Explainer: Will COVID-19 'third wave' impact children more? How to safeguard kids without vaccine?
For protecting children, doctors emphasised on following COVID-appropriate behaviour and insisted that adults must get themselves vaccinated
Amid an ongoing debate in India on how the third wave of the coronavirus pandemic may affect the children, China has authorised the emergency use of a COVID-19 vaccine manufactured by Chinese firm Sinovac, for children aged between 3 and 17 years.
Though it's not yet known when the vaccine will be put to use, the emergency use approval for CoronaVac makes China the first country to give a nod to vaccines in children as young as three.
Globally, the US, Canada, Singapore and UK have cleared the Pfizer-BioNTech vaccine for children, but it's currently authorised only for children aged 12-15. The European Commission has also authorised the vaccine for use in children up to 12 years of age.
When will India vaccinate children?
India has three vaccines approved for use in adults — Covishield, manufactured by the Serum Institute of India, Bharat Biotech’s Covaxin and Sputnik V, developed by Russia — but none for those below 18 years of age. Though trials for COVID-19 vaccines for children are underway in India, a clear timeline is awaited.
Screening of children aged 2 and 18 for Covaxin trials got underway at AIIMS-Delhi on Monday while trials have already started at AIIMS- Patna.
Last week, NITI Aayog Health member VK Paul had said that Zydus Cadila's vaccine is already being tested in children. "So when Zydus comes for licensure, hopefully in the next two weeks, maybe we have enough data to take a view on whether the vaccine can be given to children," he said.
However, WHO chief scientist Soumya Swaminathan had pegged hope on nasal vaccines being made in India while noting that vaccines for children may not become available this year.
“Some of the nasal vaccines that are going to be made in India could be game-changers for children — easy to administer, will give local immunity in the respiratory tract,” she recently told News18.
In the absence of a vaccine, several theories, multiple reports have emerged on how a possible third wave may affect the children disproportionately or severely be affected. However, the government officials have termed such reports as "misinformation".
Firstpost spoke to some doctors who have been working with COVID-19 patients to find out what they have to say on the subject.
Will COVID-19 third wave impact children more?
Dr Tushar Parikh, consultant neonatologist and paediatrician at Motherhood Hospital in Pune’s Kharadi Parikh told Firstpost that it is an assumption that the third wave may also come.
He said that during the previous pandemic a hundred years ago (Spanish Flu), three waves were seen — the first one was mild, the second one was very severe and the third was moderate.
He was of the opinion that there will be a third wave but it is likely to be milder than the first wave because of the number of vaccinations and natural infections.
“There is no evidence to say that children will be affected more or badly in the third wave but there is an assumption that since they will not have been vaccinated, they will be the vulnerable population by the time of the third wave,” he said.
Are children at lower risk of COVID-19 than adults?
Dr Ankit Gupta, lead paediatric critical care specialist at the Wockhardt Hospital at Mumbai’s Mira Road, was of the opinion that children may be at risk in the third wave, but added that there is no need to panic because 60 to 70 percent of children infected with COVID-19 are asymptomatic and of the remaining, only one percent develop severe disease. The mortality rate among children is also low, he said.
He advised parents not to panic and to ensure adherence to social distancing guidelines, COVID-appropriate behaviour, and wearing masks.
“It's important to be prepared in advance and the government in collaboration with the private sector is taking appropriate measures for the same,” the paediatric critical care specialist said.
The health ministry has come out with treatment guidelines for children with coronavirus infection but the Centre has maintained that there is no indication that children will be more or severely affected in the third wave.
How is India preparing to protect its children?
In a press briefing on Tuesday, AIIMS director Dr Randeep Guleria said there is no data that shows children will be affected in the third wave of COVID-19, either in India or internationally. He also termed as "a piece of misinformation" that subsequent waves of the pandemic would lead to severe illness in children.
"If we see the data of the first and second waves, it is very similar and it shows that children are usually protected and even if they get it, they only have a mild infection. And the virus hasn't changed, so there is no indication that children will be more affected in the third wave," Guleria had said in an earlier press briefing.
The Indian Academy of Paediatrics in an advisory issued on 22 May said though children appear as susceptible as adults, it is “highly unlikely that the third wave will predominantly or exclusively affect children”.
“We need to be prepared with more in-patient beds and intensive care beds for children,” it said.
The country's apex child rights body, the National Commission for Protection of Child Rights (NCPCR), has also said that the Centre and states should ramp up their preparations to protect children and neonates.
Several states have started taking steps like setting up paediatric task forces and ramping up facilities for children who may be affected with COVID-19.
How to safeguard children without COVID-19 vaccine?
Without a vaccine how do parents protect their children against the pandemic that has killed nearly 37.5 lakh people worldwide and infected over 17.3 crore people?
Firstpost also spoke to doctors on the measures parents should take to safeguard their children till a vaccine becomes available for younger age groups. The doctors emphasised on following COVID-19 appropriate behaviour and insisted that adults must get themselves vaccinated.
Dr Parikh said children above the age of 3-4 years can be taught about how the disease is transmitted, about the proper use of masks, hand sanitisation and social distancing.
Make your children comfortable with masks: He said he recommends parents practise ‘mask hour’ at home so children are comfortable with the use of masks while venturing outdoors. He also suggested using colourful masks with cartoon characters for children.
He spoke about a "cocoon strategy", wherein all adults should take the COVID-19 vaccine to get protected and the children in their family also get protected.
"Adults are protected by the vaccine, they can take the vaccine as it is proven in adults. For children, there is no vaccine currently and they are exposed to parents and adults in the family. When adults are protected, the child will automatically get protected. Therefore we insist that all adults should get the vaccine."
Limit exposure to family members: The Pune-based doctor said that children can play with some close family members but openly going to playgrounds and meeting friends is not recommended at this point in time.
Following government lockdown guidelines is in the interest of all and avoiding large gatherings and not meeting too many people is in the interest of the child, he stressed.
Dr Gupta too emphasised on a similar “bubble approach,” but added that it was tricky to keep children indoors.
“Children can be allowed to go to homes of neighbours whom the parents trust to be practising COVID-appropriate behaviour. While closed spaces are to be avoided, children can go for walks in the open air and even to playgrounds, with adults ensuring that children don’t come into contact with others present there,” he said.
Maintain COVID-19 appropriate behaviour: Even though the US CDC has said that fully vaccinated adults need not wear a mask, this has not been recommended in India’s guidelines. Also, as vaccination doesn’t guarantee full protection, COVID appropriate behavior needs to be continued and masks need to be worn, Dr Parikh said.
Swaminathan, speaking to News18, had said that till vaccines become available for children, the focus should be on vaccinating adults, especially teachers, and schools should remain shut till the risk of community transmission abates.
Importantly, both the doctors Firstpost spoke to, stressed that even after parents or adults in the family get vaccinated, it was important to keep following COVID-appropriate behaviour such as maintaining social distance and wearing masks.
Dr Maithili Joshi, a third-year resident doctor at the department of paediatrics at the Jawaharlal Nehru Medical College, Wardha also emphasised on a healthy diet for children, including foods rich in vitamins, iron and zinc and a good protein intake. She recommended that parents should fix the “screen time” allowed for their children and allot a fixed time for play to maintain overall health.
With inputs from agencies
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