| What is the condition known as MIS-C in children? | a severe post-COVID-19 inflammatory disorder in children which is frequently associated with complications such as cardiac dysfunction, coronary aneurysms, thrombosis, and multi-organ dysfunction etc. | Provisions to allow parent/ family member to stay with the child These facilities should have provision for the stay of a parent/ care-giver with the child. This could be an adult family member who also has mild COVID/ asymptomatic infection, or one who has previously recovered from COVID. In case the caregiver is COVID negative, he/she still may be allowed to be with the child, after due counselling, appropriate consent, and providing them with appropriate PPE (esp. a good fitting N95/ FFP2 mask). Augmentation of existing pediatric care facilities to provide care to children with MIS-C MIS-C is a severe post-COVID-19 inflammatory disorder in children which is frequently associated with complications such as cardiac dysfunction, coronary aneurysms, thrombosis, and multi-organ dysfunction etc. MIS-C cases tend to peak 2-6 weeks following the peak of COVID-19 cases in the community. | 603 | definition | 1.000 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | Augmentation of existing pediatric care facilities to provide care to children with MIS-C MIS-C is a severe post-COVID-19 inflammatory disorder in children which is frequently associated with complications such as cardiac dysfunction, coronary aneurysms, thrombosis, and multi-organ dysfunction etc. MIS-C cases tend to peak 2-6 weeks following the peak of COVID-19 cases in the community. | 17 | page=17,block=2 | 0.700 | valid |
| What can increase suspicion of COVID-19 in children? | Presence of a recent/ current confirmed case of COVID- 19 in a family member or a close contact | Screening Confirmed COVID cases (PCR/ CBNAAT/ RAT positive) MIS-C (PCR/ CBNAAT negative) Existing screening facilities Existing COVID facilities (CCC, DCHC, DCH, HDU, ICU) In addition, also in existing Paediatric facilities- HDU/ ICU services. Pediatrics ER Suspecting COVID-19 and testing in children The guidelines developed by the MoHFW for management of pediatric COVID-19 outlines the symptoms of COVID-19 (Fig 1). The indications for testing children for COVID-19 are the same as that proposed by the Ministry/ ICMR. Presence of a recent/ current confirmed case of COVID- 19 in a family member or a close contact raises the index of suspicion. At a community level, use of the IMNCI framework to manage children may suffice. The framework will be able to identify sick children needing referral. all children with fast breathing and confirmed COVID-19 will need referral for admission. | 523 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | The indications for testing children for COVID-19 are the same as that proposed by the Ministry/ ICMR. Presence of a recent/ current confirmed case of COVID- 19 in a family member or a close contact raises the index of suspicion. |
| What connection between age and illness severity was noted in earlier findings? | illness severity was associated with age (>60 years old) | Among adults with confirmed COVID-19 infection, it is well documented that 80% experience mild illness, approximately 14-15% experience moderate- severe disease and 5% are critically ill. Earlier reports had suggested that illness severity was associated with age (>60 years old) and co-morbid disease. During the second wave, large numbers of younger individuals had moderate-severe disease. Till date, children have relatively been spared of serious disease and poor outcomes. As per the available sero-survey data prior to launch of vaccination drive, children 10-17 years had seropositivity similar to that in adults, i.e., 25.3% (4). the proportion of <20 yr olds among confirmed COVID-19 cases is lower than expected. It means that children are as susceptible as adults to infection, but a large majority remains asymptomatic. Even among the symptomatics, vast majority have mild disease only. | 223 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | Earlier reports had suggested that illness severity was associated with age (>60 years old) and co-morbid disease. |
| What factors are experts suggesting could lead to a rise in COVID-19 cases among children? | Re-opening of schools and colleges | The clinical features of COVID in India are similar to that described elsewhere [5-7]. As has been seen in countries where a significant proportion of adults have received COVID-19 vaccines, the proportion of children among new cases increases gradually [in the US, the proportion has increase from 14% to 24% as in May 2nd week and changed to 19.8% in the third week (8)]. Various experts are predicting a third wave with a disproportionately high burden among the pediatric population. Re-opening of schools and colleges may contribute an increase in the infections in children. there is a need to prepare for any future sudden surge of COVID cases in the pediatric age group. It is important to augment existing health facilities for children, particularly ICU and HDU facilities, while also strengthening community level care i.e. PHCs/ | 488 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | Various experts are predicting a third wave with a disproportionately high burden among the pediatric population. Re-opening of schools and colleges may contribute an increase in the infections in children. |
| What is necessary to ensure health facilities can respond effectively to the pandemic? | it is properly linked with community-based home care. | parallely we also need to strengthen our existing health facilities particularly DH and secondary care facilities for provision of assured non-COVID-19 critical care. 7. This is also to flag here that any strengthening in the facility will only be able to respond adequately if it is properly linked with community-based home care. Lesson from the present pandemic has clearly indicated reactions by the public, rushing to the facilities, seeking care for the cases which could have been well managed at home and this may have resulted in denial of certain services for those who actually needed the admission. It is therefore also proposed that every district should have a COVID control room under the guidance of paediatrician and physician so that focus on adequate IEC, reassurance for | 278 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | This is also to flag here that any strengthening in the facility will only be able to respond adequately if it is properly linked with community-based home care. Lesson from the present pandemic has clearly indicated reactions by the public, rushing to the facilities, seeking care for the cases which could have been well managed at home and this may have resulted in denial of certain services for those who actually needed the admission. |
