The pandemic of coronavirus disease (COVID-19) has led all
of us to recalibrate both our personal and professional life
[1]. In our routine pediatric outpatient practice for
non-COVID cases i.e. well baby visits and kids
presenting with afebrile, non-respiratory symptoms, a
surgical face mask with proper hand hygiene and gloves has
been recommended for health care professionals [2]. However,
for those handling aerosol-generating procedures (AGP),
respirators and additional personal protection equipment
(PPE) are recommended [3]. Aerosol is defined as suspension
of fine solid particles or liquid droplets in air or another
gas. Aerosols of varying severity are generated on sneezing,
coughing, talking and also during normal breathing [4]. AGPs
are believed to produce aerosols and droplets as source of
respiratory pathogens that exposes the health care workers
to pathogens causing acute respiratory infections including
Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2)
[5]. AGPs are generated on performing certain medical
procedures like intubation, manual ventilation, non-invasive
ventilation, tracheostomy insertion etc. on infected cases.
However, it is not clear if the risk is due to direct
airborne transmission or secondary exposure to respiratory
droplets.
It is established that even loud speaking results in
increased aerosol generation i.e. aerosol
super-emission [6]. Extrapolating the same logic even a
crying and screaming child should produce aerosol
super-emission. Although an operational definition for AGP
is in place, the relation to crying and its possible effects
of increased aerosol generation has so far not been
stressed.
In a pandemic situation, we need to ponder on some points:
even infants and toddlers who come for routine vaccinations
or non-respiratory complaints can be asymptomatic carriers
or in pre-symptomatic period of transmission; implementing
source control measures like face mask and social distancing
in this age group practically difficult; crying, a common
occurrence in this age group, also increases the risk of
aerosol generation and transmission; and, proximity of these
kids to caregivers and their attenders along with sustained
crying either due to anxiety or fear might further increase
the risk and load of aerosol.
In view of the yet unknown increased risks posed by expected
or unexpected crying of asymptomatic children in the
transmission of COVID-19, it may be prudent to make every
effort to avoid examining a crying child without adequate
precautions.
Funding:
None; Competing Interest: None stated.
Published online:
April 26, 2020; PII: S097475591600166
REFERENCES
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Accessed April 18, 2020.