Research on Covid-19, the disease caused by the new coronavirus, is ongoing, and while information is still limited, we do know that it is not infecting children as frequently or severely as adults.
Given that millions of South Africans live with long-term conditions including allergic disorders such as eczema, hay fever and asthma (one of the most common chronic diseases affecting children), parents and caregivers are being extra cautious, especially considering that asthma, like Covid-19, is a lung disease.
Professor Claudia Gray, paediatrician and allergist at Kids Allergy – Paediatric and Allergy Centre answered some pertinent questions on the topic in a live interview hosted by the Allergy Foundation South Africa (AFSA). Here’s what families of children with asthma and allergies should know.
Does asthma increase the chances of Covid-19 complications?
Although there are certain risk factors that put one at greater risk of developing Covid-19 complications, such as being over 65, diabetes, hypertension, and chronic heart disease, people are concerned about whether asthma counts as one of those chronic lung diseases which might increase their predisposition to severe Covid-19.
The answer is that it could "possibly" put you at risk, said Gray, but only if you have severe, uncontrolled asthma, or asthma with other comorbidities such as damaged lungs, high blood pressure or diabetes, for example.
“However, the vast majority of our asthmatics, both in adulthood and childhood are mild to moderate and can be controlled. And the reality is that mild to moderate asthmatics who are well-controlled are not at much greater risk of Covid-19 complications,” Gray explained, adding:
“So we have this word ‘control’ which is central to all of this. It means compliance; it means we can do something about this. In terms of keeping your asthma under control, this has several facets to it. Of course, first of all, it means going for your regular allergy and asthma follow-up visits.
“These could be face-to-face consultations, and taking all the necessary precautions such as universal mask-wearing, hand sanitisation, and physical distancing.”
Gray further advised: “Secondly, please stay on your asthma and allergy medication. The reality is that every single medicine that we use – the controller pumps (even if they contain steroids), antihistamines, and nasal sprays are all safe to continue using during this Covid-19 pandemic.”
How does allergic rhinitis interact with Covid-19?
Hay fever, medically known as allergic rhinitis, is an environmental allergy caused by pollen, and affects the mucous membranes of the eyes and sinuses. It can lead to nasal congestion, sneezing, red, itchy eyes and other symptoms.
You’re not more likely to get Covid-19, but you have to keep your nose in tip-top shape, explained Gray, but added that it could have two indirect effects on Covid-19:
“Firstly, if you're sneezing and your nose is itchy and runny, you will find it very difficult not to touch your face, and this is one of the prevention strategies for Covid-19, so this is a really good reason to try and have your nose under control.
“Secondly, symptoms of allergic rhinitis such as a runny nose, a bit of a post nasal drip or a sneeze could, of course, mimic Covid-19 symptoms, so equally as important then, is to start pre-treating your allergic rhinitis even before your regular season.”
When your allergies are well-managed and under control, it will prevent the confusion of allergy symptoms with Covid-19, Gray explained.
“So, allergic rhinitis is not a big risk factor, but it can complicate things indirectly. Good control, therefore, is our key message," she added.
At what age should a child start wearing a face mask?
According to Gray, the mandatory wearing of face masks for children under the age of two is completely unrealistic. Gray further commented that the new guidelines for learning centres suggest that children five years and older must wear a face mask.
What kind of face mask is best for a child with asthma?
“If face masks are worn in everyday life with quiet speaking, just sitting and listening in the classroom, it will not impair anybody’s breathing, including the asthmatic patient,” said Gray.
“We suggest a three-ply cloth mask for the public, and ideally for an asthmatic a three-ply cotton face mask so that it’s quite breathable.
"In terms of the medical masks, we don’t suggest these for the public. The N95 masks are really tight-fitting and, for the average asthmatic, it might be an irritant. The bottom line is that asthmatics do need to wear masks wherever possible, and they need to find one that is comfortable for them," said Gray.
Should I send my 10-year-old son who has chronic asthma and allergies to school?
It all really depends on how severe their asthma is, whether it is well-controlled, and whether they have any other comorbidities, explained Gray.
“If it’s a child with asthma and allergic rhinitis, but it's controlled and they're on medication – and they haven’t had attacks with a very tight chest or needing attention in the last month or two – I would say it is safe to send that child to school.
“What parents do need to know is that asthma can be triggered by many viruses. The SARS-CoV-2 has rarely been borne out to be a virus that specifically causes wheezy episodes, so that’s not such a big risk factor.”
However, Gray went on to comment that the other viruses – cold viruses, flu viruses, the RSV virus, etc. – are all going to make their appearance this winter, just much later than usual because of lockdown. This means that children will be prone to getting any of these viruses and that we should bear in mind that this is completely normal for our winter season.
“Kids are not at great risk of Covid-19 complications, especially younger kids under the age of 12. They behave slightly differently to adults. But, they can be exposed to all the other viruses that normally cause wheezing and asthmatic exacerbation,” Gray said.
Reach for the asthma pump, if needed, but not a nebuliser – especially during the pandemic
Nebulisers are not recommended, as they can increase the risk to those around you. Instead, an asthma pump with a spacer is recommended as it is safer and just as effective, if not more effective, than a nebuliser.
Gray explains: “When children or adults are having moderate to severe asthma attacks, they may need a quick reliever to help them open up their chest. This is very different from their long-term controller pump or medication which should be taken every day.
“So if your chest is very tight and you need immediate relief, you need to be given what we call a ‘beta-2 agonist’, and this comes in two forms: It can be done in droplet form through a nebuliser, or it can be done with an asthma pump with a quick-acting agent, and preferably through a spacer device which makes the coordination much easier, especially for young children.”
However, if, for example, a young child is experiencing a viral wheeze or an asthma attack and they’re sitting in a hospital ward and carrying Covid-19, but it is unknown (either because they’re asymptomatic or they haven't received their test results yet), then using a nebuliser may actually spread the infected droplets into the environment, allowing other people to inhale them and become infected, explained Gray.
“That’s why we suggest, especially in the hospital clinic settings, to try to reduce the number of nebulisers used. A spacer with a pump is actually just as effective, or even more effective in those children not requiring oxygen. I don’t believe home nebulisers should be used at all.”
Most children can be very effectively "rescued-treated" with a spacer, Gray said, and these deliver medication to the airways more effectively than a pump on its own.