As cases from the second wave of COVID-19 continue to reduce, discussions of a potential third wave have already begun. Several theories have emerged which claim that children could be the most affected by the third wave of COVID-19. In the US, UK and the European Union, vaccine maker Pfizer is already authorised for emergency use in anyone above the age of 12. The vaccine maker is also expanding its COVID-19 vaccine tests in children between the age groups of 5 and 11 now. However in India, the vaccines are being administered to only adults i.e, those aged 18 and above. Does this mean that a subsequent COVID-19 could pose a real threat to children? This is what experts in the field have to say.
At a press conference on June 8, the All India Institute of Medical Sciences (AIIMS) Delhi chief Dr Randeep Guleria said that there is no data, either from India or internationally, to show that children will be seriously infected in any next wave of COVID-19. Dr Guleria added that this was a piece of misinformation.
He also explained that in the second COVID-19 wave in India, 60-70% of the children who got infected and were hospitalised had either co-morbidities or low immunity and that healthy children had recovered from the infection without the need for hospitalisation.
Dr Devi Prasad Shetty, chairperson and founder of Narayana Health, who has been appointed chairperson of the Karnataka Task Force to prepare for a probable third wave, is convinced that a subsequent wave could impact children the most. In the first wave of the pandemic, persons above 60 years of age were most affected, in the recent second wave a younger demographic was infected, and as the virus keeps changing its approach the next vulnerable group are children, he said in an interview, adding that there is a serious need to ramp up pediatric care ICUs and beds in India to prepare for a third wave.
“All I know from experts is that there is a strong possibility of a third wave. Looking at what happened in the US and Europe, the virus has behaved in a similar manner and we (India) are likely to get a third wave. And there is a possibility that the third wave virus will predominantly target children. Mainly because adults are either infected or immunised. So the COVID-19 virus has to find a new host. And the most vulnerable group in large numbers are children,” he said.
Dr Devi Shetty added that India has over 150-160 million children who are below 12 years of age. “There is a serious problem. If it happens, we should not run around like how we are currently doing because we did not anticipate the number of patients,” he said.
Giving his top three recommendations with regard to COVID-19 in children, Dr Shetty added that it is imperative to vaccinate the parents of young children within the next three months to prepare for the third wave. “If the parents are vaccinated, the chances of kids getting COVID-19 are very less,” he said.
Further, he added that managing children with COVID-19 in the ICU is ‘dramatically different from managing adults in the ICU’. “Children cannot be left alone with the nurses and doctors. There are very few nurses in COVID ICUs. The children might remove their masks if they face discomfort. So for days together, if anyone has to manage kids it has to be their parents,” he said, adding that this is why parents have to be vaccinated.
The Indian Academy of Pediatrics (IAP) states that the likelihood of children contracting a serious form of COVID-19 is unlikely in subsequent waves.
According to reports, the sero-survey held in December 2020-January 2021 showed that 25% of children in the age group of 10-17 had been infected by the virus. This is the same as the percentage of adults. This goes to show that while children are getting COVID-19, they are not getting the serious form of the infection that leads to respiratory inflammation and dropping of SpO2 levels. Considering the studies done and the lack of conclusive data, it is unlikely that the third wave will exclusively or mainly affect children, the IAP said.
While the second wave cases have almost dipped across the country, Andhra Pradesh is witnessing a surge in cases. In the past two weeks, the state has also recorded an unusually high number of kids being infected. Over 24,000 persons below the age of 18 have got COVID-19 in the last two weeks. Out of these, 2,200 are children below the age of five, according to news reports. This has led to a third wave scare with regard to children in the state.
Thousands of children have been reported infected in East Godavari and Chittoor districts. Around 3,800 children developed COVID-19 symptoms in Chittoor district, which is considered a big COVID-19 cluster. Medical experts in the state have however clarified that the infection in children is nowhere as severe as that seen in adults. With increased exposure, the infection is more likely to transmit to other patients.
The US began inoculating children in specific age groups in May after its Centre for Disease Control and Prevention (CDC) approved the Pfizer jab for those aged 12-15. More than 6,00,000 children have been vaccinated so far. The vaccine has also been approved for emergency use in Chile, Canada, Japan, the Philippines, Israel, Dubai and the European Union.
On June 4, the UK approved the use of the Pfizer/BioNTech vaccine in children aged 12-15. The coronavirus vaccine has already been approved in the UK for persons aged 16 and above. The country’s Medicines and Healthcare products Regulatory Agency (MHRA) green signalled vaccines for the 12-15 age group, saying it is safe and effective in this age group and that the benefits outweigh the risks.
An Al Jazeera report also confirms that Pfizer will be taking a lower dose and testing its COVID-19 vaccine in a larger group of children below the age of 12. The study will have around 4,500 children at more than 90 clinical sites in the US, Finland, Poland and Spain, according to the report. The company will use lower doses at the earlier stages of the trial.