Recently, All India Institute of Medical Sciences (AIIMS) director Dr Randeep Guleria had warned that the third wave might hit India sooner than later. He said people are crowding in markets and malls without following any Covid-appropriate behaviour.
“I feel a third wave may hit earlier, possibly in 12 to 16 weeks,” he added. With the speculations of the third wave to arrive sooner than anticipated, the fear of children getting affected by it the most is housing in the parents’ minds across the country. However, experts do not agree with such speculations. Interestingly, no one knows who started the unsubstantial discourse but it needs to be addressed properly.
Dr Chandrakant Lahariya, medical epidemiologist, in an op-ed published in Times of India, said that all the scientific and epidemiological evidence from all Covid-19 waves suggest children between the ages of 0 to 18 are at relatively low risk of developing moderate to severe disease. While everyone is speculating children to get most affected by the third wave, the available data show a different approach.
According to data, only two to five percent of the Covid-19 cases that needed hospitalization in India were between the age group of 0-18. Notably, this age group comprises of 40 percent of India’s population. On the other hand, adults are at around 10-20 times higher risk of contracting a severe infection.
He said, “There is no evidence from any part of the world that a third or any subsequent wave will affect children disproportionately.” Though the mutants have shown higher transmissibility, there is no change in the virus that may lead to potentially severe infection in any age group.
The flaws in representing the numbers of cases among children
During the months of April and May 2021, there were several reports across media platforms that Maharashtra has been reporting a higher number of infection among children. By that time, the State had reported over 99,000 cases where children were affected by the virus. Going by the numbers, it was a 3.3 times increase in such cases. If the data is checked only to this point, it is more than enough to create panic, especially among parents. However, there is more to the picture.
In these months, Maharashtra reported around 29 lakh Covid-19 cases. Now, 99,000 will make only 3.5 percent of the total cases. Notably, children between the age group of 0-10 make up to 24 percent of the total population in the State. Another point that needs to be considered here is that India reported four times the cases compared to the first wave.
It was obvious that every age group would contribute to the numbers. However, the increase in cases among the 0-10 age group was still less than compared to the older age groups. Dr Lahariya noted that the majority of the children who needed hospitalization had some underlying illness which added to the problem.
‘Media is misleading the public with numbers’
Pradip Awate, State Surveillance Officer for Maharashtra and in charge of monitoring epidemic-prone diseases in the state as part of the Integrated Disease Surveillance Programme of the Union Health Ministry, talked to The Hindu Business Line on the matter. Asserting the speculations to be baseless, he said that there is no evidence that indicates the virus would mutate to infect children at a high rate.
Blaming media for spreading misinformation, he said that the number of children affected by the virus remained somewhere between 1 to 1.5 percent in the last six months, and it has not fluctuated to an alarming level. He agreed that the number of cases was higher in the recent months but compared to the overall cases reported by the State, the percentage remained largely the same.
“Most importantly, the death rate and complications reported in children are very less compared to adult cases. In May 2021, the death rate in the age group below 18 is 0.007 per cent in Maharashtra. If 10,000 children get affected, one death is reported, and children who have other health issues might face complications,” he added.
On June 1, Dr VK Paul, Member (Health), NITI Aayog has explained today that though children are not immune from this infection and do/can get infected, it has not taken serious shape in children. He said that the infected children would either show no symptoms or there will be minimal symptoms.
Dr Sanjay Marathe, known for his studies on pediatric vaccines, said, “There is no documentary or epidemiological evidence that kids will get affected in large numbers in the possible third wave. All is postulation based on statistics. Government has started preparations in anticipation which is a good thing. We need more pediatric beds and ICUs in the future. But, parents need not panic because of this.”
The Indian Academy of Paediatrics (IAP) issued an advisory in which they said, “Children are as susceptible as adults and older individuals to develop infection but not severe disease. It is highly unlikely that the third wave will predominantly or exclusively affect children.”
The advisory also urged the parents to take care of the mental health of their children. It added, “Apart from the infection, parents should watch out for mental health issues in children and keep a watch to prevent child abuse and violence. Also, it is worth limiting screen time and prepare children for safe school reopening as per the IAP guidelines.”
