The Coronavirus Flu Emergency in Italy: Legal Issues Regarding Minors

The COVID 19 infection has been faced as an epidemic, through measures to enforce
a high degree of isolation. These regulations hold for minors, as well, with consequent
difficulties for this age group, which at the moment seems to be least vulnerable to the
severe complications of COVID 19.


Introduction
In 2017 in Italy, researchers identified a coronavirus cluster in bats in northern Italy, with peculiar genetic characteristics [1], but no further inquiry was conducted on its virulence in the hosts. The new coronavirus causes "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). Propagation happens person-toperson through respiratory droplets transmitted when a patient sneezes or coughs [2]. At greatest risk of grave complications are those with chronic diseases and low immune response [3], including the elderly, while the symptomatology in children appears to be less grave.Transmission by asymptomatic subjects has not been excluded, and thus currently isolation is the first form of prevention  [5], which currently seems to be less severe than the clinical forms in adults [6]. One accompanied by systemic toxic symptoms, such as malaise or restlessness, poor feeding, bad appetite and less activity." There can also be "abdominal discomfort, vomiting, abdominal pain and diarrhoea". In the most severe cases, "septic shock, metabolic acidosis and irreversible bleeding and coagulation dysfunction may occur." "In the early phase of the disease, white blood cell count is normal or decreased, or with decreased lymphocyte count [10]. Radiological signs attest the presence of viral pneumonia at the beginning, which can advance to the point of signs of lung consolidation [11]. Kunling Shen et al. [12] [13] or in Italy [14]. In fact, on the basis of current scientific evidence, it can be hypothesized that in children and young adults the infection presents few symptoms or is asymptomatic [15].
There has been no indication of vertical transmission from mother to infant, not even through maternal milk [16]. In fact, the Italian Society of Neonatology has proposed that a woman who has tested positive for corona virus but is asymptomatic should be allowed to nurse and be close to her newborn. Instead, if she shows symptoms of fever, coughing and respiratory secretions, she and her newborn should be separated, if she consents to this and if the logistics of the hospital permit it [17]. No standard treatment has been identified, and current treatment plans for children are adapted from those for adults [18]. Contact between medical personnel and patients must be kept to the minimum; visitors should have limited access and wear proper protective items [19].
In such a context, there is also need for psychological support [20].

Care for Minor Patients in Italy
The choice in Chinese healthcare protocols to isolate minors suffering from COVID 19 and to limit their contact with others seems quite problematic for an Italian setting. The situation in which a healthy parent desires to stay with a child sick with COVID 19 presents complex questions. Italian guidelines on precautionary isolation contain no explicit exceptions when the patient is a minor.
However, in such a case, even if the parent uses personal protection devices to prevent contagion, allowing him or her to stay there may indicate a lack of proper attention to and protection of the health of the parent. Italian legislation recognizes the minor as a vulnerable subject for whom specific protections should be provided by parents or legal representatives, who are also required by law to care for the minor's health. Minors "must receive information about healthcare choices in a form appropriate to their ability to understand, so that they can express their wishes" (L. 219/17 art. 3). Informed consent to treatment for a minor is provided by parents or legal guardians [21,22].
When off label treatment is proposed, as may be the case with COVID 19, the weight of the parents' informed consent is even more important [23]. considerations not strictly of a healthcare nature concern the right to study and the risk of stigmatization and discrimination. It is evident that the restrictive regulations introduced with the most recent ministerial ordinances closing all schools and universities in Italy will undermine the right to study of minors, but in the interests of preventing possible COVID 19 infection, which in the long run may be the greater good.