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MIL OSI Translation. Region: Russian Federation –

The risk groups for the severe course of the coronavirus will include children suffering from primary immunodeficiency, cancer and hematological diseases, diabetes mellitus, severe kidney, heart and lung damage.

A meeting of the COVID-19 Clinical Committee was held in Moscow to discuss the treatment of coronavirus in children. It was held in the format of a video conference. Participated in the meeting Sergei Sobyanin

“The fight against the pandemic has not subsided for a year and a half, and today the number of cases and hospitalizations in Moscow is practically at the peak of the numbers that we saw in previous waves. Today, the detection rate is about seven to eight thousand cases per day, and the number of people who are in hospitals has reached 12.5 thousand. These are big numbers. And of course, with such an increase in the incidence and the number of hospitalizations, restrictive measures play a rather large role. But an even greater role is played, of course, by the work of the entire medical system, the entire health care system of the city of Moscow, ”said the Moscow Mayor.

According to him, the clinical committee has developed a number of modern treatment regimens for COVID-19, and today every sick Muscovite is guaranteed high-quality medical care.

Clinical Committee on COVID-19 was founded in the spring of 2020 at the initiative of Moscow doctors. Its main task is to systematize scientific and practical data on the treatment of patients with coronavirus infection and develop appropriate recommendations for doctors. Chairman of the Clinical Committee – Head of the City Department of Health Alexey Khripun

The experience gained over almost two years of the pandemic has shown that mainly adults fall ill with COVID-19. The severity of the disease and the likelihood of an unfavorable outcome increases with the age of the patient.

New strains and modern drugs

Children usually carry the coronavirus asymptomatically or mildly. Nevertheless, during the pandemic, more than 190 thousand children were diagnosed with a new coronavirus infection in the capital. Most of them (65 percent) are schoolchildren, many of whom are between 14 and 17 years old. Children are rarely admitted to the hospital; about five percent of them needed inpatient care.

But recently, new strains of COVID-19 have begun to make more changes in the clinical picture of the disease in adults and children. The number of patients with moderate and severe forms of the disease has increased. Another new feature is the rapid development of clinical symptoms.

“Unfortunately, the number of sick children in this wave is much higher than in the previous one. Almost two to three times more. The number of hospitalizations is even higher. This, of course, requires the development of new approaches to the treatment of children, ”stressed Sergei Sobyanin.

As with adults, children with chronic conditions are at greatest risk for severe illness and subsequent complications.

Sergei Sobyanin noted that if drugs and new methods are not used in relation to children with serious chronic diseases, this can lead to disastrous consequences. Coronavirus infection in such children is much more difficult, and the progression of the disease itself contributes to this, added Ismail Osmanov, chief physician of the Z.A. Children’s City Clinical Hospital. Bashlyaeva, chief freelance pediatric specialist-nephrologist of the Moscow Department of Health.

At the same time, doctors note that children began to get sick with coronavirus more often and more severely. The number of sick infants and young children has increased – their share in the total number is 11 and 10 percent, respectively.

A specific childhood, albeit very rare, complication of coronavirus is multisystem inflammatory syndrome. For the first time in world practice, it was registered in April 2020. The syndrome is manifested by damage to a number of organs and systems, including the gastrointestinal, cardiovascular and central nervous systems.

Ismail Osmanov said that today 13 thousand children are on outpatient treatment, and 175 young Muscovites are on inpatient treatment.

Moscow doctors have accumulated extensive experience in identifying, diagnosing and treating children with coronavirus infection. The basic medical institution for helping young Muscovites is the Z.A. Bashlyaeva, where they began to provide assistance to children with COVID-19 in the spring of last year. For a year and a half of work, the doctors of the hospital have accumulated invaluable experience in treating this dangerous infection, including in young patients from special risk groups. In total, more than five thousand children received treatment at the hospital.

From the very beginning, their treatment is carried out in accordance with the Moscow recommendations “The procedure for the management of children with acute respiratory infections, including COVID-19, who are on outpatient treatment” and the “Clinical protocol for the treatment of children with a new coronavirus infection who are undergoing inpatient treatment.” They comply with federal recommendations, but are more detailed and superior to them in the use of innovative drugs, in particular immunobiological, aimed at preventing a cytokine storm.

How will COVID-19 in children be treated now?

