Protecting Children in the Third Wave

Reports of over 8,000 children testing positive for COVID-19 virus in Maharashtra's in Ahmednagar district in May is a worrying development and should put parents in other states, besides health authorities, on notice. Data related to children contracting the infection in Rajasthan in the current second wave have also sounded the alarm bell. Over 3,500 children in the age group 1-10 years and over 10,000 children in the age group 11-20 years testing positive in the state in April and May call for special measures to protect the children in the third wave. Expert opinions are divided over the hypothesis of children being predominantly or exclusively affected in the third wave. There is, however, agreement among them that the country needs to remain prepared with more in-patients and intensive care units for children to improve paediatric COVID services in hospitals. Data of the first and the second wave certainly point towards more children being affected in the current wave as compared to last year. The Supreme Court also instructed the Central government to start preparing to handle the third wave and cautioned that children might be affected. It is hoped that reports of large children contracting the virus in these two states have set the bell ringing in the northeast region and steps have been taken to protect the children. Surging infections and critical cases have stretched the health systems in these states and advanced planning to manage the third wave with adequate provision for treatments for children will be needed. Gradual fall in COVID-19 positivity rate in Assam is good news but the state is still far from turning the corner in the second wave. The State government has hinted at gradual unlocking from the second week of June if the trend of improvement continues. Some health experts have attributed high fatalities in the second wave to delay in the hospitalization of patients in home isolation with moderate or severe symptoms. The spread of infection in tea garden areas and rural areas is a cause of concern and the state will have to continue strict enforcement of the micro-containment zones when it decides to gradually unlock, lift the prohibition on inter-district movement and relax timing for shops and marketplaces, besides curfew hours. The preparation of a set of guidelines for parents well in advance will be crucial in containing the spread of infection among children. Odisha government has already issued a Standard Operating Procedure under which all districts have been asked to ensure that 15 per cent of hospital beds are kept reserved for neonatal, infant and other paediatric age groups. COVID ward for children is different from adult COVID wards, as one of the parents is to be allowed to remain as an attendant in case an infant is admitted. The special situation of both the parents of an infected infant being hospitalized because of moderate or severe COVID infection requiring oxygen or ICU care must not be lost sight while formulating the guidelines for paediatric COVID management in the third wave. Child-friendly care facilities will be needed to put in place in COVID wards so that the affected children do not feel isolated or stressed. The Education Department cannot afford to ignore the reports of surging infections among children in different states in the current wave. It must be guided by the Health Department on key decisions such as reopening of offline classes, holding examination for school students even after withdrawal of partial lockdown to prevent paediatric infection becoming a serious health emergency for the already overburdened health systems in the state. A key challenge to prevent the spread of COVID infection among paediatric age groups is the lack of availability of vaccines below 18 years. Bharat Biotech, the manufacturer of COVAXIN will be conducting stage 2 and 3 clinical trials among children in the age group 2-18 years over the next few weeks. Regulators in the United States, European Union have authorized the use of the Pfizer-BioNTech Covid-19 vaccine in children aged 12 years. Apart from breaking the chain of transmission in all age groups, the availability of vaccines for children will take away much of the worries of their parents. The country as a whole and most states were caught ill-prepared to handle the current second wave even after learning many lessons in the first wave. Experts repeatedly sounding the alarm bell of the third wave of COVID -19 pandemic hitting the country and some of them cautioning that more children could be infected, every single state must be on their toes to better manage it. There is no room for complacency over flattening the curve of the current wave and preparations for the paediatric COVID care units must continue parallel to handling the second wave even after a decline in infections. Parents and society must extend a helping hand to the government. We must not fail the children.