Silence the wave

Shying away from the third wave is no solution to combat the virus. Being prudent, vigilant and taking preventive measures can keep our children safe, writes Dr Kishore Kumar

Covid-21 is definitely different from Covid-19 — meaning the Covid-19 in 2020, was milder in many aspects. People got infected and though it killed many, the households were spared if they practised masking and safe distancing. This second wave in 2021 (that’s why I call it Covid-21 — though it is not an officially recognised word) has left parents looking for information on protecting their children and the steps to take if their child, or a family member, has symptoms of Covid-19, or tests positive. Because once one person has got infected, virtually ALL members of the family have been infected this time around, suggesting high infectivity.

As the virus continues to evolve, paediatricians have been seeing 20 to 30 positive kids per week — with symptoms like cough, fever or chills, shortness of breath or difficulty in breathing, muscle or body ache, sore throat. These symptoms are very similar to adults and often confused with seasonal flu which used to be very common around this time of the year. But do we realise that all this is an indication that the third wave is not waiting to happen, it is already here? Unlike the first wave, now entire households are becoming infected with the virus and it is likely to impact children too.

In the first wave, we all said that Covid-19 doesn’t infect children because they have fewer Angiotensin-converting enzyme 2 (ACE2) receptors in their lungs, but it is important for parents to know that it is possible for anyone, of any age, to contract Covid-19 — including children. If anyone can predict a pandemic, we wouldn’t have had a pandemic. Also, pandemic behaviour and mutations of the virus is left to anyone’s imagination. Generally speaking, pandemics in the past have lasted for close to 2 years before it stops causing agony.

As the cases continue to rise, children with Covid-19 infection may be asymptomatic, mildly symptomatic, moderately sick or have a severe illness. Asymptomatic children are usually identified while screening. Such children do not require any treatment except monitoring for the development of symptoms and subsequent treatment according to assessed severity. In such cases, other than a lot of fluids and paracetamol, (if they have a fever) should be the immediate course of remedy. Children with mild disease may present with a sore throat, diarrhoea, cough with no breathing difficulty.

Few children may have gastrointestinal symptoms like severe stomach pain. Most children ie., 99%, get a mild infection and don’t require any treatment. However 1% or even less than 1% of children get the serious disease — unlike adults wherein 5 to 6% of people are known to get a serious infection. Serious disease in children is generally less common because they don’t have many comorbidities, unlike adults who may have diabetes, COPD, cancer, hypertension, heart disease etc.

What should parents do?

Infection in kids is generally not common because they have fewer ACE2 receptors. But it doesn’t mean they won’t get an infection. However, the kind of infection we are seeing in senior people like gasping for oxygen is unlikely to happen in kids for various reasons including fewer ACE2 receptors in the lungs and less morbidity like an absence of heart disease, hypertension, obesity etc. However, they are known to get multi-system diseases which are still rare. In April-May 2021, Maharashtra reported nearly 29,00,000 new cases and 99,000 were children among them belonging to less than 10 years of age, (accounting for 3.5% of total cases). Gujarat saw a similar trend and many newborns were noted to be affected. What it means is in this second wave we are already seeing newborns and children being affected. In the first wave, everyone predicted that we are a country vaccinating BCG at an early age and that’s the reason why we are unaffected.

We, however, got the first wave after 2 months of it hitting the USA and UK. In the second wave, we were naïve when UK and USA were suffering. We ignored it and ended up battling the wave after 2 months. Now with vaccinations and other preventive measures, UK and USA have all returned to normal life. Why will we have the third wave? This is just “prediction overboard” because we were ridiculed for not predicting the second wave. Parents need to know that children react to how adults behave — already kids are suffering mental illness because of solitude, anxiety in parents, lack of interaction with other kids, absence of school and so on....and seeing and hearing of deaths....the last thing we need is creating more anxiety and fear in them to scar them for life. Let us be sensible and get vaccinated so that the kids won’t get the disease.

When to get a test for your child?

Get your child tested for Covid- 19 if he/she has these symptoms of
infection:

Cold

Mild cough

Fever

Body pain

Pain in the abdomen

Loose motions

Vomiting

When family members that your child has been in contact with test positive for Covid-19.

Your child has symptoms of Covid-19.

Your child has a fever that has continued beyond three days.

If you have a family member with a Covid-19 positive report, you need to isolate immediately in a separate room from the rest of the family (if possible). Children should be shifted to a different room or different house (maybe of a friend or a relative). If by any chance, the child develops a fever, it is difficult to know the difference between a common cold/fever and Covid-19 without a test.

This could also be a signal that every case of fever or cough in your child may or may not be Covid-19 — especially if a family member is suffering from Covid-19 or has recently recovered from the virus. However, a test is mandatory.

Parents or the caretaker should maintain a monitoring chart including counting of respiratory rates 2-3 times a day when the child is not crying, looking for chest indrawing, any discolouration of body, cold extremities, urine output, oxygen saturation monitoring (hand-held pulse oximeter) if feasible, fluid intake, activity level, esp for young children. In a small baby, one can use monitors like ray baby to monitor the baby’s breathing. When out and about in public, adults and kids should wear a mask that covers both nose and mouth, especially in situations outside the home where physical distance isn’t possible.

Parents should help younger children practice wearing masks before returning to school so kids are comfortable wearing them in class. Kids should wash their hands after using the bathroom, sneezing, coughing or blowing their nose, before eating (even snacks) and immediately after coming inside from playing outdoors.

Last but not least, even though there is no evidence that there will be a third wave affecting only children, we should prepare for the worst until this pandemic is over — which will be declared by WHO and no one else. What we need to remember is that the adult population remains at higher risk of moderate to severe disease and children get infected from adults. So preventive measures are the best measures you can take to protect your children but not cause mental stress and anxiety in them.

(The author is a neonatologist.)