The Union Health Ministry has issued clinical guidelines for the treatment of Covid-positive children amid concerns that a possible third wave of the coronavirus infections may target those aged below 18. In a detailed document titled ‘Comprehensive Guidelines for Management of COVID-19 in Children’, the ministry said the antiviral drug, Remdesivir, is not recommended for use on children, and steroids should be used to treat only moderately severe and critically ill patients in hospital settings.
“Remdesivir (an emergency use authorization drug) is NOT recommended in children…There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” the document reads.
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.
Experts say abuse of steroids could be the main reason behind the Mucormycosis (Black Fungus) outbreak in the country.
Children aged 5 and below may not wear masks, whereas those aged between 6-11 years, may wear masks under the supervision of their guardians.
Doctors treating Covid-positive children must be highly selective in ordering high-resolution CT scans of patients, it says.
To reduce mortality in Black Fungus patients, doctors have been advised to treat the disease as an emergency and not wait for “culture results”.