By Dr Annemie Burke and Dr Corné de Vos

This section is to share some literature about COVID-19 with our members and to answer questions where possible.  We will update it regularly with new information.  As always we have to highlight that this is general information and that we can’t give any medical advice to individuals.  Please contact your doctor with any questions specific to yourself or your child.


What is COVID-19? 


COVID-19 is the new respiratory illness caused by the coronavirus, and it has now been described by the World Health Organization as a pandemic.

Symptoms of COVID-19 will be mild for many, but are most severe in those with existing lung conditions.  There is huge media coverage of the pandemic, but we advise looking at these trusted websites for the facts.  In South-Africa visit https://www.nicd.ac.za or COVID-19 South African Resourse Portal for local information or visit:


  • Follow this link to explain COVID-19 to children in different SA languages.

Children and Teens get less severe disease compared to adults.

  • What seems to be consistent so far, in multiple settings in multiple countries, including the U.S., is that the majority of COVID-19 infections in individuals under the age of 19 tend to be mild,”
  • “Infection in pediatric patients of all ages tends to be associated with significantly lower rates of hospitalization and significantly lower rates of critical and severe illness.” Kristin Moffitt, Harvard Medical School

Why do children have milder disease?

We don’t know why. It’s likely a combination of factors related to body chemistry, immune function, and even social factors such as how children are cared for and spend their days.

Children under 1 year old have a higher risk for severe disease

  • Infants under one year of age—had a higher risk for significant illness
Age % risk of severe or critical disease
Less 1 years old 10,6%
1-5 years 7,3%
6-10 years 4,2%
11-15 years 4,1%
16 and older 3%

Common symptoms in children

The most common symptoms seems to be cough, sore throat and fever.

(New England Journal of Medicine)

Why will many children go untested and undiagnosed?

Most children doesn’t meet the criteria for testing

  • Samples for virus are taken from nasal and throat swabs
  • Virus is also detectable in stool, even several weeks after diagnosis
  • Unclear if you can get infected from contact to stool
  • Wash your hands carefully after toileting and diaper management
  • Decontaminate surfaces thoroughly (Gastroenterology 2020)

Limit caregivers who has contact with your young children!


  • Choose caregivers who have limited contact with other people and who can be trusted to practice social distancing, wash their hands frequently, and stay away if they feel at all sick.
  • Limit the number of people who have contact with young children.
  • As far as possible, keep young children at home. If you take them out, keep them inside strollers or otherwise limit what they touch.
  • Wash their hands even more often. They just can’t stop themselves from touching things and touching their face.
  • (Boston Children Hospital)


Be particularly watchful should young children get sick 

Call your doctor for advice rather than bringing your child in for mild or moderate illness

However, you should absolutely seek medical care if your child has

  • any trouble breathing — rapid or forceful breathing, a pale or blue color to skin, trouble feeding or talking, or doing usual activities because of breathing problems
  • a high fever you can’t get down , there have been some concerns raised about using ibuprofen with COVID-19 — use paracetamol instead
  • unusual sleepiness
  • pain or irritability you can’t soothe
  • trouble drinking or refusal to drink, and is making less urine,
  • (Boston Children Hospital)



Information adapted with permission from the TOFS website.  Follow them for regular updates

Are TOFs at increased risk?

Whilst many OA/TOF patients are used to coping with respiratory illness, they have an increased risk from all types of flu and viruses, including COVID-19.  Our understanding is that younger people are generally coping well, however not all TOFs are the same and we must all exercise common sense to help protect ourselves and control spread of the virus.

Current government guidance is for all to STAY AT HOME and avoid non-essential contact with others.  And for those with increased risk (those over 70, with underlying conditions or pregnant) to be particularly stringent in following social distancing measures.   This is especially important for Adult TOFs with a history of long-term respiratory disease as well as parents and cares.  Whilst the virus seems to have a worse effect on adults than children, we all have a duty to protect the vulnerable.

The NHS website in the UK lists those categories of people thought to be at most risk, referred to as ‘shielded’ or ‘extremely vulnerable’.  It isn’t surprising that OA/TOF patients aren’t listed, many of those born with a rare disease won’t be included.  And many TOF patients, who are fortunate not to have ongoing respiratory issues, or only mild respiratory symptoms will not fit into the shielded/extremely vulnerable category.  There is no ‘one size fits all’.  

Prof Alyn Morice, respiratory expert from Hull in the UK, tells us ‘The advice depends very much on the status of the patient. Someone who has just a chronic dry cough but is otherwise well has no need to take any other measures than that recommended by the government.

If people have damaged lungs, bronchiectasis or repeated “chest infections”– in reality aspiration events- then I would regard them as a vulnerable group and the current advice is that they should consider self-isolation for the duration.’

I’m a TOF parent.  Should I trust my instincts re worsening symptoms?

Yes.  Government advice for Covid-19 is that if you suspect you have the virus you must self-isolate (please see guidelines) and manage your symptoms at home. It has been found that children are generally coping well with the virus, however due to the complex nature of OA/TOF and VACTERL it is important to keep an eye on symptoms and follow your instincts. 

What to do if you or your child develops symptoms?

  • Current medical advice is that the best chance of getting over the virus for those with underlying chest issues is to get your chest as healthy as possible.  For TOFs this means taking prescribed antireflux treatment regularly.  This will reduce the risk of reflux irritating the airways. 
  • If you are prescribed inhalers, it is particularly important to take your preventative inhaler regularly as this settles airway swelling and reactivity. 
  • If you/your TOF is prescribed other chest medication such as montelukast or carbocysteine (amongst others) this should be taken regularly too. 
  • In addition, if you do chest physio, or help your child with routine chest physio exercises, please continue these as part of your daily routine. 

You can help control the spread of the virus by maintaining good hygiene:

(COVID-19 South-African Resource portal)

– Wash your hands regularly with soap or an alcohol-based hand sanitizer.

– Avoid touching your eyes, nose, and mouth with unwashed hands.

– Avoid close contact with people who are sick.

– Cover your cough or sneeze with a flexed elbow or a tissue, then throw the tissue in the bin.

– Clean and disinfect frequently touched objects and surfaces.