“I Thought We’d Already Had COVID-19, but No”

“On Sunday, October 11^th, my eleven-year-old boy began to feel tired,” Kathy Flores tells us. “He looked like he had a slight cold. I thought it was a common bug, but as a precaution, I didn’t send him to school the next day.” At some moment, she thought about the coronavirus, but discounted the idea. “I thought we had all had it already, but that some of us had been asymptomatic.”

Kathy’s husband and her teenage daughter had already gotten COVID-19 in June, but it was “mild”.  Since they didn’t isolate themselves when symptoms began, they believed “we had all had it”.

When her son began to get worse, she sought help from her pediatrician in Diriamba. The doctor’s diagnosis was clear: “It’s a suspected case [of COVID].” The fevers got more intense, and he complained of body aches. “We isolated him, because my Dad, who’s 71, lives with us,” Kathy Flores recalls.

The worst part was to see him lying in bed without the energy to do anything. They kept him entertained “watching television”. With the treatment the doctor prescribed, he began to improve.

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Flores believes that her son caught the disease at school. “At the beginning [of the COVID-19 pandemic], I didn’t send him to school. But later I had to give in. I’ve noticed that people aren’t being careful like they were before. I, myself, thought that it was something we had put behind us. That was a big mistake,” she says.

“Melina”, who works in Esteli’s free trade zone, made the same mistake.  She let her asthmatic nine-year-old daughter go on an excursion with her cousins. She thinks now that the girl may have gotten infected that day. Her daughter had an intense cough – Melina describes it as “terrible” – and a persistent fever. These were the first symptoms that concerned her. She immediately took her daughter to the hospital.

“She had to be admitted because she was having trouble breathing. They isolated her in a separate room. For the first few days, I felt that it was pretty serious. But the medical attention helped her begin to recover,” Melina states.

They sent her home with the prescribed treatment, and the little girl had to stay isolated at home. “It seems like the disease has begun to cede, and I can see she’s getting better,” Melina indicates.

Increased incidence among children

Contagion among children from COVID-19 is relatively low worldwide. For that reason, there’s a perception that children and teens aren’t affected by the pandemic. In the case of Nicaragua, there’s no official data on the number of minors who’ve been infected. Even the independent “COVID-19 Citizens’ Observatory” doesn’t have a separate registry of these cases.

Confidencial published a special report about COVID-19 in July 2020. The report noted that the public hospitals had begun to see cases of children with COVID-19. However, to date, Nicaragua’s Health Ministry hasn’t offered any details about the number of cases involving minors, or their condition.

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Nonetheless, infections in children is a reality that has grown in the last few weeks. Medical sources from diverse Managua hospitals confirmed this fact to Confidencial.

In Leon recently, eight children were admitted to the hospital with suspected cases of COVID-19. “We’re in the season for respiratory illnesses, but obviously COVID-19 continues affecting us. Many children who may be asymptomatic are infecting other children. These, in turn, can pass the disease to the adults in their households,” a doctor from Leon explains. The doctor asked to remain anonymous for fear of reprisals.

Similarly, a doctor from La Mascota, a Managua children’s hospital, confirmed that they’ve seen at least four positive COVID cases. These have occurred in the last few weeks. “People have lowered their guard, and COVID-19 continues moving silently among them. If the children don’t receive medical attention in time, there’s a tendency for their cases to get worse. That’s why several have been hospitalized,” the doctor comments.

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One private school in Managua returned to in-person classes at the beginning of October. By the end of that month, they had reported their first positive case of COVID-19. The case involved one of the high school students.

The student’s close contacts were ordered to return to online classes as a preventive measure. “It’s hard to follow the tracks of the virus at school. [The infected student] could have been in contact with many other students, and these, in turn with their families. It’s a time bomb. Even though they say they’re taking measures, there’s generalized fear around the school,” states the mother of a student there.

Multisystem Inflammatory Syndrome

Although there are fewer cases in minors compared with those reported in adults, there’s been an increase in later problems. There are growing numbers of children who suffer adverse effects well after they’ve “recovered” from COVID-19.

“Children were fairly protected during the first months of the pandemic,” explains Dr. Maria Mercedes Somarriba. Dr. Somarriba is a pediatric infectious disease specialist who belongs to the Multidisciplinary Scientific Committee. She continues: “We’ve seen parents relaxing [their protection]. The repercussions from that are more cases, since the parents aren’t taking the due precautions.”

Dr. Somarriba specifies that early attention is crucial in avoiding complications. There’s a condition called Multisystem Inflammatory Syndrome that can appear 4-6 weeks after a child or teen has had COVID-19.

“It’s a disease that affects many body systems, and it has a broad range of symptoms.  It’s important that children be seen by specialists if these appear, to assure opportune detection,” she explains.

Symptoms of MIS in children can include fever, abdominal pain, diarrhea, reddened eyes, intense fatigue, rashes, and vomiting.

A study of Multisystem Inflammatory Syndrome was carried out in 14 health centers across five Latin American countries. These included Mexico, Colombia, Peru, Costa Rica and Brazil. The study was later published in The Pediatric Infectious Disease Journal. It analyzed 409 children, and detected the syndrome in 95 of them (23.2%)

The summary concludes: “This study shows a generally more severe form of COVID-19 and a high number of MIS in Latin American children, compared with studies from China, Europe and North America. It supports current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level.”

Children, too, should take precautions

Maria Van Kerkhove, is the COVID-19 technical lead of the World Health Organization. She affirms that the majority of the children and adolescents who get COVID-19 have mild cases. However, she emphasizes: “That’s not universal.”

“We have examples of children who have become seriously ill and have needed intensive care. Some have died. We can’t say that the disease is universally mild or asymptomatic in children,” she cautions.

For that reason, Dr. Somarriba insists that children and adolescents should continue to follow the same preventive measures as adults. “Quarantine, physical distancing, hand-washing, face masks, hand sanitizer, and disinfecting surfaces, plus avoiding crowds,” she reminds us.