20 months into the pandemic, how are our kids doing? 2
Students wear face masks in a school in Brgy. Batasan Hills, Quezon City on Feb. 3, 2020. Photo by Mark Demayo, ABS-CBN News/File

Kids can now go out—here’s how we can protect them from getting Covid

A pediatrician talks about the impacts of Covid in the physical, emotional and mental health of kids and teens, and what we can do as adults.
RHIA GRANA | Nov 17 2021

For most of the pandemic, attention has largely been focused on the effects of Covid on the elderly. Which is logical considering how the virus impacted the health of this vulnerable population and took the lives of many. 

But while children have been found to be more resilient when it comes to the virus, have we bothered to ask how our kids and teens are doing? To paraphrase the popular The Who album title, “Are the kids alright?” 

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Dra. Olivia Camille Reyes, Centre Medicale Internationale’s Pediatric Emergency Medicine specialist, confirmed that kids do physically well when they get infected with Covid-19. In fact, children comprise only 9% of the total number of Covid cases reported in the country, Reyes said. The case fatality rate (average number of people who succumb to a disease in a particular period of time) is only at 0.4%.

A webinar hosted by the Manila House Private Club addressed this timely topic on the effect of Covid on kids—which is especially relevant since they are now allowed outside in Metro Manila areas under Alert Level 2. A number of children are also starting to attend face-to-face classes and are adjusting to a new normal.

Children enjoy a playground in Marikina City
Children enjoy a playground in Marikina City on July 20, 2021. Photo by Mark Demayo, ABS-CBN News

Common symptoms

The most common symptoms of the Covid virus in children are fever, cough and colds. Majority of children (80%) present symptoms. The tricky part is that these are also the top three most common symptoms one would see in a sick child whether he or she was struck by Covid or not. Hence it’s difficult to treat kids without suspecting they have the coronavirus. “About 80% of the diseases that we treat in children are respiratory,” said the medical practitioner. “They’re actually viral so the symptoms don’t differ from Covid.”

Children show mild symptoms, which makes them efficient transmitters of Covid-19. “The scenario is, you have a child with very mild symptoms but has the same viral load as adults. So while the child’s condition might not necessarily turn sour, we are concerned about the child being able to transmit the disease very fast and very well to other people,” Reyes explained. 

Some kids experience upper respiratory tract infection (e.g. flu, sore throat, cough) while long-haul Covid symptoms have not been routinely reported in children. Reyes noted, however, that they do have patients who report long-term headache or difficulty in concentration long after they have recovered from the disease.

Moderate, severe and critical conditions, exhibit as pneumonia, severe sepsis or bloodborne infection, and acute thrombosis, which happens when there’s massive inflammation and blood clots formed in the blood vessels. A rare condition that parents need to also be familiar with is the multi-system inflammatory syndrome (MIS-C).

“MIS-C is very rare and it’s very similar to what we call Kawasaki disease, which manifests as symptoms that attack the blood vessels of the skin. When the virus gets in the body, the immune system reacts to the virus in such a way that the immune system also fights its own body,” the doctor explained. “It attacks the blood vessels so it can cause redness of the eyes, sore throat, inflammation of the vessels of the heart, and skin rash (very flat and fine) all over the abdomen and the body.”

As precautionary measure, Reyes advised parents to have their children checked even if they have very mild symptoms. If the abovementioned symptoms occur, kids will need hospital care and very close monitoring in order to mitigate the condition.

“Treatment wise, it’s mostly providing supportive care. For severe cases, we give steroids (dexamethasone IV) and some treatment options that we use in adults like Remdesivir. Very important for treating MIS-C is the IVIG, which is the same treatment that we give to Kawasaki disease. Sometimes we give convalescent plasma,” she stated. Reyes also added that Vitamin D and zinc sulfate play very important roles in boosting the body’s immunity.

kids vaccination
Since children are being allowed to go out now, and schools are reopening, vaccination is highly advised, said Dr. Reyes. Photo by Zandro Ochona, ABS-CBN News

Child healthcare service delivery

During the early stages of the pandemic, everyone was preoccupied taking care of adults who got infected with Covid. This resulted to an abrupt halt in the delivery of routine child care services, observed Dr. Reyes.

“During that time, there was no health supervision and monitoring for children. The vaccinations of children were delayed or halted, dental care in children suffered and anticipatory guidance which is something that we routinely do to be able to anticipate problems at each stage of development of the child—these things weren’t really being done for the kids that needed them.” 

Sick children were practically displaced during this time. They weren’t welcomed in clinics because they could be Covid carriers or they could get Covid themselves. Almost always, they were directed to the emergency department.

