Dr Joanne Paul

EWMSC senior paediatric emergency specialist: Dr Joanne Paul

The first child in Trinidad and Tobago to die from Covid-19 was a seven-year-old boy who went into cardiac arrest when he was rushed to hospital.

A senior medical official told the Express yesterday that the child suffered from severe diarrhoea and vomiting for three days and by the time he was taken to the Wendy Fitzwilliam Paediatric Hospital at the Eric Williams Medical Sciences Complex (EWMSC) his condition was very grave.

The child was immediately taken to the Intensive Care Unit (ICU) at the hospital where nothing was spared in trying to save him, the official said.

Unfortunately he did not survive and his death has left his family in grief and shock.

The official said if anything must be learnt from this tragedy is children suffering from severe symptoms must immediately be taken for care.

On November 20, the Health Ministry issued a release disclosing the child’s death but no further information other than the gender of the child was disclosed.

EWMSC senior paediatric emergency specialist Dr Joanne Paul in a telephone interview with the Express yesterday said most times children who are infected with Covid-19 are asymptomatic but there are signs to look out for if they get ill.

She said it’s not like in adults where there are respiratory issues.

“They have other symptoms, so it’s really multi-system with regard to children. You looking for things that are generalised, what we call ‘cargo’ in children or lethargy, you are also looking at the brain, the heart and the bowel,” she said.

“When the Covid cases—the ones who have to be kept for a few days—they will commonly come in with profuse diarrhoea and fever,” she said.

She said the child’s heart rate should be monitored.

“If you find the child’s heart rate is a bit fast, with fever it goes up slightly, but if you put your hand by the heart area and you find it is really fast and lethargic that is a sign that something is amiss,” she said. Paul said with respect to the brain, if you talk to the child and they seem “out of it” something is wrong.

She said parents should have a relationship with their medical “buddy”—doctor, paediatrician or trusted nurse for guidance—and don’t wait to rush the child when he or she becomes severely ill.

Asked how soon should a child be taken for care if they suffer from severe symptoms such as diarrhoea and vomiting, Paul said:

“Don’t wait, come in and have a check, I usually say over-call it for kids because you want to make sure your child is OK. Be sensible. But if your instincts say this is not my child, something is wrong, don’t wait, just come in.”

Cardiac arrest

Paul said the trend of a child’s health must be monitored as they either get better really fast or very ill really fast.

She reiterated that a buddy system of checking in with your doctor via phone is important.

“Take some responsibility where you’re saying, ‘I know what’s happening with Delta, I’m going to take care of myself and make sure I do my normal public health measures at home and I’m going to be aware of what to look out for in my child knowing his brain, heart and the bowel in terms of fever, diarrhoea and behaving strangely,’” she said.

Paul said people should not be afraid to go to the hospital but should do so after monitoring the child’s symptoms.

“We have the emergency departments which are busy but it doesn’t matter, if you are worried, it’s your child, come to your health facility,” she said.

Questioned about a child suffering from cardiac arrest when infected with Covid, Paul said it is not common but it happens.

“What happens is that with Covid it makes everything inflamed and therefore you have those symptoms where the brain and the heart (are) inflamed, if the heart is inflamed it starts to beat faster because it can’t function as normal, the same way when the brain is inflamed it makes you drowsy and when the bowel is inflamed you get diarrhoea,” she said.

Paul explained that when a child is brought to the Emergency Department there are two pathways, with those who are suspected of having Covid placed on one pathway in an isolation area to be assessed and tested.

“Typically we do the initial screening of the antigen test which is not conclusive obviously but it gives us some extra information and of course we do the PCR testing,” she said.

Questioned if there is an uptick in the number of children presenting to the Emergency Department, Paul responded: “For sure, it’s a mixture of cases. We are seeing a lot more possible Covid cases but also a lot more flu.”

She said around this time there is an increase in the number of influenza cases.

“As per what the Minister said he is correct, we’ve been seeing a lot more babies having Covid because of course they are the ones who are home with the Covid-positive parents and they are also getting sick,” she said.

Paul said the hospital is recording babies and adolescents presenting with Covid.

“Definitely an increased volume of cases both Covid and influenza. As school is out we are having more movement in society, we are having more community transmission of influenza itself, so it’s very mixed right now,” she said.

One death too many

Questioned on what happens when a child is tested positive for Covid at the hospital, Paul said if the child is well and doctors are completely happy with them they are sent home where they are requested to stay in quarantine.

She said a follow-up check on the child is made the next day.

“If we find they are looking dehydrated we might keep them for 24 to 48 hours, Covid or no Covid. We watch you for a day or two, because they are so small they can easily get sicker,” she said.

Paul said children have fewer symptoms and don’t get as sick as adults do “but the problem is when a child dies that’s a significant thing. I’m not saying when an adult dies it’s not significant but the two vulnerable groups are children and pregnant women”.

Paul said she understands parents who are of the view that they do not want to vaccinate their child because children are usually asymptomatic with Covid “but I’m saying that one child who dies is one too much and that’s the whole point of us doing this whole campaign (vaccination), at least me, I don’t want any child to die”.

Yesterday at the Health Ministry’s news conference Health Minister Terrence Deyalsingh said over the last three months, 14 babies under one-year-old contracted Covid, 11 of whom were younger than three months old.

He said the babies were infected by their parents who were not vaccinated.

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