A year after the Coronavirus pandemic wrecked our collective lives, our society has been grappling with fear and insecurity. As a result, we have seen misinformation spread like wildfire, and many resorting to bizarre and incorrect methods of dealing with the virus. With this column, which will be published every Sunday, we aim to address any health or vaccine-related question our readers might have about the coronavirus pandemic.
In this week’s column, Dr Narendra Kumar Arora, a paediatric gastroenterologist and a senior member of the National Covid-19 Task Force, has answered the queries. Dr Arora has answered questions on how COVID-19 and its vaccine impact children.
Which vaccine will be the safest for children to take?
Only those vaccines which have undergone systematic trial and then approved by the drug regulators will be given to the children. There are a few vaccines globally that have undergone a systematic trial in children and, their data is now available for both the immune response and safety. In India, Bharat Biotech’s vaccine is under clinical trial for children between 2 to 18 years of age and its results are expected in a few months. There is another Indian vaccine by Cadila-Zydus, which is a DNA vaccine; this has also been assessed in children between 12 and 18 years. Besides, we would be able to administer the vaccines made by international manufacturers (such as Pfizer and Moderna) to immunize children between 12-18 years of age when we get them.
What kind of side-effects can the vaccines have on children?
The purpose of conducting clinical trials in children is to look for safety, along with its protective effects. Generally, side-effects in children are similar to those seen in adults. And therefore, post-vaccination a child may feel a little unwell, local pain, mild fever for one or two days. Though any unusual serious side effects in children are not expected, close monitoring of side effects through the national AEFI surveillance system, which monitors adverse effects post-immunization in all the age groups will be done.
What are the peculiarities faced by children who are infected by the virus? How are these infections different from the adult COVID infection and disease?
In most cases, children either remain asymptomatic or develop the mild disease for which we prescribe symptomatic treatment such as paracetamol for fever, oral rehydration for diarrhoea, and cough syrup for cough and congestion. In some cases, children may develop moderate to severe disease and have symptoms such as high fever, breathlessness, breathing difficulty for which the treatment remains the same as that for adults.
In rare cases, after 2-6 week of the onset of the disease a rare Multiorgan Inflammatory Syndrome may occur, which require prompt hospitalization. Signs and symptoms of the multisystem inflammatory syndrome in children (MIS-C) include (though not all children have the same symptoms): fever; vomiting and diarrhoea; pain in stomach; skin rash; rapid breathing; red eyes; swelling of lips and tongue; excessive crying, drowsiness, and excessive sleepiness. The initially infected child may have become asymptomatic but starts developing the symptoms again 2-6 weeks after initial recovery.
Children can’t express and manage on their own. How can the parents take care of the children with covid?
We have seen that in most cases both children and parents are infected together. However, in some cases where a child is affected and parents are not, great care should be taken by the adult who is nursing the child. The care provider should wear a mask, face shield, PPE while taking care of the child. Also, the caregiver should isolate oneself from the rest of the family.
Parents should watch for the following symptoms that indicate the severity of the illness in children: first, if the child has a high, persistent fever after 5 -6 day of the onset of symptoms; second, fast breathing, difficult or noisy breathing; breathlessness or if the child is excessively crying; and severe diarrhoea with fluid and electrolyte loss (dehydration).
In a rare case, as we have already discussed above a child may develop a fever with drowsiness, skin rash, breathing difficulty, or other symptoms such as convulsions after 2-6 weeks of the onset of the symptoms. In these cases, multiple organs may get involved and so, the child needs to be hospitalised promptly.
What steps should be taken by the government to prepare for the third wave that is likely to affect children?
Children below one year of age are at a higher risk of developing the severe disease as their immune systems do not form fully in the first year. Such children may need ICU care with ventilator support. Similarly, older children with moderate to severe disease need to be nursed at the hospital. So, special facilities where parents can stay with Covid positive children, especially those below 10 years of age, will be needed. These facilities should also be equipped with Intensive Care Units.
Besides, we may need to come up with more facilities to take care of pregnant women who are Covid-19 positive as there are high chances of the premature birth of the child. Such children require Neonatal Intensive care units. So, we need to add children-friendly facilities in existing Covid-care centers as well as we need to set up new facilities. Some state governments have already started ramping up the covid care facilities accordingly.
The second wave of the Covid-19 was more severe than the first wave. Can there be more waves? What is the most effective way to control the spread of the pandemic?
When a viral outbreak occurs, it infects the most susceptible population in an area. Those infected by it also develop a degree of antibodies which, protect the person against infection for some time but protect the person from severe infection for a very long time. The second wave has infected a large proportion of our population most had asymptomatic infection.
There will be pandemic waves in the future but predicting the timing is difficult. The severity will be determined depends on what kind of preparation we make now. The second wave was primarily driven by Delta and Alpha variants of the COVID 19 virus; India had almost 75% of the population which did not have any antibodies in January 2021 i.e., the susceptible population and on top of this, there was complacency in terms of leaving corona appropriate behaviour and large social congregations.
In preparation for the next wave, the country has established a good epidemiological and genomic surveillance system so that potential dangerous variants are identified early and prompt actions are taken to control the spread of these variants.
In addition, as a society, everyone has to adopt corona appropriate behaviour as a matter of lifestyle. Finally, the country is going to have sufficient vaccines in the coming weeks for all. This will be our key weapon to fight the pandemic. The country has the infrastructure to deliver vaccines in every part of the country. Every citizen has to come forward and get the vaccines as these become available. This is the most potent weapon to take up any challenges which future waves bring upon us.