Ministry of Health issues guidelines for Covid-19 treatment in children

According to the Ministry of Health's guidelines, the clinical characteristics of children with Covid-19 often have symptoms such as: Incubation period from 2-14 days, average 4-5 days. During the onset, children have one or more symptoms such as: Fever, fatigue, headache, dry cough, sore throat, stuffy nose/runny nose, loss of taste/smell, vomiting and diarrhea, muscle pain... however, children are often asymptomatic.

Clinical symptoms in childreninfected with Covid-19Common symptoms include: fever (63%), cough (34%), nausea or vomiting (20%), diarrhea (20%), difficulty breathing (18%), nasopharyngeal symptoms (17%), rash (17%), fatigue (16%), abdominal pain (15%), Kawasaki-like symptoms (13%), no symptoms (13%), neurological symptoms (12%), conjunctivitis (11%), and red throat (9%).

Taking Covid-19 test samples from children. Photo: Archive

Children also experience other (less common) symptoms such as: Skin and mucous membrane lesions (erythema of the fingertips, skin rash...); cardiac arrhythmia; acute kidney injury; serositis (pleural effusion, ascites, pericardial effusion); enlarged liver, hepatitis; brain disease (convulsions, coma or encephalitis).

Accordingly, most children only have upper respiratory tract infections with mild fever, cough, sore throat, runny nose, fatigue; or pneumonia and usually recover after about 1-2 weeks. About 2% of children have severe progression, usually on the 5th - 8th day of the disease. Of these, some children (about 0.7%) need treatment in intensive care units with severe complications such as acute respiratory distress syndrome (ARDS), myocarditis, sepsis, septic shock, and multisystem inflammatory syndrome (MIS-C). Severe prognostic factors include obesity, developmental delay, cerebral palsy, chronic lung disease, immunodeficiency, diabetes, congenital heart disease, etc. The mortality rate in children is very low (< 0.1%), most deaths are due to underlying diseases.

Life of students in concentrated quarantine area. Photo: NVCC.

During the recovery period (usually from day 7 to 10), if there are no serious complications, the child will gradually lose clinical symptoms and recover.

According to the Ministry of Health, risk factors that make children susceptible to severe disease progression are: Premature birth, low birth weight; obesity, overweight; diabetes, genetic diseases and metabolic disorders; children with chronic lung diseases, bronchial asthma; cancer (especially hematological malignancies, lung cancer...); chronic kidney disease; children with organ transplants or hematopoietic stem cell transplants; cardiovascular diseases (congenital heart disease, heart failure, pulmonary hypertension, coronary artery disease or cardiomyopathy, hypertension); neurological diseases (including dementia, mental disorders); sickle cell disease, thalassemia, other chronic hematological diseases - Congenital or acquired immunodeficiency diseases; liver disease; children being treated with corticosteroids or other immunosuppressive drugs; systemic diseases.

A student in a centralized quarantine area. Photo: NVCC

Risk factors for thrombosis in children with Covid-19 include: Treatment in the ICU requiring prolonged mechanical ventilation; having a central line (catheter) or longline; D-dimer ≥ 5 times the upper limit of normal; obesity (BMI > 95th percentile); children with a family history of venous thrombosis of unknown cause; personal history of thrombosis or immunodeficiency; active malignancy, nephrotic syndrome, latent or active inflammation, thromboembolic events in patients with hemoglobin S; congenital or acquired heart disease with venous stasis (specialist consultation); children with arrhythmia (specialist consultation).

The Ministry of Health also guides the principles of Covid-19 treatment in children as follows:

- Follow standard infection prevention measures before and during treatment and care.

- Classify sick children according to severity and treat them according to the severity of the disease.

- Follow the ABC first aid principles: Control airway, support breathing, circulation.

- Individualize treatment measures, especially for severe and critical cases.

- Treat the cause with antiviral drugs.

- Treat cytokine storm with corticosteroids, blood filtration, IL receptor production inhibition or antagonism.

- Anticoagulant treatment in children should be carefully considered, especially in children < 12 years old.

- Use antibiotics/antifungals when there is clinical and laboratory evidence.

- Other supportive treatment: Ensure the child is breastfed and has adequate nutrition according to the severity of the disease, electrolyte rehydration, physical therapy, and mental health.

- Symptomatic treatment: Fever reduction, cough relief, pain relief...

- Treat underlying disease if any.

The Ministry of Health also noted that for drugs that have not been recommended for use by the World Health Organization, have not been licensed for circulation, or have not been granted emergency use authorization in any country in the world, their use must comply with the Ministry of Health's clinical trial regulations. For drugs that have been recommended for use by the World Health Organization, have been licensed for circulation, or have been granted emergency use authorization in at least one country in the world, treatment can be prescribed according to the patient's disease progression.