Children aged five years and below might not need to wear masks but those aged between 6 and 11 years may do so under parental supervision. While antiviral drug Remdesivir is not recommended for kids, steroids should be used to treat only moderately severe and critically ill patients in hospital settings — these are some of the dos and don’ts of the clinical guidelines issued by the Union Health Ministry for the treatment of Covid-positive children amid concerns that a possible third wave of the coronavirus infections may target those aged below 18.
The Directorate General of Health Services (DGHS) guidelines for children also recommended the rational use of High-resolution CT (HRCT) scan of chest.
Intriguingly, the new rules have come days after AIIMS director Dr Randeep Guleria had said that there is no data to suggest any such threat to children.
He had said, 60-70 per cent of the children, who got infected and were hospitalised during the second wave, had either co-morbidities or low immunity, and healthy children recovered with mild illness without need for being admitted.
In a detailed document titled “Comprehensive Guidelines for Management of COVID-19 in Children”, the DGHS said: “Remdesivir (an emergency use authorisation drug) is NOT recommended in children…There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years.”
The Government has recommended use of what it called the “6-Minute Walk Test” on children above 12 to assess “cardio-pulmonary exercise tolerance”.
“Attach pulse oximeter to his/her finger and ask the child to walk in the confines of their room for 6 minutes continuously. Positive test: any drop in saturation < 94%, or absolute drop of more than 3-5% or feeling unwell (lightheaded, short of breath) while performing the test or at end of 6 minutes; Children with positive 6-minute walk test may progress to become hypoxic and early admission to hospital is recommended (for observation and oxygen supplementation),” it said.
The test is not recommended for patients with uncontrolled asthma. In cases of severe Covid illness, oxygen therapy must be immediately initiated, fluid and electrolyte balance should be maintained, and the corticosteroids therapy should be started, it adds.
As steroids are harmful in asymptomatic and mild Covid cases, they should be administered only in hospitalised moderately severe and critically ill Covid-19 patients under strict supervision.
“Steroids should be used at the right time, in the right dose and for the right duration,” the centre said in the document amid concerns raised by the experts that abuse of steroids could be the main reason behind the mucormycosis (Black Fungus) outbreak in the country.
As for HRCT scan of the chest, the DGHS said it provides better visualization of the extent and nature of lung involvement in patients with COVID-19. “However, any additional information gained from the HRCT scan of the chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment. Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in COVID-19 patients,” the guidelines said.