In a discussion paper published by India Task Force established by Lancet titled “Preparing for covid-19 part iii: planning, protocols, and policy guidelines for paediatrics”, it was said, “current statistics indicate a larger number of children with COVID-19 during the second wave in India than the first wave, owing to an overall increase in cases during the second wave, while the proportion of children affected nearly remained unchanged.”
It further added, ” Preliminary review of cases within representative facilities further corroborates the low case severity and low overall mortality rates in children.” During the discussions of the task force, the experts clarified that “there is no reason to suspect or predict that there would be a more severe disease in children in the third wave and it is less likely that the children will be affected more. Third-wave may come following the nature of the virus however managers should get ready.”
Head of Paediatric Pulmonology Dr SK Kabra, AIIMS, said, “The speculation of third-wave hitting children is based on three observations. Firstly there is speculation that below 18 will remain susceptible after immunisation drive began for beneficiaries above 18 years. Secondly, people who already got infected may have resistance against the third wave and thirdly due to immunization of the adult group, there will be a mutation in the virus. All these reasons may not be true though there is a possibility that the third wave of Covid-19 may be there but no reason to believe that this will be more severe in children.”
States preparing for the third wave keeping the speculations in mind
The misleading media reports did affect the policymaking process, and states have started to prepare for the third wave keeping possibilities of children being affected by the virus at a higher rate in the third wave. As per reports, the Karnataka State Commission for Protection of Child Rights recommended setting up paediatric Covid taskforces in every district. On June 22, it was reported that the state has set up an expert committee to protect children from a possible third wave.
In a report submitted by the committee, they estimated that around 3.4 lakh children in Karnataka are likely to be affected during the third wave of Covid-19. It also explained the challenges that the healthcare system in the state may face while managing Covid-19 infection in children and suggested measures to control the spread.
On June 22, C Vijayabaskar, Former Health Minister of Tamil Nadu, urged the state government to be prepared with at least one lakh Covid pediatric beds. DT Next quoted him saying, “AIIMS has warned that the country will soon face a third wave of COVID-19 and more shocking news is that children below the age of 18 years would be affected more. With a population of 1.71 crores below 18 years, experts warn that at least 10 percent of children will be affected, which will take the count to close to 20 lakh. Among them, at least 10 percent would be hospitalised, which would take the count to 2 lakh. If not for 2 lakh, the state government should be ready for at least 1 lakh Covid pediatric beds.”
In May itself, Uttar Pradesh CM Yogi Adityanath had announced that 100 additional pediatric beds would be installed in each district to combat the third wave of Covid-19 infection. Reports suggested that he directed the state health officials to make special arrangements in the hospitals to ensure the best treatment for severely infected children.
UNICEF’s detailed FAQ on Covid-19 in Children
In a detailed FAQ sheet, UNICEF said, “As the number of people across India testing positive for the COVID-19 has increased, the number of children contracting the virus has also increased. However, we have not seen a sudden spike in the overall percentage of children affected by COVID-19 in India.” The organization clearly mentioned that though the number of children affected by Covid-19 in the second wave was higher, there was no sudden spike in the overall percentage.
The experts from UNICEF, World Health Organization (WHO), All India Institute of Medical Sciences (AIIMS), New Delhi, Ministry of Health and Family Welfare (MoHFW), the Indian Academy of Pediatrics (IAP), and the National Neonatology Forum (NNF), worked on the FAQs. They urged the parents not to panic if their child contracts Covid-19 infection.
The experts urged everyone to follow Covid-19 protocols and maintain social distance. It was advised to stay at home as much as possible. If anyone contracts the virus in the family, the first step is to isolate the patient in the family so that the virus does not spread among other members. No one should enter the room where the family member is isolating. The proper treatment advised by the doctor must be followed. In case all family members are hospitalized but children, the authorities must be notified about the situation on 1098 so that they can take care of the children while the family members are recovering. More details can be read here.
Prepare for the worst anyway
Though the evidence does not point towards the possibility of children getting most affected by Covid-19 during the third wave, there is no harm in preparing for it. Increasing the number of pediatric Covid beds will only help in avoiding the possibility. However, as the experts said, there is no need for the parents to panic. Instead, follow the Covid-19 protocols and ensure you take all the precautions to avoid infection in the family.