BENGALURU : Children are expected to be especially at risk of Covid-19 infection during the third wave. While there is an immediate need to update data on this particular population to know how and to what extent we need to prepare in terms of health infrastructure, Dr Asha Benakappa, Head of the Department of Paediatrics, Chandramma Dayananda Sagar Institute of Medical Education and Research speaks on symptoms to watch out for, where we went wrong and why more children are getting infected during the second wave.
Do you agree with the assessment that the third wave will hit children?
I agree that a high number of children will be affected. But we don’t have to wait till the third wave. We are already seeing an increase in such cases. As per the data from the state war room, 74,898 children aged between 0-9 years have tested positive and 1,88,439 are children in the 10- 19 years age group. The proportion of children affected by Covid-19 was 4% (in India) for children below 14 years during the first wave. Now, it is between 10-14%. These numbers tell us that this particular population needs attention and it should start NOW.
Why are more children testing positive for Covid-19 during the second wave? Is it the new variant?
I don’t really think it is the variant. Infection pool is high. Mutations keep happening. Each mutant is aggressive, contagious and has the capacity to bypass vaccine immunity. The earlier theory that children do not have many ACE2 receptors does not explain the infection in newborns and deaths in very young children. Now, science believes that there must be alternate receptors for virus entry. The complacency on the part of parents during the lull after the second wave became the problem for children.
Did the numbers surprise you? Or was this expected?
No, we were expecting this. Firstly, children did not go to school. This means they did not get innocuous respiratory infections which normally occurs about six to eight times per year. It is these respiratory infections that help children develop the immunological system. There are many viruses which children get exposed to in a year. These infections took care of the immunological system. Now, with them staying indoors, this immature immunological system let the virus enter the body. The respiratory hygiene we followed made them more vulnerable and parents became the main source of infection. Also, some of their routine vaccinat ions have also stopped. We would give them live vaccines like measles, H1N1, etc and this has stopped. So, breaking the vaccine schedule, maternal and child health, family clusters, have made children very vulnerable.
What symptoms do children show? Is it different from adults?
Yes, they are different from adults. Most of the children are asymptomatic. However, during the first wave, we saw the same symptoms like cold, loss of smell, sore throat, chills, cough and fever in children too. But, during the second wave, we have seen that the symptoms are not limited to just the respiratory system. Children are showing gastrointestinal (GI) symptoms like loss of appetite, skin rashes, vomiting and diarrhoea.
Are children susceptible to ‘long haul’ or ‘long Covid’?
In some countries where children were asymptomatic and pre-symptomatic, children have come with manifestation of breathlessness, increased heart rate, mental fogging, depression, etc, after a year or so. This is called a long Covid. But this is expected of any virus infection. Earlier, in polio, we used to hear from parents about their child losing sensitivity in a leg after a few years of polio. Covid-19 is a RNA virus. The mutated inactive virus stays in our body for many years. Earlier also, measles used to manifest six years later. In India, again there is no data to prove this.
Is there any particular post-Covid symptom in children which is showing up rampantly?
A dangerous and severe disease which can lead to death is MIS-C (multi-system inflammatory syndrome in children). Paediatricians should look for warning signs such as elevation of inflammatory markers, fast breathing, lethargy and seizures for early detection of MISC. Right now, there is no data for the state but, in India, over 1,000 cases have already been reported.
What precautions should be taken when a child tests Covid-19 positive?
We have a protocol. 1)Asymptomatic patients Watch for further symptoms; 2) Symptomatic but mild Treat cough, fever, etc; 3) Moderate Supervised treatment and monitoring in a hospital set-up; 4) Severe and complications In a paediatric intensive care setting. 5) MiS-c To be treated in a super-speciality hospital. Treatment of this would be very expensive and the outcome, most often, is not good. There is no immunity-boosting medication for children. Give them healthy, nutritious and home-made food. Isolate/ quarantine yourself if any symptoms occur and avoid family clusters. Children aged below 2 shouldn’t wear masks, but face shields. Those aged above 2 should compulsorily mask up before stepping out.
Parents are anxious about getting their wards vaccinated. Do you advocate vaccines for young children?
I am not for it. Children are evolving body parts. Ours is all senescence. Instead, following Covid norms is the best. Vaccines can protect one for only a few months. It is better to wait and watch. Covid- 19 is a disease of the social behaviour of humanity. Only social vaccine will help.
Is the state doing enough to protect our children?
No. We need to do more. There are too many challenges when it comes to this population. First of all, where is the data? The war room data has only the number of cases, deaths, discharges. But what we need is segregated data. We also don’t know which are the paediatric hospitals, how many beds are available, Covid obstetrician care and NICUs have to be set up. When we talk of children, we automatically need to involve pregnant mothers too. It is important to know how many pregnant mothers have tested positive, and separate data for newborns, 0-6 years, 6-15 and 15-18 year-olds has to be made available. Not just cases, but also deaths and the cause should be listed in the war room figures. It is only if we have data we will know how many children might actually need ICU care. With the current data, only 1 per cent will need ICU care. But, we may be wrong. So first, let’s fine-tune our statistics. Secondly, the state should issue clear guidelines to treat mild, moderate and severe cases. Thirdly, a good number of beds should be made available for children in various hospitals and other facilities should be ramped up. We should have paediatric ventilators in place and it needs expertise to handle them. We cannot set up Covid Care Centres exclusively for children and expect them to stay there without their mother. The CCCs should be like daycare centres. All these need to be thought about much ahead.
How long do you think kids will have to stay away from their friends, teachers, school?
At least for the next two years it will be difficult. If we vaccinate all the covirgins (those who are not vaccinated or got the infection) soon, especially the 18-45 population, then it might be a possibility of slowly allowing children to step out.