India could see its third COVID-19 wave peak in October and children could be more susceptible to SARS-CoV-2 during this peak if they continue to stay unvaccinated, a recently released report by a government panel selected by the National Disaster Management Authority has said.
The report titled 'Third Wave Preparedness: Children's Vulnerability and Recovery' highlights that the country needs to urgently work in the direction of improving pediatric infrastructure as well as capacity building and strengthening human resources. It has been sent to the Prime Minister's Office for further consideration.
Even though there is not enough evidence backing the theory that the third wave could adversely affect children, the report notes that children who are unvaccinated continue to remain at risk of contracting as well as transmitting the infection. An All India Institute of Medical Sciences study conducted in collaboration with the World Health Organisation found a high number of children with COVID-19 antibodies
Children, so far, have either been asymptomatic or have been mildly symptomatic. However, there have also been reports of COVID-19 infected children suffering from Multisystem Inflammatory Syndrome when they have low immunity or any pre-existing co-morbidities.
To reduce the possibility of children being infected, several countries have approved the Pfizer vaccine for children between the ages of 12-18. India only approved its first COVID-19 vaccine for this age group on Friday.
The report further states that committee experts are divided on whether a third wave is inevitable in the country but concur that every citizen should follow COVID-19 appropriate behaviour. The decreasing number of cases should not make people believe that the virus has disappeared. Alongside, the increasing R- value (number of people infected by one person) is now an area of concern, believe the experts.
The third wave could be driven by the highly transmissible Delta Plus variant. As the government has earlier stated, it is expected to be milder than the second surge which saw close to four lakh cases daily. After observing the situation that has arisen in countries like Israel and US which have high vaccination rates, this panel has asked the government to not only rely on vaccination as the only way to curb the spread of the virus.
Recommendations For Health Of Children
With the need to increase infrastructure for children health, the Union Government has asked hospitals to allocate at least 20 per cent of their beds for children health care. Furthermore, a few states such as Maharashtra and Kerala have also set up special pediatric care COVID-19 task forces to ensure that the situation does not get out of hand.
The Centre is also asking states to follow the WHO guidelines on reopening schools for offline classes. If a particular area has no COVID-19 cases or very sporadic cases, all schools can be reopened but they should follow COVID-19 protocols of masking and social distancing. If there are certain clusters, schools in those areas will not reopen but schools outside that cluster can continue to function. Finally, if there is community transmission, no schools will be allowed to function.
Ensuring that families of children are vaccinated, developing different policies for children on the basis of their environment (urban, rural, special needs), vaccinating children with co-morbidities, disabilities, or special needs, creating awareness programs, are some of the areas that the committee wants the government to focus on.
A home care model should also be adopted wherein on ground health workers can identify the unmet COVID-19 needs of the population.
Recommendations For Health Of Women
The report states that the government needs to work on improving the vaccine coverage among women as they have refused to take the vaccine due to misinformation floating on the effect of vaccine on fertility, menstruation; along with inaccessibility to technology, lack of mobility, requirement of husband or male guardian's permission and company to visit vaccination centres.
Improving mother and neonatal care with special emphasis on COVID-19 protocols is another recommendation for women health care. The committee has also asked that the government works to ensure that existing gender inequities between male and female child (less attention on health and nutrition) do not act as hindrances for women seeking COVID-19 care. Protection from domestic violence and abuse at homes should also be a part of the home care model.
Recommendations For Overall Health System Strengthening
A study conducted by professors and alumni from Pandit Deendayal Energy University (PDEU) in collaboration with Nirma University has found that if India continues to vaccinate at the rate of 3.2 per cent, the third wave could witness close to 6 lakh cases, daily. But, if the government manages to increase vaccination to one crore doses daily, India will only see a quarter of the cases it witnessed in the second wave.
In the other recommendations, the committee believes mental health and psychosocial care services require strengthening as COVID-19 and the ensuing lockdown has affected the mental well-being of many people in the country.
The committee has also highlighted that communication shared with people about COVID-19 appropriate behaviour needs to be improved. Other concerns such as availability of ambulances, effective data management, and ensuring food availability should also be worked on simultaneously.