In the last week of August 2021, about 200,000 children tested positive for COVID-19 in USA – more than 20% of the total cases that week in that country. Here in India, while there has only been a marginal increase in cases among children, Punjab and Bihar are seeing a noticeable uptick, and schools have just started opening up again. Even though doctors and educationists are of the opinion that schools must reopen in India too despite the pandemic, parents are worried.
What if their child gets infected at school and brings it home? What if a new variant is tougher on children? What if the third wave targets children more? These are questions and worries each parent has – and they are not unfounded. But doctors say that the best way for parents is to be prepared, and not panic.
We should accept the inevitability of a third wave and prepare well for it, say doctors. “Initially, the thinking was that by October we could immunise most of the adult population, and that 60% prevalence of immunity was enough to provide herd immunity,” observes Dr Preetham Kumar Poddutoor, Medical Head of the Secunderabad cluster at Rainbow Children’s Hospital. “However, the Delta variant has changed things to a large extent. So, we have examples such as Israel where over 70% of vaccination has not been able to halt transmission.”
However, Dr Preetham adds, there is no need to feel panic specifically with regard to children.
While some specialists have forecast a larger impact of the third wave on children, Dr Preetham says that there is no particular evidence to suggest that any of the current variants affect children especially. The focus on children came about because of the assumption that most adults will be sufficiently vaccinated. “In countries that have experienced third or fourth waves, there is no evidence to demonstrate that the virus has shown a preference for any specific section of the population,” he observes.
Dr. Preetham Kumar Poddutoor
During the second wave attributed to the Delta variant, Dr Preetham observes, there was no significant spike in paediatric cases. “While we had stories on every news channel of adult hospitals reporting shortages of beds, this was not the case with children’s hospitals. None of the children’s hospitals actually had significant admissions,” he says.
For children, the pandemic has resulted in extreme isolation thus far. “Online education is having a toll on children psychologically, because they have been stuck inside the house for the last year-and-a-half,” says Dr Preetham. There is, therefore, a need for them to return to school. The question then becomes, how can parents help their children avoid infection from their peers.
The rules are the same for children as for adults, says Dr Preetham. He stresses on four aspects of protection.
“The first is mask etiquette. Parents have to teach their children how to wear the mask, when they can remove it, and where and where not to touch the mask.”
The second requirement is to ensure that children are properly taking care of their masks. “They should not be wearing the same mask every day and masks should be washed on a regular basis,” says the doctor. He also advises that children should use a three-layer surgical mask rather than a single-layer cloth mask.
Thirdly, there must also be a collective effort by parents and schools to ensure that symptomatic children are kept away from others. “If somebody is asymptomatic, there is not much that can be done. But parents and teachers should take efforts to ensure that a child is kept at home if they show any signs of cold, cough or other symptoms of COVID-19,” he says.
Finally, the doctor says, children should be taught the importance of hand hygiene, and encouraged to frequently wash and sanitise their hands, especially before they touch their mouth, nostrils or eyes.
So far, says Dr Preetham, most COVID-19 cases in children have been detected following the infection of an adult in the household, and children have largely been asymptomatic or shown only mild symptoms.
In general, children rarely require hospitalisation due to any of the current variants. “The red flags to watch out for are a fever lasting more than three days, breathlessness, oxygen saturation below 94%, higher levels of lethargy and inactivity, and significant loss of appetite.” In such cases, parents should go to an emergency room and get a chest X-ray and other examinations done, says Dr Preetham.
However, parents of children with co-morbidities should exercise a higher level of care and pay closer attention to any symptoms.
One significant post-COVID complication that parents should watch out for in children is MIS-C or Multisystem Inflammatory Syndrome. “This is an inflammatory condition in which the body gets triggered into a hyper-immune response due to the virus,” explains Dr Preetham. As a result, four to six weeks after recovering from COVID-19, the immune system begins to attack the body’s own organs and systems.
Symptoms of MIS-C include high fever, rashes on palms and soles of the feet, swelling on palms or soles of the feet, abdominal pain, lethargy, seizures, a high irritable pitch in babies, low blood pressure presenting as shock, vomiting and/or diarrhoea, and conjunctivitis in the eyes.
While MIS-C has severe effects, it can be managed and treated well with early detection, says Dr Preetham. That’s where advanced centres such as Rainbow Children’s Hospital come in. “At our hospital we have treated nearly 200-250 cases. Hence, we have become quite experienced at detecting this condition early and treating it effectively,” says Dr Preetham, adding that Rainbow Children’s Hospital in Secunderabad also has the advanced medical equipment required needed for complex cases.
Rainbow Children’s Hospital in Secunderabad.
There is some good news on the horizon with regards to vaccination, observes Dr Preetham. Vaccine maker Zydus Cadila’s ZyCoV-D has been approved for emergency use for children aged between 12 and 17 years, and this vaccine is expected to be rolled out from October. Results are also expected in early September from Covaxin trials on children aged between 2 and 18 years.
However, it is not yet clear what the government policy on COVID-19 vaccination for children is going to be. “Recently, the head of the government’s vaccination task force NK Arora said that the priority is on vaccinating adults and once they are covered to a large extent, we can look at vaccinating children,” says Dr Preetham.
There has been some debate on whether flu vaccines can mitigate the effects of COVID-19. Dr Preetham points out that one study has suggested that the flu vaccine can mitigate the severity of COVID-19 and reduce hospitalisation rates.
As with previous phases of the pandemic, says Dr Preetham, the best solution to preventing and managing COVID-19 is to follow proper procedure and not panic. With proper mask use, sanitization and early detection, most children can be protected from the most severe consequences of the disease.
This article was created by TNM Brand Studio in association with Rainbow Children’s Hospital.