The discussion about the return of students to schools generates many doubts, mainly about who would be able, or not, to return. Children and adolescents are not the main victims of covid-19, even though they may develop, in rare cases, pediatric multisystem inflammatory syndrome (SIM-P), a serious condition that affected 197 individuals in the country until the end of August.
But in relation to the basic health condition, who should avoid going back to school as soon as they are released, without still having the desired vaccine? Below you can see a relationship with diseases that can aggravate covid-19 in children and adolescents, prepared with information from the Sociedade Paranaense de Pediatria based on data from several other medical societies.
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According to pediatric infectious disease doctor Victor Costa Junior, vice president of the Paranaense Society of Pediatrics and who works at Hospital Pequeno Príncipe, in Curitiba, children who have a basic disease should not return at the first moment. “Even because we don’t know how the virus will return from the epidemiological point of view”, he says.
Children who should not return to classroom before the vaccine
There is no definition of a risk group in childhood and adolescence, but specialists have some conditions that would increase the risk of severe conditions:
Chronic neurological diseases
Neuromuscular diseases with reduced respiratory volumes (vital capacity <60%).
On mask or tracheostomy ventilation or with cardiac involvement
Diseases with bulbar involvement or progressive neurological diseases and neurological diseases undergoing immunosuppressive treatment.
Chronic kidney disease
Stage 5 (dialysis), especially if associated with lung disease or immunosuppression.
Autoimmune rheumatic diseases
Pediatric rheumatological patients using corticosteroids at a dose greater than 0.5 mg / kg / day or undergoing immunosuppressive treatment may be at increased risk.
Patients with systemic connective tissue diseases often have specific organ disorders that can put them at greater risk for significant pulmonary, cardiac, and renal impairment.
Chronic liver diseases
Some conditions could worsen the liver condition in case of infection with the new coronavirus, such as: biliary atresia or other biliary diseases, liver failure, hepatic metabolic disease, chronic hepatitis, liver tumor, cirrhosis.
Children under 1 year of age have a higher risk of developing severe and critical conditions compared to the others.
Patients with this condition have a higher mortality rate related to respiratory infections, possibly due to reduced immune function.
Immunosuppression by drugs
Prolonged exposure to elevated serum levels of corticosteroids (endogenous or exogenous) causes immunosuppression making individuals more vulnerable and at high risk for infections.
Immunosuppression by neoplasia or chemotherapy
Those receiving specific forms of treatment for cancer are extremely vulnerable, including induction chemo for acute lymphoblastic leukemia and non-Hodgkin’s lymphoma, for acute myeloid leukemia, among others.
There are several conditions that may present an increased risk of developing the severe form of covid-19, among primary immunodeficiencies, such as those combined with T and B cells, and secondary ones, such as those that require the use of immunoglobulin or prophylactic antibiotics and with comorbidities and in several other cases.
In adults, severe obesity is known to be a risk factor for severe forms of covid-19. In children and adolescents, cases of severe obesity should receive special attention due to the risk of complications from the disease.
Prolonged exposure to elevated serum levels of corticosteroids (endogenous or exogenous) causes immunosuppression making individuals more vulnerable and at high risk for infections. These patients usually have associated comorbidities such as obesity, diabetes mellitus and hypertension, which increase the risk of complications. Individuals with this uncontrolled syndrome, from any source, are at increased risk of infections, in general.
People with the syndrome and with morbidities such as heart disease, chronic respiratory problems, asthma, obstructive sleep apnea and diabetes mellitus are the group most at risk for severe forms, as well as those with immune deficiency, are being treated for cancer with chemo or for autoimmune diseases such as rheumatoid arthritis, lupus or psoriasis.
Congenital heart diseases
It is a risk group for covid-19 congenital or acquired heart diseases with significant hemodynamic repercussions (heart failure, pulmonary hypertension or hypoxemia) and heart diseases that have already undergone surgical correction, but that maintain signs of heart failure, pulmonary hypertension, cyanosis or hypoxemia.
There are still other conditions that could increase this risk, such as chronic cyanosis with reduced ventricular function and severe cardiomyopathies.