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Health Situation in Children and Adolescents Infected with COVID-19 in Selected Geographical Area

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Health Situation in Children and Adolescents Infected with COVID-19 in Selected Geographical Area Health situation in children and adolescents infected with COVID-19 in selected geographical area. Study carried out between March and May 2020. María Cecilia Santana Espinosa, MS. Assistant Professor at Cuba’s National Schools of Public Health. María Esther Álvarez Lauzerique, PhD. Assistant Professor at Cuba’s National Schools of Public Health. Julia Maricela Torres Esperón, PhD. PProfessor at Cuba’s National Schools of Public Health. Berta Lidia Castro Pacheco, MS. Assistant Profession at the Finlay-Albarrán Faculty. President of the Cuban Society of Pediatrics. CONTENT Introduction | 03 Methodology | 06 Results | 09 Conclusions | 16 Recommendations | 18 References | 20 INTRODUCTION Infection with the new coronavirus (2019-nCoV), re- The spectrum of manifestations described in 171 named SARS-CoV-2 and identified in 2019 in Wuhan, children (from 1 day old to 15 years old) infected with China, is the cause of the coronavirus disease 2019 (CO- SARS-CoV-2 and treated at Wuhan Children’s Hospital VID-19). According to data from the World Health Or- have shown that the most common signs and symp- ganization (WHO)1, the disease has spread across the toms include: coughing (48.5 % of cases), pharyngeal world and taken on pandemic proportions. Since De- erythema (46.2 %) and fever (41.5 %). Other less com- cember 2019, when the new coronavirus SARS CoV-2 mon signs and symptoms, found in less than 10 % of and the infection it causes (COVID-19) were identified, children, were diarrhoea, fatigue, kidney rhinorrhoea data on its pathogenesis, incidence and possible treat- and nasal congestion. Tachypnea on admission was ments have been known practically “in real time’’, found in 28.7 % of children and hypoxemia (saturated through the publication of numerous scientific texts. oxygen) with saturation of <92 % during the period of In the paediatric field, a small proportion of cases hospitalization, in only 2.3 % of the children. The most with respect to the general population has been re- frequent radiological finding was the bilateral ground- corded. Most paediatric patients have mild, flu-like glass opacity, observed in 1/3 of the cases3. symptoms, such as short-term fever. In the case of Twelve image abnormalities were found in the chest Cuba, the situation is in line with international data computed tomography (CT) of asymptomatic children, published to date2. similar to those observed in adults with pneumonia The first published works on paediatric cases from caused by COVID-19. The assessment of imaging cha- China corroborated the impression that children are racteristics with clinical and laboratory findings can not as severely affected as some adult patients3-5. In facilitate the early diagnosis of the pneumonia caused this sense, it has been documented that children, even by COVID -198. those who present mild cases of the disease, can be an With the spread of the pandemic in Europe and important source of transmission of the virus with an America, observations indicate that the situation infection rate among contacts of 7.4 % in children un- among children is similar. There is still concern for im- der 10, similar to the average adult population, with a munosuppressed infants and children, or those who 7.9 % 6. It has also been found that children can excrete have other underlying conditions, such as chronic the virus, mainly in faeces for a prolonged period of lung disease (like asthma) or cardiovascular disease9. time, even a month, and that they can have high viral The situation of children and adolescents in Cuba loads in respiratory secretions7. during the pandemic appears to be similar according -4- INTRODUCTION to the number of reported cases. However, the imple- committed to people’s health have come together to mentation of studies describing the situation of this carry out a multidisciplinary research that allows population in greater depth than the statistics dis- for the characterisation of health care. The National closed daily do, is a necessity for future projections School of Public Health, the Cuban Society of Paedia- of a disease that, because of its newness, still leaves trics and the Children’s Health Nursing Network were many scientific unknowns; both epidemiological and involved in the study. The proposed objective is to des- clinical. cribe the impact of COVID-19 in children and adoles- In view of the risk posed by the COVID-19 for chil- cents, and its main characteristics in selected territo- dren and adolescents in Cuba, a group of professionals ries of the country. -5- METHODOLOGY Table 1. Selected provinces and municipalities. A quantitative descriptive cross-sectional study was