In the second wave of Coronavirus, nearly 11.5% of the 56 lakh Covid-19 cases reported between January 1 and April 21 were below 20 years. On Monday, Delhi government-run Lok Nayak Jai Prakash Narayan Hospital said that it has recorded around 40 cases of "severe" coronavirus infection among children during the second wave. In Karnataka, around 1.4 lakh children were infected with Covid in the period between March-end and mid-May.
When the first wave of the pandemic hit, it was generally accepted that children aren't seriously impacted by the virus. But at present, there is alarming evidence that indicates that children are no more immune from COVID-19 and that the new mutant B.1.617.2 might have put them at risk.
On April 19, 2021, Shruti Dhapola's 11-month-old baby tested positive for coronavirus. A Delhi-based journalist, Dhapola later wrote in an article in the Indian Express, "as parents we were also aware that this is the first virus our son had encountered in his life. Before Covid-19, he had never fallen sick, never experienced a fever or even body ache. Add to that the uncertainty around the virus, the fear that something would go wrong was overwhelming."
Why are there so many Covid cases being detected among children? With no vaccine available yet for children, what does it mean? Will the third wave hit children? BOOM spoke to a few doctors to understand.
Are more children being impacted by the second wave of COVID-19? Why?
"Not too many children were seen infected with COVID-19 during the first wave last year," highlights Dr. Neeraj Bansal, Senior Pediatrician and Newborn Specialist at Kalra Multi-specialty Hospital, Bathinda. Dr Bansal said that the reported cases were mostly asymptomatic or mild cases with very rare cases presenting with Multi-organ failure or Systemic Inflammatory Response Syndrome (SIRS), both considered as serious conditions. "There are many folds jump among newborns infected with covid during this wave, and serious infection is being found in newborns too. Many children are needing invasive & noninvasive respiratory support during the current wave," says Dr Bansal.
Can a pregnant woman pass on the infection to her child?
The mutant virus is also impacting a lot of pregnant women. During pregnancy, lung capacity and patient immunity decrease. So pregnant women are at a higher risk, notes Dr. Mangala Patil, Consultant Obstetrician and Gynecologist, Wockhardt Hospital. She said that the vertical transmission from mother to baby is very rare. "In our hospital, we haven't seen a baby being positive right after delivery. If the baby tests positive after 24 hours, it is most likely due to droplet contact through people around."
Guidelines by the World Health Organization seem in sync with Dr. Patil's assessment. To date, the active virus has not been found in samples of fluid around the baby in the womb or breastmilk.
Should pregnant women receive the COVID vaccination?
Accepting the recommendations of the national expert group, the Union Health Ministry has allowed for vaccinating lactating women. However, the official guidelines by the Ministry currently do not recommend vaccination for pregnant women. Pregnant women may, however, receive the vaccine if they are at high risk of exposure to the COVID-19 virus or very likely to be in contact with people with COVID-19. Despite the Centre's no go-ahead, the BMC has issued an order stating that pregnant women can get vaccinated by submitting a letter from a gynecologist and their own consent in writing.
Health experts have argued that it is better to get all pregnant women vaccinated. Dr. Patil suggests, "Patients planning for pregnancy or they opt for IVF conception, it is better to first take the vaccination."
What about COVID-19 testing for kids?
In most diseases, testing is the only way to find out what ails a patient. However, with young children, that can be quite difficult. "It's a tough job for RT PCR and Rapid Antigen samples to be collected. But then, these are the only confirmatory tests which we have right now," highlights Dr. Mayuri Yeole, (MD Pediatrics) Associate Consultant, Apollo Hospitals. "It is really heartbreaking to see young babies, just a couple of days old or a couple of months old babies go through these tests. But there is no other option."
Dr. Yeole further adds, "Specificity of RT PCR test is much greater than Rapid Antigen test. So, we usually advise the RT PCR test."
Can children infect others?
Generally, with children, the challenge is the possibility of spreading the disease to people who are at greater risk for severe illness, such as older adults and people with underlying conditions such as heart disease, lung disease, or diabetes in the family. "Asymptomatic children can act as a carrier in a big way. They are often undiagnosed and spread to the elders in the family. Parks and play ways are major sites for transmission of COVID among children," says Dr. Bansal.
What are some of the common symptoms of Covid among babies and children?
Most children with COVID-19 have mild or no symptoms and recover easily, although some have become severely ill. "Common symptoms seen are just like a normal flu, namely cough, cold, congestion, fever, loss of appetite, loss of taste & smell to name a few. Respiratory distress, pneumonia, shock & multi-organ failure are seen in serious cases," shares Dr. Bansal.
How to monitor a baby's oxygen since existing oximeters do not necessarily always work for them?
Detecting the infection early is critical for the prevention of the progression of the disease and initiating treatment. Recent studies indicate that a pulse oximeter is more useful for COVID screening than other methods. But the question remains: Do they work for young children too?
Dr. Bansal clarifies, "Babies have special monitors that help measure vital parameters and oxygen saturation levels. And they are easily available in most of the places, so it is not very difficult to keep track. That said, adult oximeters can be easily used in children above 5 years of age, although its accuracy might not be reliable."
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Are children with serious underlying conditions such as cancer disorders at higher risk of COVID infection?
"Children with blood and cancer disorders are generally considered at a higher risk of infection due to weak immune systems. But in our experience at Medanta, around 15 children were affected in the first wave, while around 18 children have been impacted during the second wave. Most were asymptomatic and had mild symptoms. All these children recovered without any treatment. Published research across USA, Italy, Spain, UK, and China also have indicated similar experience in children with Covid19 and blood and cancer disorders. That said, on an average COVID-19 infection does lead to a break in therapy for 2 weeks in most children with blood and cancer disorders," explains Dr. Satya Prakash Yadav, Director, Pediatric Hematology Oncology & Bone Marrow Transplant, Medanta Hospital.
What are some of the challenges pediatrics and health workers facing while dealing with infected young kids?
Dr. Bansal says that one of the biggest challenges they are facing is the huge dearth of Pediatric Intensive Care Units or dedicated Covid Neonatal intensive care units. "Children on ICU/Ventilator require a high level of Pediatric Intensive Care Unit (PICU)/Neonatal Intensive care unit (NICU). Because these children present with fulminant Acute Respiratory Distress Syndrome (ARDS), they need specialists/intensivists to manage them," he says. The doctor said that there is a huge shortage of both Pediatric ICU's and specialists in peripheral areas in rural India as well as in the cities. "So, we need to do with whatever resources or expertise we have at our disposal," pinpoints Dr. Bansal.
Should children be vaccinated?
Although research is being conducted if a vaccine should be made available for young babies, toddlers, and children, experts suggest making children a lesser concern in the pandemic would be a huge mistake. Vaccine makers such as Pfizer, Moderna and BioNTech have therefore recently started child trials for vaccination among kids aged 12-plus. Dr. Yeole explains, "It is better if vaccinations are made available to children because eventually the kids will have to go out of homes." On being asked about how we can prevent infection in young children, Dr. Yeole asks us to go back to the drawing board, "Avoid stepping out with kids, do not rush out, wear a mask, wash your hands. That's how we can keep the kids safe."
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Will we have a third wave impacting India's young children, the most?
We do not know when the third wave of COVID will strike or how it will impact the kids. But amid national & international political barbs being traded, there is a serious apprehension and sense of impending doom. Experts argue against an alarming overreaction. "Kids have a really great immunity to fight with the infection. If we follow proper COVID appropriate behaviour such as staying indoors, mask-wearing and sanitization, we can save the day," concludes Dr. Yeole.