| What is the reason the current COVID care infrastructure focuses on adult cases? | due to the small proportion of paediatric cases | So, adequate importance should be given to the symptoms and clinical findings to assess a child for seeking further medical advice. Once COVID vaccines are approved for children, community level programs should focus on appropriate communication to facilitate a wide coverage. Categorization of COVID Health Facilities On 7th April, 2020, the Ministry of Health and Family Welfare issued a guidance document on appropriate management of suspect/confirmed cases of COVID-19. Based on this guidance, every state and UT have augmented or created infrastructure for managing COVID cases which are largely catering to adult cases due to the small proportion of paediatric cases. This infrastructure developed for COVID care needs to be augmented for managing paediatric COVID- 19 cases for future. | 625 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | Based on this guidance, every state and UT have augmented or created infrastructure for managing COVID cases which are largely catering to adult cases due to the small proportion of paediatric cases. |
| What mental health risks might arise if COVID patients are left alone in the wards? | this may have an impact on their mental health leading to isolation and depression | are not left unattended in the wards as this may have an impact on their mental health leading to isolation and depression. 7) Male and Female toilets should be conveniently located. Critical care beds: HDU and ICU 1) Critically ill patients requiring highly skilled lifesaving medical aid and nursing care will be admitted here. 2) Generally, Paediatric HDU beds are for patients with single organ failure where a specialist can monitor and manage. Paediatric ICU beds are for patients with multiple organ failure and life is eminently at threat requiring ventilator support with backup for super and multispecialty care. | 40 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | are not left unattended in the wards as this may have an impact on their mental health leading to isolation and depression. | 22 | page=22,block=2 | 0.700 | valid |
| What role does the District Health Administration play when a new hospital is converted into a COVID hospital? | the RKS of the nearest hospital or as decided by the District Health Administration will work as the RKS/Hospital Management Committee. | A. Effective governance of the public health system includes the establishment of institutional arrangements (existing facility and stand-alone COVID hospital) and policies along with their continuous monitoring to ensure proper implementation. Apart from ensuring good leadership, it also includes specific interventions such as: B. Existing hospitals have RKS in place, in-case a new hospital or temporary building is converted into COVID hospital, then, the RKS of the nearest hospital or as decided by the District Health Administration will work as the RKS/Hospital Management Committee. C. During pandemic, epidemic, disasters, or such crises, state and district administration support in procurement/supplies/hiring of HR and in establishing various need-based services for the hospital. D. Every district taskforce/RKS should include paediatrician as a member. E. | 457 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | Existing hospitals have RKS in place, in-case a new hospital or temporary building is converted into COVID hospital, then, the RKS of the nearest hospital or as decided by the District Health Administration will work as the RKS/Hospital Management Committee. C. |
| Why is the distribution of electric load important in a facility? | overloading at any point can result in mis happening like electric fire hazard or can damage the equipment | Fire detectors, extinguishers, sprinklers, and water connections should be functional and easily accessible. Electrical Load 1. Distribution of electric load along with load balancing to various equipment and installations in a facility is very important since overloading at any point can result in mis happening like electric fire hazard or can damage the equipment. 2. fluctuation in voltage also adversely affects the equipment and hence automatic voltage regulators which regulate fluctuating input power voltage and maintain constant output voltage should be provided. So, electrical installation is a specialized job and must be given due importance to ensure proper care with reduced risks to the patient. | 261 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | Distribution of electric load along with load balancing to various equipment and installations in a facility is very important since overloading at any point can result in mis happening like electric fire hazard or can damage the equipment. |
| Why should children's wards be separate from adult wards in COVID-19 facilities? | for their mental comfort and to ensure parent is allowed to accompany the child | This infrastructure will need additional resources to care for the increased number of child patients who often would need accompanying one family member. Children's area/wards should preferably be separate from adult wards for their mental comfort and to ensure parent is allowed to accompany the child, in contrast to the policies in adult area. to cope up with a COVID-19 related condition unique to children- MIS-C, there is also a need to strengthen the existing health facilities for providing assured quality critical care. The emergency services need strengthening. There has to be appropriate triage systems in place. To keep patients suspected to have COVID-19, while awaiting reports, a holding area is required. The available holding area mainly for adult patients may be augmented to provide appropriate space for children. | 224 | relationship | 0.970 | https://nhm.gov.in/images/pdf/programmes/RBSK/Operational_Guidelines/CoVID_Care_Services_for_Children_and_Adolescents.pdf | Children's area/wards should preferably be separate from adult wards for their mental comfort and to ensure parent is allowed to accompany the child, in contrast to the policies in adult area. |