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Covid-19: How safe are your kids? – The Big Story News

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When 13-year-old Sanaya Kukreja (name changed) had fever, her parents had a difficult time persu­ading her to get an RT-PCR test. “But since we were told children don’t get Covid, we didn’t insist on the test or medicine,” says her mother from Hyderabad, over the phone. The unrelenting fever finally subsided after six days, and the other symptoms disappeared too. However, two weeks later, Sanaya began to feel a sharp pain in her chest. When her parents took her to Hyderabad’s Apollo Hospital, she was diagnosed with MIS-C, or Multi-system Inflammatory Syndrome in Children, a condition in which the vital organs of children get inflamed two to six weeks after recovery from Covid and can be fatal if not treated in time.

Though there is no data to ascertain whether Covid has infected more children in the second wave compared to the first, the figures from states do confirm that the infection has spread among the young. Karnataka, for instance, reported 19,378 cases in children below 10 between March 2020 and September 2020, when the first wave was at its peak. From then on, until May 20 this year, the state has seen 49,257 cases in this age group. As of May 23, of the total 5.56 million Covid cases in Maharashtra, 171,335, or 3.1 per cent, were children under 10. In Delhi, the rise in under-18 cases has prompted some hospitals to set up separate Covid wards and ICUs for children.

“The virus will find those who are susceptible,” says Giridhar Babu, an epidemiologist at the Public Health Foundation of India (PFHI) in Delhi. “Since most of the elderly have been infected or have been vaccinated, the virus will continue to infect those who are not protected. As infections continue, it can target more and more people in the younger age group, including children.”

Doctors confirm that they are seeing a larger number of paediatric Covid cases, but cannot say with certainty if these are due to the earlier or new Covid strain. “The higher numbers need not be due to the new Covid strain alone,” says Dr Jesal Sheth, a senior consultant paediatrician at the Fortis Hospital in Mulund, Mumbai, and a neonatal inten­sive care specialist. “It could just be due to the fact that children did not follow Covid-appropriate behaviour. There was widespread socialising in January and February 2021; some schools also reopened. Often, kids go to the garden to play or run without following masking and social distancing measures.”

Is Covid more severe in children?

Doctors are still not sure if children go on to develop severe symptoms of Covid. The data so far suggests that a majority of the infected children are asymptomatic or mildly symptomatic. “Children are as susceptible to Covid infection as adults and older individuals but not necessarily to a severe form,” says Dr Shyam Kukreja, senior director and head of the paediatric department at the Max Super Speciality Hospital in Patparganj, Delhi. “It is highly unlikely that the current wave will predominantly or exclusively affect children. The common symptoms may include fever, sore throat, cough; children also complain about feeling tired, although almost 90-95 per cent of infections in children are mild or asymptomatic.” The IAP (Indian Academy of Paediatrics), a body representing over 32,000 paediatricians in the country, has also confirmed that at least 90 per cent of Covid-positive children will have very mild symptoms or none at all. However, experts caution that even 5-10 per cent hospitalisation can overwhelm the system if Covid spreads unchecked.

Kolkata-based paediatrician Dr Madhura Chatterjee outlines the challenges in treating young children. “For example,” she says, “you cannot do CT scans on growing children unless absolutely necessary due to radiation exposure. There is also some measure of trauma for any child who is hospitalised. We also have far less paediatric and neonatal ICUs in the country compared to for adults.” Uttar Pradesh, for example, has 78 newborn care units (each having 12 beds) to treat critically ill children.

Dr Urmila Jhamb, head of the paediatric department at the LNJP Hospital in Delhi, says that they admitted 40 children, including 15 infants, with severe symptoms this year. “We only had those who needed oxygen or ventilator support in the hospital this year,” she says. Last year, the hospital treated 400 children, but these included any child testing positive, not just those requiring hospitalisation.

Why Covid in children is a concern

Photo by Yasir Iqbal

“Since most children are asymptomatic, detection of the infection itself is a challenge,” says Kukreja. And testing children on time is crucial, not just for their health but also to protect other household members. Children are powerful transmitters of the disease as very often parents don’t even know that their child is positive. According to Dr V.K. Paul, member, NITI Aayog, even though there were fewer cases of Covid in children in the previous wave, the seropositivity survey in January and December showed roughly the same positivity rate for 10- 18-year-olds (25.3 per cent) as for those above 18 (21.4 per cent), indicating that a large number of children were asymptomatic.

When your child does test positive, all paediatricians insist that parents avoid giving them medication meant for adults (see box What to do if your child gets Covid). “If a child has Covid symptoms, diagnosis followed by a doctor consultation is a must,” says Dr Anupam Sibal, a senior paediatrician who is the group medical director at the Apollo Hospital in Delhi. “Please do not self-medicate children on adult antibiotics, steroids and other Covid medications. For mild infections, parents or guardians should be informed beforehand about when to consult a doctor and instructed to monitor children and keep a close watch. In cases of infection with high fever, children should be very closely monitored from the very beginning.”

