It is not just Covid-19 that is worrying parents, but other respiratory diseases as well. According to pediatrician Ana Escobar, cases among children under five years of age have increased a lot, especially in the 0-2 age group.
In an interview given during the Brain Congress 2022, held earlier this month in Gramado (RS), the doctor also warned about the importance of wearing a mask from the age of two, washing your hands and practicing social distancing.
About the masks, she stressed the importance of using the item. “The pandemic is not over and we are subject to new variants and subvariants. There will be moments with more and [haverá] others with fewer cases. When it decreases, you can relax the use of mask. Now it has to strongly recommend the use of a mask in closed environments, including schools.”
What respiratory diseases affect children most at this time? All respiratory diseases are on the rise, especially in young children, under 5 years and especially 0 to 2 years.
In 2022, children under the age of two were not exposed to anything, so their immune systems were not bombarded. What happens now? Everyone is without a mask, they are starting to go to school and their immune system is attacked.
There are several types of viruses in circulation, such as rhinovirus, metapneumovirus, in addition to respiratory syncytial, which causes bronchiolitis.
Along with that, at this time, April, May and June, we have drier air and much more polluted cities, like São Paulo. This increases the amount of environmental allergens, which are triggers for triggering asthma.
Some doctors talk about environmental asthma. It’s the same thing. Asthma is a process of bronchospasm, when the bronchus closes. What makes the bronchus close? First, you must have the genetic predisposition; second, an environment that triggers the allergens.
These children with asthma need to use corticosteroids and the inhaler. Are they harmful? Is it the only treatment for asthma? There is treatment for acute and chronic crisis. The chronic is done with a bronchodilator and corticosteroids at low inhaled doses, which have no systemic effect in children. The big problem is when you treat it acutely with high-dose corticosteroids. Then it can have a systemic effect. Corticosteroids cannot be given for a long time because they inhibit the hormonal axes.
Is asthma preventable? Yes, to the extent that we can minimize the triggers that lead to an acute crisis. For example, a person who lives in the countryside, eats and sleeps well, has no stress and leads a healthy life has a lower chance of developing seizures than someone who lives in the city, breathes dust and sleeps poorly.
Is Covid-19 dangerous for children with asthma? When there is any infectious respiratory disease in children with asthma the risk is higher because the lung is compromised.
How to protect children against Covid? According to the Brazilian Society of Pediatrics, children over two years old must wear a mask, maintain social distance and wash their hands.
The Government of São Paulo recommended the return of the use of mask. In your opinion, should it be an obligation or a recommendation? The pandemic is not over and we are subject to new variants and subvariants. There will be times with more and [haverá] others with fewer cases. When it decreases, you can relax the use of mask. Now it has to strongly recommend the use of a mask in closed environments, including schools.
Recommend or oblige? In Brazil, it would be correct to use the expression strongly recommended, but for the Brazilian spirit it would mean “I will not use”. “Thank you” is not the best word, but it can be the most effective.
So, is it a must-have? That’s it.
In 2020, we heard that Covid in children was not dangerous and they would hardly contract the disease. Has the virus changed? We have begun to understand the virus’s mechanism of action. For it to enter inside the cell, it needs a receptor. With a smaller amount of receptor, children began to have milder cases of Covid, because a smaller amount of virus was able to enter the cell. The virus has the key and our cell has the lock. Only variants appeared. And what characterized them? The key just got better. Children began to be affected.
At the same time, we understand that children could have multisystem inflammatory syndrome, as a result of Covid. It’s serious. However, it affects only 0.6% of children. You may think it’s a small amount, but if it’s your child, it’s 100% for you. Want to see your child intubated? So, let’s start preventing Covid in children. One more reason: children can also have long Covid.
Is the vaccine immunity of children the same as that of adults? It’s more or less the same thing. Immunity induced by the disease or vaccine tends to last around four months—perhaps from the disease even less.
Can children get the Covid vaccine along with others? They can. We only give the interval between Covid doses.
What to do when parents don’t want to vaccinate their children against Covid without clinical justification. Should the issue be resolved with a fine and imprisonment, for example? Depends on the case. I think it’s up to the judge to decide based on the clinical case. From a medical point of view, every child has the right to be vaccinated. It’s in the ECA and we have to respect it.
Do you consider it safe to attend school at this time? Face-to-face schooling is essential for children’s development. The online scheme served the moment when we were getting to know the pandemic, understanding the risk of the disease. Children can and should attend school. Second, the pandemic will have worse and better times. In the worst case we will have to be responsible enough to put a mask on children over two years old and send them to school. Third, everyone’s responsibility is huge. Is your child sick? Do you have any flu symptoms? Do not send to school. On the third day, test and if it is positive, comply with the quarantine of at least seven days.
* The reporter traveled at the invitation of Brain Congress 2022
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Ana Maria de Ulhoa Escobar
Pediatrician, full professor and coordinator of the discipline of preventive and social pediatrics at the Department of Pediatrics at the USP School of Medicine, in addition to being an ambassador for the Jô Clamente Institute (ex-Apae) in São Paulo
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