We saw a shift toward teleconsultation. While this worked for some, there were a lot of diseases in children that need to be personally checked or observed for a prolonged period of time. Teleconsultation is not really the best platform for such cases.

Meanwhile, children with comorbidities—those who need infusions, for instance—suffered because hospitals were overwhelmed with Covid cases.

face-to-face classes
Dr. Reyes said we need to continue to be more vigilant in order to mitigate any serious or severe symptoms that can coexist with Covid illness.

On kids’ mental health

This year’s UNICEF report on “The State of the World’s Children” focused on mental health. This is the first time the report focused on the subject, said Dr. Reyes. Previous years highlighted malnutrition, health and sanitation. 

The mental health problems can be attributed to factors brought about by the pandemic: lack of opportunities for play and interaction, the loss of routine due to closed schools, increase of sedentary behavior, disrupted sleep cycles, and decreased opportunities for connecting with friends.

“Stress and anxiety increased in children during that time. There was fear of infection. There was a lot of uncertainty. There was a lot of information that they couldn’t process. There were also challenges adjusting to different ways of doing things,” the doctor said. For instance, having to do online classes and staying indoors 24/7. 

The pediatric emergency medicine specialist noted an increase in depressive symptoms and sadness during the first half of the pandemic. “Depression and suicide rates actually increased,” she said. But as children adjusted towards the latter part of 2020 and early part of 2021, child experts observed that rates have stabilized and went down. Grief, due to loss of loved ones, also adversely affected the mental health of some children.

The pandemic highlighted behavioral problems in children. “Because they are cooped up in the house, they are not able to express themselves, they are not able to establish meaningful relationships, there’s an increase in bottled up feelings and anger, feelings of negativity and irritability,” she said. The situation aggravated cases like ADHD and autism.

Meanwhile, younger children became dependent and clingy toward their parents and with adolescents around them. This is because they are not able to explore the world outside. They couldn’t do anything else. “There were a lot of conduct problems and disruptive behaviors. And corollary to that will be substance and alcohol abuse [among teens]. There is limited evidence, but in some countries, they saw that boys and young men would turn to substance abuse and drinking to escape the effects of Covid.”

On a positive note, the pandemic increased family time. This resulted to positive changes in parent-child relationships. There was also an increase in connections and conversations between siblings. Some children actually appreciated the break from the pressures of schools and exams during the normal period.

Kids at Manila baywalk
Physical activity is encouraged to help reduce anxiety and depression and release stress. Photo by Mark Demayo, ABS-CBN News/File

Covid in our midst

Covid will probably be in our midst for a long time. So there is a need for “perspective shifts” as we journey towards the future, said Dr. Reyes.

When the children get infected by the disease, continuous monitoring by a health professional is highly advised. It is good that we know more about the virus now. Therefore, we need to continue to be more vigilant in order to mitigate any serious or severe symptoms that can coexist with Covid illness. 

Since children are very efficient transmitters of the virus, it is necessary to isolate them if they exhibit any symptoms. The doctor also stressed the importance of having an emergency action plan when things get worse. “Communicate with your physician what are the things that you should watch out for and where do you go if and when the symptoms of your child get severe,” Reyes said.

Since children are being allowed to go out now, and schools are reopening, vaccination is highly advised. While it is prudent to note there are some side effects reported among the younger child population (12 to 15), it is very important to look at it this way, the doctor said, the benefits outweigh the risks.

Reyes also reiterated the importance of disease prevention thru the development of healthy eating habits, having enough sleep, and physical activities. Good sleep results in improved attention and behavior. Physical activity helps reduce anxiety and depression and release stress. It also improves cardio-respiratory capacity, strength of bones, and reduces the risk of developing comorbid conditions.


Coping with mental health problems

To help young children cope with daily stressors, the doctor said it is important to ask them how they feel. For adolescents, writing and journaling may be an option for dealing with anxiety. She recommended listening to music to soothe the nervous system, practicing meditation and gratitude (helping kids realize and reflect on what they are grateful for).

Social media time-out is always a good idea. “At some point during the day, just put the phone down and connect with your child,” Reyes advised. Find alternative activities to lessen screen time. “It is very important to have interactions outside of technology.”

Parents also need to be comfortable in bringing problems to the surface. “I know a lot of parents don’t like talking to their children about sad things. They want things to be positive but sometimes the child can’t help it. Sometimes they feel sad. So it’s very important to be asking them how they feel.” 

Kids have been largely spared from the devastating physical effects of the Covid virus. But their lives have been disrupted, too, by the challenges brought by the pandemic. “Children are very resilient and they bounce back,” Reyes said with optimism. “Are the kids all right? Right now, they are not all right. But in time, the kids, in my assessment, will be.”