- Children could be at similar risk as adults during the third wave: Report
- Vaccinate children with comorbidities on priority: Experts
- 82% shortage of paediatricians in primary health centres: Report
New Delhi: While the experts and policymakers discuss the reopening of schools that were shut last year due to the coronavirus pandemic, a new report has noted that the country is not fully prepared if in case more children get infected in an anticipated third Covid wave. The report, prepared by a committee of experts constituted under the National Institute of Disaster Management (NIDM) which works under the Ministry of Home Affairs (MHA) has said that children might be at a similar risk as adults in the next COVID wave and calls for improving paediatric hospital facilities.
The report titled ‘COVID-19 Third Wave Preparedness: Children’s Vulnerability and Recovery’, which is based on consultations with experts and secondary research, said that the risk of the third wave is upon the country which is likely to peak in October. Earlier this month the centre said the ‘R’ (Reproductive) value, which is the number of people a coronavirus positive person infects, had risen above the danger mark of 1.0; the last time it was over this level was in March when it was 1.32, and that was before the second wave.
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Third Covid Wave: Are Children At A Higher Risk?
According to the report, there is no sufficient data to suggest that a third of Covid will affect children more than adults and added that there is cause of worry, if not panic as children are still unvaccinated. It said,
Experts warned of an imminent third COVID-19 wave while the nation was still in the middle of a raging second wave. In the first week of May 2021, K Vijay Raghvan, Principal Scientific Advisor to PM, called the third wave of COVID inevitable and that it could cross age groups and may put children at similar risk as adults.
While talking to NDTV, Dr MC Misra, former Director of All India Medical Sciences (AIIMS) and one of the authors of the report said,
As we saw that during the first wave and the second wave, children were affected less than 10 per cent. The findings of the seroprevalence study which was undertaken by AIIMS in 18 states with over 45,000 samples show that sero-positivity among children was about 55 per cent and 62 per cent in adults. This shows that children have been by and large spared by the onslaught of this pandemic so far barring a very small number of children who were severely impacted. Many experts and the Indian Academy of Paediatrics do not believe that children would be extraordinarily impacted by the third wave. There is no indication that the variants we have seen till now will impact children differently. Children are vulnerable mainly because there is no vaccine for those below 12 years.
Dr Ranjit Ghuliani, additional medical superintendent and professor in Paediatric Department, Sharda Hospital, Greater Noida, however, has expressed concerns regarding the impact of the third wave on children as adults around them are getting some immunity against the virus either via vaccines or the natural infection. He said,
While there is no strong evidence, we are extrapolating the data from the western countries. It has been observed there at the cases among children have been more in the third wave. So, there is absolutely an urgent need to be prepared and to vaccinate more and more people who are eligible to get the vaccine.
Paediatric Facilities Nowhere Close: National Institute of Disaster Management
According to the report, paediatric facilities such as doctors and equipment, like ventilators and ambulances are nowhere close to what may be required in case a large number of children become infected in the third wave of COVID-19. The report highlighted that there is about 82 per cent shortage of paediatricians in primary health centres and up to 62.8 per cent of positions for paediatricians in community health centres were vacant.
While talking about how hospitals are gearing up for the third wave and ramping up paedratic facilities, Dr Ghuliani said,
The Uttar Pradesh government has directed all Covid hospitals to prepare for the third Covid wave and we are working towards this direction. Apart from reserving over 100 beds (including isolation and Intensive Care Unit beds) for children, we have established protocols regarding admission of children in the hospital and training of the staff including those from non-paediatirc departments, nurses, junior resident doctors among others.
He added that in most cases, when children are Covid positive, they are not the only ones in the family to be infected as usually they get it from the elders in the family. He said,
At Sharda hospital, we will be admitting the infected child along with the infected parent or care taker as this will be helpful in managing the child in the hospital. In case the parent or the child is in critical condition, then there will be a full-time nurse to look after the child. If both parents or other elders of the family are not Covid infected and only the child is infected, then we will have a form signed by the elder wiling to stay with the child saying that they are informed about the risk involved in being the Covid setting to take care of the child.