Following the meeting, the clinical committee approved a new algorithm for monitoring and treating children with COVID-19 from high-risk groups. He also approved the use of innovative drugs: monoclonal virus-neutralizing antibodies and human anticoid immunoglobulin. Such treatment regimens will be used in children in Russia for the first time.

In accordance with the new algorithm, children with concomitant diseases such as primary immunodeficiency, oncological and hematological diseases, diabetes mellitus, severe kidney, heart and lung damage will be classified as risk groups for the severe course of the coronavirus.

The infrastructure for the treatment and observation of these patients is formed by a children’s remote consultative center located in the structure of the telemedicine center, as well as a short-term hospital in the children’s city clinical hospital named after Z.A. Bashlyaeva.

“Children from risk groups will be under the supervision of the center’s doctors from the moment they are diagnosed with coronavirus. They will undergo full diagnostics and treatment using innovative drugs – monoclonal virus-neutralizing antibodies and anticoid globulin. Children will also be closely monitored after treatment. We already have the first experience of using these drugs by the decision of the medical commission, and it is positive, ”Ismail Osmanov said.

The identification of patients from high-risk groups will be carried out using a single digital platform that analyzes data from an electronic medical record.

Further, pediatricians of the Children’s Remote Advisory Center will contact the parents of sick children undergoing treatment for COVID-19 at home. Such children will be taken under supervision and, if necessary, will be sent for examination and treatment to the short-term inpatient department of the Z.A. Children’s City Clinical Hospital. Bashlyaeva. They will be in the hospital for only a few hours. Special vehicles are used to transport them to and from the hospital. In the hospital, the child, together with his mother or father, will be placed in one of 10 Meltzer boxes, which ensure complete isolation of the patient.

The examination program will include blood and urine tests, computed tomography, ECG and more. According to the results, doctors can offer to undergo treatment with innovative drugs from the group of virus-neutralizing monoclonal antibodies and a special human anticoid immunoglobulin.

These drugs are administered once intravenously using a dropper and act in a similar way to antibodies that the body produces on its own to fight infection. These drugs will help the body fight COVID-19 faster at a time when its own antibodies are just beginning to be produced. That is why it is important to administer the drug as early as possible in order to stop the development of the disease in time and prevent complications requiring hospitalization.

After the treatment, pediatricians of the Children’s Remote Advisory Center will contact the child’s parents every day for two weeks in order to monitor his condition.

On the third, seventh and 11th day, patients will undergo PCR, ELISA and other laboratory tests to assess the effectiveness of therapy, track the formation of their own immunity, and also make timely decisions on further treatment tactics.

The first short-term hospital for additional examinations and treatment with innovative drugs appeared in Moscow in June this year on the basis of two leading hospitals – City Clinical Hospital No. 52 and City Clinical Hospital No. 15 named after OM. Filatov. The hospital’s patients are pregnant women at risk of severe COVID-19.

Today, more than 200 women have received monoclonal antibody therapy. Doctors of the telemedicine center conducted over four thousand consultations. The use of the drugs showed high efficiency: no adverse events were registered, a rapid neutralization of the virus and an improvement in the condition of the patients were noted. The birth is going well.

The first results of vaccination among children

Vaccination is the only remedy that can provide a sustained and long-term reduction in morbidity. Mass vaccination against COVID-19 of the adult population of Moscow began in December 2020. As of October 27 this year, almost 5.1 million people have received the first component of the vaccine.

Today in the capital, a study is being conducted on the safety and efficacy of the Gam-Covid-Vac M (“Sputnik V”) vaccine in children. The first stage of the study involved 99 minors (56 boys and 43 girls) aged 12 to 17 years. 92 volunteers received both components of the study vaccine. The volume of the drug administered is 1/10 or 1/5 of the immunizing dose for adults.

The results of the first stage of the study allow us to draw the following conclusions:

– double vaccination of volunteers with the Gam-Covid-Vac M vaccine, both 1/10 and 1/5 of the immunizing dose, aimed at adults, can lead to the formation of good post-vaccination cellular immunity;

– the drug has shown a favorable safety and immunogenicity profile;

– indicators of safety and immunogenicity are superior to those in adult participants in a similar study of the first and second phases.

Currently, volunteers are being pre-selected to participate in the second phase of the study.

EDITOR’S NOTE: This article is a translation. Apologies should the grammar and or sentence structure not be perfect.

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