PROVINCES MUNICIPALITIES carried out in selected municipalities of the country, Pinar del Río Consolación del Sur from March to May 2020. Arroyo Naranjo ɐ UNIVERSE Centro Habana The universe was made up of 230 children and La Habana Habana del Este adolescents from all provinces of the country and La Lisa the municipality Isla de la Juventud, who had been San Miguel diagnosed as confirmed cases between weeks 13 Mayabeque San José and 23 of the period corresponding to the confir- Matanzas Matanzas mation of cases in the country. Villa Clara Camajuaní SAMPLE ɐ Sancti Spiritus Taguasco The sample was non-probabilistic of the type “Sam- Ciego de Ávila Venezuela ple of extreme cases”. This type of sample is useful Camagüey Camagüey in researches about unusual problems, such as the case of the COVID-19 pandemic. It allowed to eva- Santiago de Cuba Santiago de Cuba luate characteristics, groups or situations distant from the “normality” or “prototypes”. ɐ STUDY VARIABLES The sample was distributed into five age subgroups: The included variables of the study were: inciden- less than 1 year old, from 1 to 4 years old, from 5 to ce; biological sex; age in years, source of infection; 9 years old, from 10 to 14 years old and from 15 to clinical status at diagnosis; place of residence, statis- 18 years old, which were obtained from 9 provinces tical week and geographical location. across the country. Among them, researchers selec- The statistical calendar was organized in statistical ted 13 municipalities that, because of the number weeks. Each one includes seven days, from Sunday of confirmed individuals, sources of transmission to Saturday, throughout the year. This calendar and forms of presentation of the disease, accounted has been established for annual case reporting by for 96 cases. That represented 42.2 % of the total the World Health Organization (WHO). It allows amount of children and adolescents notified during to compare data between territories and countries, the period under review. particularly in the case of communicable diseases. The selected provinces and municipalities are des- Based on this calendar, each country establishes its cribed in Table 1 below. own that covers the 52 weeks of the year. -7- METHODOLOGY The national database, compiled by the temporary The results are presented in tables and graphs group for the monitoring and control of the epide- through frequencies, percentages, rates and ave- mic at the Ministry of Public Health, was used as rages. The data obtained were subjected to quali- the primary source of information. tative analysis of the content, by means of succes- The statistical package used for processing was sive approaches through exchanges via e-mail and SPSS, version 21.0. WhatsApp by researchers. -8- RESULTS The study of the COVID-19 epidemic in Cuba, in the pe- These results coincide with those described in other riod between statistical weeks 13 to 23 (until May 31st COVID-19 studies2 on the incidence in this age group, May, 2020) showed low incidence of the disease in the as well as the clinical situation at the time of diagnosis. population group under 18 years old. Up to that date, About 63.5 % of these confirmed cases were asympto- 230 cases had been notified in the country, which re- matic at the time of diagnosis (See Figure 1). present a rate of 0.98 x 10 000 inhabitants for that age The upward trend in asymptomatic cases shows group. that as the epidemic progressed over time and the Observations reveal that throughout the period stu- number of cases decreased, those with no symptoms died, the behaviour of the epidemic had a downward and signs prevailed. tendency in reported cases. The peak of notifications, This situation may have led to a decrease in risk in weeks 15 to 17, corresponded the 23.7 % and 17.5 % perception by families. Hence the importance of kee- of the total diagnosed (Table 2). ping the population aware of the need for surveillance Table 2. Confirmed and asymptomatic cases of COVID-19 in children and adolescents, by statistical week. CUBA, 31 May 31, 2020. STATISTICAL WEEK CONFIRMED CASES OF COVID-19 ASYMPTOMATIC YES NO YES NO 13 5 5,2 0 0,0 14 6 6,2 0 0,0 15 22 22,1 15 68,2 16 9 9,3 4 44,4 17 17 17,5 13 76,5 18 8 8,2 8 100,0 19 9 9,3 5 55,6 20 5 5,2 5 100,0 21 6 6,2 4 66,7 22 4 4,1 3 75,0 23 5 5,2 5 100,0 TOTAL 96 100,0 62 64,5 -10- RESULTS in these age groups, since asymptomatic children and mity which is a usual practice, culturally rooted in adolescents can live together with and transmit the the country. This makes the situation critical, as it is disease to others who are chronically ill and therefore precisely the oldest population the one that is most at more vulnerable to complications. risk of complications and death. As a result of epidemiological research and active Age is one variable of analysis in this type of surveillance established in Cuba to address the epi- study.
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