Post-recovery complications remain a threat as well. MIS-C, as well as other secondary infections from fungi and bacteria, can turn deadly for children if they are not hospitalised in time. Early diagnosis, says Dr Kukreja, is the only way to treat post-Covid complications. That may be difficult, given the limited number of Covid specialists, paediatric care units and diagnosis centres for children. “There are some reported events of multi-organ involvement in Delhi and Mumbai,” says Babu. “But when the overall numbers are large, a small percentage will still need more paediatric resources than what the country has right now. Paediatric care for Covid must be expanded.”

Covid in neonatals

So far, Covid-related deaths have been extremely rare among neonates and infants, but experts say they cannot be ruled out. On April 16, a 15-day-old infant died of Covid at the Diamond Hospital in Surat. In Kolkata, 34-year-old Rupa Moitra delivered a perfectly healthy baby boy at the Rajarhat Health Centre. However, two weeks after she took him home, the child developed high fever. No hospital was willing to do a Covid test and by the time they could get him to a hospital, the child died as it was already underweight and Rupa, who suffered from acute iron and vitamin D deficiency, had been unable to breastfeed the child. “Children from middle or upper-class families in larger towns and cities who test positive have a better nutritional profile and access to medical care,” says Dr Chatterjee. “Now, as the virus spreads, you will find more vulnerable groups getting Covid. The nutritional profile of mothers in urban slums and the condition of neonatal care in smaller towns puts these two groups at high risk.”

However, according to the World Health Organization, the risk of a mother transmitting the virus to the child in her womb is as little as 0.05 per cent; it is after birth that the real risk emerges. Improper handling, particularly when the mother is also positive, has already led to neonatal infections across the country. “There is also a higher risk if the mother turns Covid-positive in the last two to three months of her pregnancy, compared to being infected a few days or weeks before delivery,” says Dr Sheth.

India already accounts for the highest number of neonatal deaths in the world, as per a 2019 fact sheet released by the WHO. The establishment of 800 special newborn care units (SNCUs) across the country since 2011 has improved the situation somewhat, but these are still unequipped to handle any surge in Covid-positive newborns. “Already, the SNCUs are full and beds are in high demand,” says Dr Rajesh Khanna, deputy director of health at Save the Children, India. Outside of these SNCUs, neonatal care units at the primary and secondary health centres are barely equipped to deal with regular births, leave alone Covid ones.

Diane Coffey, assistant professor at the University of Texas and author of the 2017 study, ‘The association between neonatal death and facility birth in Uttar Pradesh’, says: “The Better Birth Study (which observed 4,888 deliveries across 30 facilities in Uttar Pradesh) found that essential parts of care at birth, such as taking a pregnant woman’s blood pressure at admission, taking the newborn’s weight and temperature, maintaining skin-to-skin contact between mother and newborn for the first hour after birth, and initiating breastfeeding in that hour, were very often not done.”

Manpower for neonatal care is another concern. Having spent 25 days a month in a paediatric Covid ICU, Dr Sheth says doctor morale is already very low. “The anxiety level is so high because of Covid and limited resources. Parents are often frantic and we have to work to reduce their stress, our own stress and make sure we save the patient.”

Will the third wave be more severe for children?

As of now, according to experts, we do not know if Covid strains of the future will affect children more seriously. “What is clear is that more children have been infected in the second wave in terms of absolute numbers. Children have also reported different symptoms this year—gastric issues, for instance. Earlier, it was largely just a cough and mild fever,” says Dr Sibal. Singapore, which has 333 cases of the B.1.617 strain first noticed in India, has said the variant seems to spread faster among children.

With vaccination yet to cover those under 18, they will remain vulnerable in the event of a third wave. At present, Covaxin, India’s indigenous vaccine, is being tested on children. Sources in the Union ministry for health and family welfare say this may be a possible precursor to expanding vaccination for those under 18 later this year. In the meantime, flu shots and antibody cocktails administered immediately after infection could help contain Covid, protecting both children and their families from the virus.

“We have time before a third wave,” says Dr Sheth. “We must invest in widespread awareness programmes to protect children and newborns and build up our neonatal and paediatric resources to cope with future numbers.” The country cannot afford any delay.

What to do if your child gets Covid

  • Consult a doctor if your child has fever for more than four consecutive days
  • If your child has underlying health conditions, consult a doctor from the onset of symptoms itself
  • Do not treat children yourself with medication meant for adults
  • Children with mild symptoms of cough and fever can be treated at home
  • Cases of severe disease in children are rare. However, call a hospital if the patient develops breathing difficulties, confusion, bluish lips or an inability to keep down liquids
  • Try to keep your child in positive spirits as mental trauma adds to the stress of being unwell
  • Children require rest, plenty of fluids and a healthy diet when recovering from the illness
  • Those who have had severe Covid need to continue with follow-up consultations with the doctor even after recovery to prevent any possible secondary complications
  • Some children can develop MIS-C post-recovery. Symptoms include fever, belly pain, vomiting, neck pain, rash, red eyes and lips, swollen hands or feet. Call a doctor if you see such symptoms

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