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Correspondence

Indian Pediatr 2019;57: 586-587

Does a Crying Child Enhance the Risk for COVID-19 Transmission?

 

Somu Sivabalan1 and MV Srinath2*

1Department of Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai; and 2Department of Pediatrics, Saveetha Medical College and Hospital, Thandalam,

Kancheepuram; Tamil Nadu, India.


Email: [email protected]

 


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

1. Balasubramanian S, Rao NM, Goenka A, Roderick M, Ramanan AV. Coronavirus disease (covid-19) in children – What we know so far and what we do not. Indian Pediatr. 2020 Apr 9. Available from: https://www. indianpediatrics.net/CONVID29. 03.2020/SA-00159.pdf. Accessed April 23, 2020.

2. Clinical Infectious Diseases Society, India. Infection control in stand-alone out patients and small nursing homes in the setting of COVID. Available from: http://www.cidsindia. org/pdf/covid-19/infection-control-in-standalone-OPs.pdf. Accessed April 25, 2020.

3.        Ministry of Health and Family Welfare.  Government of India. Novel Coronavirus Disease 2019 (COVID-19): Guidelines on rational use of Personal Protective Equipment. Available from: https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtective Equipment. pdf. Assessed April 25, 2020

4.        National Research Council. 2020. Rapid Expert Consultation on the Possibility of Bioaerosol Spread of SARS-CoV-2 for the COVID-19 Pandemic (April 1, 2020). Washington, DC: The National Academies Press. Available from: https:// www. nap.edu/read/25769/chapter/1. Accessed April 18, 2020.

5.        Tran K., Cimon K., Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS One. 2012; 7:e35797.

 6.  Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Aerosol emission and superemission during human speech increase with voice loudness. Sci Rep. 2019; 9: 2348. Available from: https://www.nature.com/articles/s41598-019-38808-z. Accessed April 18, 2020.


 

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