We talk about it with Dr. Ilaria Saredi, Family Medicine Specialist in Dubai

The school restarts safely after months of forced shutdown due to the Covid-19 pandemic marked by a period of distance learning as an anti-Covid containment measure. This has led to a number of disorders and among the most frequent: increased irritability, sleep disturbances and anxiety disorders, highlighted by a survey on the psychological and behavioral impact of lockdown in children and adolescents in Italy, conducted by the Gaslini pediatric hospital in Genoa.

"The return to school represents a return to almost normalcy after many months of difficulties and restrictions. It will be a different newspaper than usual, but it will allow children and teenagers to relate to each other in person with all the nuances that this entails, with benefits also on their mood and psyche. However, we must not forget that we are experiencing a period of health difficulty that persists, so it will be necessary to teach our children the important precautions for a safe return to school.". The words of the doctor Ilaria Saredi, Family Medicine Specialist in Dubai, with which we took stock of how to recognize the symptoms of SARS-CoV-2 infection and distinguish them from other viral infections, on the nasopharyngeal swab and how to perform it correctly for children.

Dr. Ilaria Saredi

What are the prevention measures to avoid the risk of contagion in schools?

“First of all, respect social distancing (ideally 2 meters), and where this is not possible, protective barriers will have to protect pupils from possible virus-laden droplets. The masks they remain important in the prevention and containment of the virus and should be worn and discarded properly several times a day. For those who intend to wear one cotton mask, I recommend having a spare for the second part of the day and washing them in the washing machine at at least 60 degrees centigrade. I also recommend not using softening products due to their allergenic potential. It is also important to equip the children with sanitizing gel and disinfectant wipes to be able to protect yourself at all times, and to remember the importance of washing hands before meals and after touching common surfaces. The prevention measures also include measuring the body temperature to check if the child, often asymptomatic, has a fever. By fever we mean a body temperature equal to or higher than 37.5 ° C ".

It is therefore very important to comply with all prevention measures to counter the spread of the SARS-CoV-2 virus. Since the start of the pandemic, parents and health care workers have been concerned about how affected children would be from the infection. As for the contagion, according to results of a research published in Nature Medicine which has developed models of transmission of the Covid-19 disease on the basis of data from 6 countries, including Italy, it has emerged that children and young people under 20, in addition to being very often asymptomatic, have a susceptibility to infection equal to about half that of those over 20 years old.

What are the main symptoms of Covid-19 in children to pay attention to and not confuse them with those of other viral infections?

“The symptoms of Covid-19 disease caused by the Sars-CoV-2 coronavirus are unfortunately very little specific and sometimes in common with other viral respiratory diseases common in the autumn and winter period. No.and children may vary: from fever to cough, general malaise and tiredness, sore throat, runny nose, headache, cough, diarrhea or vomiting, rash, muscle aches, loss of taste and smell, abdominal pain. They have been described some cases of multi-systemic inflammatory syndrome in children after Sars-CoV-2 coronavirus infection, but these remain rare. The syndrome can be dangerous due to the significant inflammation of the blood vessels with possible damage to the heart. In this case, the signs that should not be underestimated may be excessive and unusual tiredness for the child associated with skin rash, abdominal pain, vomiting and / or diarrhea, red and chapped lips, red eyes, swelling of the hands and / or feet. Children presenting with these symptoms should be evaluated by a doctor urgently ”.

What to do in the presence of a symptom without fever?

“The absence of fever in the presence of flu symptoms cannot exclude the risk of having contracted the virus, but it reduces the probability that it is Covid-19. However we cannot be sure because we have seen a multitude of clinical presentations and the swab remains the only test that allows to distinguish the SARS-CoV-2 coronavirus infection. It would be interesting - as a doctor - to be able to test all our patients in order to see the broad spectrum of clinical presentation of the disease and to refine our clinical-diagnostic skills, but this is not currently possible for several reasons.

The certainty of the diagnosis is the swab. Isn't there a risk of doing it every time a flu symptom occurs with the consequence of keeping the baby at home for too long?

“The best solution is to keep the child at home when the first symptom appears, such as a stuffy or runny nose, to limit the contagion of flu viruses in the classroom. If the symptoms were self-limiting and no others were added, the child could go back to school once the clinical condition completely resolved. In doing so, the contagion of all viruses and bacteria that can cause diseases with symptoms similar to COVID is greatly limited. If, on the other hand, a child should have multiple symptoms, it would be good to perform a COVID test to ascertain the negativity before reintegrating the school community. Once it is ascertained that it is not Covid-19, most children will only need a purely symptomatic treatment: you can manage the fever with paracetamol, increase hydration, use honey for coughs (in children over 18 months) to ensure adequate vitamin C intake and that children get adequate rest, ”.

What is a nasopharyngeal swab and how is the examination done?

“In general, the nasopharyngeal swab is a simple procedure, often performed in children even in the pre-Covid era to quickly test for flu in the doctor's office. It is picked up with a small stick with the cotton tip a small amount of nasopharyngeal secretions - all lasting about 3 seconds - and allows to detect the presence of viruses in the upper airways from the first day of symptoms ".

When should nasopharyngeal swab for SARS-CoV-2 coronavirus be performed?

“When you have come into contact with people who are positive for the virus or in case of typical symptoms. If the child has a typical symptom he should stay home from school, call his doctor to explain the situation and discuss whether or not to swab ”.

How to prepare the baby for the tampon?

“It is known that it is not easy to manage a child who has to undergo tests of this type, but it is important to prepare him for the collection correctly. Reassure him and let him know that he must undergo the test to help him heal. The parent should warn the child before the exam so as not to take him by surprise and frighten him about the procedure and the doctors ”.

In case of positive virus SARS-CoV-2, what to do?

“The therapy of COVID-19 does not differ from the supportive therapy of the flu syndromes in subjects with little symptoms. Above all, it will be necessary to swab the whole family and implement quarantine for all family members for 14 days. However, we recommend that you contact your trusted doctor who will evaluate each individual case and will be able to advise you on the basis of new scientific evidence which is constantly updated ". 

With the reopening of schools of all types and levels including nursery schools, there are important factors to consider for the protection of the health of children and school workers at the time of living with the SARS-CoV-2 coronavirus.

Doctor, in conclusion: what are your advice for families? 

“Explain to your children what precautions to take at school and why, teach them to use the masks correctly and not to touch the outside once used. We improve our hygiene habits in general during this pandemic and help our children to live it in a peaceful way by guiding them and not frightening them in the face of daily life. We favor outdoor life over closed places, movement and fresh air are necessary for healthy and happy children ”.

Below are the hygiene precautions and the theme on the obligation to wear masks disseminated by the Ministry of Health.

  • Hygienic precautions -All children should be encouraged to comply with the rules of hygiene and prevention of infections, such as not putting their hands in their mouths, not rubbing their eyes and washing their hands frequently and thoroughly with soap and water or alcohol-based hand sanitizer. 
  • Masks - They are not mandatory for children under the age of 6 and for children with disabilities that are not compatible with the continuous use of the mask and those who interact with them. There are many fake news that run on the matter. The Italian Society of Pediatrics (Sip) in a video popular has denied a series of false reports circulating on social media, stating that "healthy children who wear the surgical mask for several hours a day do not risk oxygen deficiency or death from hypoxia", "the mask prevents the spread of infections and should be worn by children to avoid the transmission of the coronavirus among asymptomatic ". Furthermore, there is no evidence documenting a link between use of the mask and an alteration of the bacterial flora or intestinal dysbiosis. 


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