According to Dr Srinivas Midivelly, Consultant Paediatrician, Yashoda Hospitals Hyderabad, the country is working towards improving the health infrastructure for children. He said,
We, as a country are on the right path. If we look at the experience of last two waves, we see that mostly children suffer with mild or asymptomatic infection and rarely develop complications like Multisystem inflammatory syndrome in children (MIS-C). There were also less cases of Covid related pneumonia in children and so less ventilators and oxygen support were required for them. States have still started stockpiling critical medical items required during Covid treatment of children. We will be able to handle it.
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Recommendations Of The Expert Panel And Way Forward
Here are the recommendations made by the expert panel in the report, in order to tackle the third wave and protect children from it:
- Improve Paediatric Facilities: The NIDM has called for improving health facilities for children significantly. Hospitals should be well equipped with a comprehensive childcare model, the report said, adding that they should accommodate both children and their parents – to minimise the mental and emotional impact of being hospitalised.
- Need To Focus On Mental Health Issues Among Children: The report said that everyone dealing with a child in any setting must know basic psychological first aid so training regarding this must be provided. Child and Adolescent Mental Health (CAMH) to be integrated at Primary Healthcare Centre (PHC) level.
- Prioritise Vaccination Of Children With Comorbidities And Disabilities: The NIDM also red-flagged the issue of co-morbidities (leading to weakened immune systems) among infected children and said their vaccination must be an “immediate priority”. Between 60 and 70 per cent of Covid-positive children have co-morbidities, according to Health Ministry data. The report has asked for vaccinating children with comorbidities and disabilities on priority. India has recently approved Zydus Cadila’s three-dose RNA vaccine for children over 12 and as per the Union Health Minister, the rollout of this vaccine for children will be soon.
- Improving Overall Vaccination Coverage: The report strongly recommends increasing the overall vaccination coverage significantly and said that vaccines can help in challenging the third wave. It has also called for vaccinating all teachers and school staff as essential workers. At the current rate of vaccination India will fall well short of the target of vaccinating 34 per cent of its population by the end of the year, the report said. It also flags the need for campaigns to overcome both vaccine hesitancy (reluctance to get vaccinated) and apathy (believing there is no need because the pandemic is over). It also cited a study conducted jointly by the Pandit Deendayal Energy University (PDEU) and Nirma University which stated that if India’s vaccination rate does not improve, then India could witness 6 lakh cases per day in the next wave.
- Recommendations For Schools: On the question of re-opening schools, the report said that as schools are not open and a large number of children are missing out because a lot of poor children do not have access to smartphones or internet facilities, majority of the children in the country, especially in rural areas, are dependent on the Public Education System. Hence, it recommended that:
– the governments should undertake holistic measures like ensuring that they provide learning materials such as textbooks and stationery and ensure access to the children even in the remotest parts of the country;
– there should be innovative/ alternative/ blended ways of teaching and learning such as through story books in vernacular languages, arts and crafts along with life skills learning;
– school provide for other support too, such as Mid-Day meals;
– there is a need to have policies to include rural children in online education;
– many girls lose out on the teaching-learning process due to existent gender inequality in the society so special provisions regarding this have to be carved out,
– training of teachers for better communication through available and accessible technology along with specialised skills to reach out to students with special needs and those in rural India.
- Other Measures: The report has outlined a series of measures for children’s safety – including awareness campaigns so they may be familiar with Covid protocols, programmes to ensure children in rural areas and from disadvantaged communities are protected. It said, “‘Children’ are not a homogeneous group, and the policies cannot be the same for different groups of children.” The report also emphasised on raising awareness to make people understand that children are different from adults and their needs are different. Teachers and guardians should be trained as to what to do if a child is infected. The Report has emphasised on continued adoption of Covid-appropriate behaviour by the public and a consciously gradual loosening of restrictions.
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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.