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Tatenda Simango

I hope I find you well and in good health. In this week’s article we will look at how Covid-19 has been seen to affect specific groups in our community. We will also cover how Covid-19 may affect our psychosocial well-being as well as coping strategies.

Covid-19 can also affect pregnant women. At present there is no evidence that pregnant women, including those living with HIV, are at higher risk of severe illness than the general population. It is important that pregnant women take precautions to protect themselves against Covid-19. No vertical transmission (mother to child transmission in utero) has been documented, transmission after birth via contact with infectious respiratory secretions is a concern. Infants born to mothers with suspected, probable, or confirmed Covid-19 should be breastfed.

Infant and Young Child Feeding Mothers need to be re-assured that it is safe to breastfeed their children. Mothers should be counselled to continue breastfeeding should the infant or young child become sick with suspected, probable, or confirmed Covid-19 or any other illness.

Mothers suspected or confirmed to have Covid-19 and are isolated at home should continue recommended feeding practices with necessary hygiene precautions during feeding: cough etiquette, regular hand washing with soap.

In our communities where eating in a common bowl or feeding children by hand is common, it is preferable to use the child’s own plate and spoon to avoid transmission. If the mother has respiratory symptoms, use of a face mask when feeding or caring for the infant is recommended. Locally available or adaptive face masks can be used as an alternative.

Children can and have been infected with Covid-19, children may play a major role in community-based viral transmission. Pre-school-aged children and infants were more likely than older children to have severe clinical manifestations. More severe outcomes have been associated with underlying pulmonary pathology, and immuno-compromising conditions. Common symptoms (including fever, cough, shortness of breath) were less frequent in paediatric patients.

Myalgia, sore throat, headache, and diarrhoea were also less commonly reported by paediatric patients. It affects the under one-year-olds more.

There is also evidence of fecal shedding in the stool for several weeks after diagnosis, leading to concern about fecal-oral transmission of the virus, particularly for infants and children who are not toilet trained, and viral replication in the gastrointestinal tract. Prolonged shedding in nasal secretions and stool has substantial implications for community spread in childcare centres, in schools, and in the home.

However, four percent of virologically confirmed cases had asymptomatic infection, and this rate almost certainly understates the true rate of asymptomatic infection because many children who are asymptomatic are unlikely to be tested.

At present there is no evidence to suggest that there is an increased risk of infection and increased severity of illness for people living with HIV; with the understanding that they have achieved viral suppression through antiretroviral treatment and do not have a compromised immune system and have no other co-infections or comorbidities. People living with HIV are advised to take the same precautions as the general population. There is insufficient data to assess the effectiveness of any type of antiretroviral for treating or preventing Covid-19.

While there is no available data yet on how Covid-19 impacts people co-infected with HIV and TB, people living with HIV who are also living with TB or who are TB survivors often have lung damage. They therefore may be more susceptible to Covid-19 and may develop serious illness. People living with HIV and TB co-infection or are pulmonary TB survivors who are likely to have damaged lungs should take precautions to protect themselves against Covid-19 and pay attention to guidance on physical distancing of at least one meter.

Infants and children with HIV should be up to date on all immunisations and continue their ARV therapy and other medications as prescribed.

Mental well-being will be affected by lockdown, more so if one is infected or affected by Covid-19. It is normal to feel sad, distressed, worried, confused, scared or angry during this crisis. This makes it important to keep in touch with family and friends through phone calls and making use of social media platforms. As you stay at home, maintain a healthy lifestyle (including a proper diet, sleep, exercise and social contact with loved ones at home). Do not use tobacco, alcohol or other drugs to cope with your emotions. Decrease the time you and your family spend watching or listening to upsetting media.

Help children cope with the stress. Children may respond to stress in different ways. Common responses include having difficulties sleeping, bedwetting, having pain in the stomach or head, and being anxious, withdrawn, angry, clingy or afraid to be left alone. Respond to children’s reactions in a supportive way and explain to them that they are normal reactions to an abnormal situation.

Listen to their concerns and take time to comfort them and give them affection, reassure them that they are safe and praise them frequently. If possible, create opportunities for children to play and relax. Keep regular routines and schedules as much as possible, especially before they go to sleep, or help create new ones in a new environment. Provide age-appropriate facts about what has happened, explain what is going on and give them clear examples on what they can do to help protect themselves and others from infection. Share information about what could happen in a reassuring way.

Put measures that prevent sexual abuse and exploitation for children in affected families eg children left alone due to quarantined parents. If you experience sexual and gender-based violence during this time, help is still available from Government clinics and organisations such as:

Musasa Project (Toll free number 08080074)

Adult Rape Clinic (0775 672 770) or

Zimbabwe Women Lawyers Association (08080131)

Additional information has been adapted from the Ministry of Health “Key messages brief on Covid-19”, updated 15 April 2020.

Tatenda Simango is a medical practitioner. He can be contacted via email [email protected] or follow him on Facebook 9th Avenue Surgery