-a-la-respuesta-frente-a-la-covid-19-Links ]

Received: March 13, 2021; Accepted: March 15, 2021

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