The Omicron variant is driving the third wave of the pandemic in India. First identified in South Africa, the variant of the Coronavirus has been the cause for an increased number of cases the world over.
While earlier variants were noted to cause mild symptoms in children, if any at all, the Omicron wave has proved otherwise in many countries. The US continues to report an uptick in children being hospitalised with symptoms, UK has seen admission of 576 children under the age of 5 in early January, and France has reported six times higher admission of children in hospitals than in the previous waves.
The trend was earlier reported in South Africa, as evident by preliminary report submitted to the WHO.
Amid India's Omicron wave, BOOM spoke to two paediatricians in Mumbai, Dr Ananya Mukherji, senior resident, Department of Pediatrics, Jagjivan Ram Railway Hospital, and Dr Tanmay Khapde, Pediatric Medical Officer, Mahim Maternity Home, MCGM, to help understand the affect of the variant on children. Here, they answer questions and dispel some myths.
Are more children in India getting Covid-19 compared to earlier waves? Is Omicron leading to more hospitalisation among children?
Dr Mukherji (AM): In my experience, the rate of hospitalisation is not higher in India as compared to the US. The rate of positivity is certainly high but that does not translate to higher hospitalisations. However, Indian studies have not yet been published which tell us the exact percentage. In my judgement it won't be more than 1 or 2 per cent.
Dr Khapde (TK): We are getting covid positive children (up to 12 years) every day since the last two weeks. Before Christmas, I had no patients. The last lot of paediatric patients I received was in the second wave.
Most of them have mild symptoms and are being managed at home. I have not hospitalised any children in this wave except neonates who were transferred with their Covid-19 positive mothers in Covid dedicated maternity homes.
However, we must wait and watch for long Covid symptoms like MIS (Multisystem Inflammatory Syndrome) which can be observed two to three weeks later in both children and infants.
Are children more susceptible to this variant? Why?
AM: Children are no more susceptible than other populations. They are more likely to not follow hand washing and Covid appropriate behaviour. This leads to an increased rate of infections in them.
TK: Omicron is around but the old Delta variant has not gone away. This wave also has Delta patients. The original Coronavirus has mutated to a drastic degree. There will be more variants cropping up. The problem is that we are not vaccinating a 100 per cent. The likelihood of variants will then drop.
Those who have not received vaccines (including children) become reservoirs for the virus and mutations.
What are the symptoms to look out for with children? Are they any different from those observed in adults?
AM: Cough, cold, nasal discharge, fatigue, fever, and decreased appetite are the main symptoms. These are like adults.
TK: High-grade fever and Upper Respiratory Tract Infection (URTI) is what we are looking out for. Respiratory distress is also something we keep a lookout for. This is the time for influenza and other bacterial infection. So, there is a challenge in diagnosis sometimes.
What specific precautions can parents take to keep their children safe?
AM: Taking care of their general health, encouraging exercise and play activities, routine vaccinations, and yearly flu shots if your child has increased propensity for catching cold.
TK: I am not in favour of starting schools before children are vaccinated. But the vaccination process is not picking up quickly. Because we are dealing with airborne and droplet transmission, we have no option but to implement the same Covid protocol as adults. However, this is very difficult to follow for unsupervised children. The mask is not going to stay on if you send them to school. And unlike theatres that are voluntary, it is not possible to have 50 percent attendance in schools. Even if the mask is on, social distancing won't be assured.
At what point in the infection should parents worry? When is hospitalisation for children recommended?
AM: If a child is having fever that is not getting controlled by paracetamol, child is drowsy or not responsive as before, not able to eat anything or even drink water, not passing urine as before. These are some markers of severe illness and would require admission as soon as possible.
TK: Parents should not panic and there should not be forced hospitalization. Everyone thinks of hospitalizing children and senior citizens. Children do not have comorbidities. But those who have existing comorbidities and congenital conditions, it is necessary to observe them. If parents can monitor the child at home, there is no need for hospitalisation.
Warning signs are excessive lethargy, excessive irritability, not feeding well, convulsions, vomiting, and other unconventional symptoms like diarrhoea, constipation, pedal oedema, body ache, headache, rashes on the body, or not passing urine and blood in urine.
What post-Covid care do you recommend for children?
AM: If the child was asymptomatic not much is needed post Covid. Just a balanced healthy diet with adequate vitamins and minerals. Don't give multivitamins and calcium supplements unnecessarily. Take care of a child's overall health and ask your paediatrician about any doubts you have however small they may be.
For symptomatic children always consult a paediatrician for advice because the care depends on the type of symptoms and severity of disease.
What are your recommendations about masks for children?
AM: Double masking is not recommended for children. A simple triple-ply surgical mask is enough for community settings. If Covid positive, then N95 masks should be used but it's difficult in case of children because they won't be as compliant as adults.
TK: If they can tolerate a three-ply mask surgical mask, it's sufficient. I would not mandate an N95 mask for them. Only children above two years need to wear masks. Masks are not recommended for children below that as per IAP guidelines.
I have also observed that if you give a child a mask on one day, they will soil it by the next day. So, daily changing of masks are recommended.