How safe are our children from COVID-19?

By Nina Badgaiyan & Vedeika Shekhar

As seen worldwide, the COVID-19 pandemic has had an adverse impact on health and therefore on economic and social systems. While we are yet to fathom its long-term impact, what is becoming clear is that the pandemic is affecting different age groups in different countries. Though it is shown that the fatality is higher in the older age groups, the risks and impact of COVID-19 on children have so far escaped attention.

In India, children under five years comprise a sizeable population, constituting over 15% in comparison to 65 years and above, constituting only 6% of the total population. Further, in comparison to India, children under five years comprise around 6% and 4% of the total population of the US and UK, respectively. Children are likely to develop antibodies to wade off the virus with frequent bouts of respiratory illness. However, it still does not rule out the possibility of children not getting affected by a novel coronavirus.

In India, one child under the age of five years dies every four minutes due to pneumonia. According to a report, ‘Fighting for Breath in India’, shockingly, pneumonia killed more than 1,27,000 children under five in 2018, amounting to more than fourteen children every hour. Often termed as the ‘forgotten global epidemic’, it emerged as the biggest killer of children under five, claiming14% of young lives in 2017.

According to the same report, acute malnutrition was found to be one of the main reasons for pneumonia deaths, accounting for more than half of childhood pneumonia deaths in India. As malnourishment is a proven underlying cause of childhood morbidity, associated with infectious diseases in developing countries, the impact of COVID-19 in a country like India where every third child is stunted (38%) and underweight (36%) and every fifth child is wasted (21%) could be phenomenal.

COVID-19 belongs to a family of viruses that severely constrains the function of lungs, and pneumonia is caused in severe cases. Children contracting COVID-19 can fall into four categories: asymptomatic infection; acute upper-respiratory-tract infection; mild pneumonia; and severe pneumonia. Could we emphatically say that children in India run the risk of suffering from serious consequences of this pandemic due to a high incidence of pneumonia? There are not large sets of data and evidence yet available to reach any such conclusion.

However, what is worrying is that research by the Centre for Disease Control and Prevention demonstrates that Chinese children with acute respiratory distress syndrome were more likely to contract the novel coronavirus than other children. There seems to be a link between respiratory problems and COVID-19 among children. Therefore, ignoring the possibility of double burden impact on children in India, where a large number of children’s lungs are already compromised by pneumonia as a consequence of malnutrition, could be a big mistake.

Although whatever data is available suggests that children are less likely to contract the severe form of COVID-19, most of it is from developed countries, where malnutrition rates are not as high as in India. India should be ready to address this problem if it does become a reality.

If at all we are faced with more malnourished children getting this virus and higher pneumonia cases, are we prepared enough? First, acknowledging the criticality of this possibility will pave the way for finding a solution. Each state has nutrition rehabilitation centres for treating severe and acute malnourished children, these could be made ready to treat children with COVID-19. It is crucial that these centres overcome their infrastructural and facility challenges and provide timely treatment to these children. In the context of severe disruption to services/insufficient commodities, the allocation of treatment services for acute malnourishment should be equally prioritised or combined with other public health interventions, such as specific ICU beds allocated to COVID-19 patients.

Further, as evidence suggests that children show milder or asymptomatic symptoms of COVID-19, there is a critical need for aggressive testing among them as they may play a potential role in community transmission of the virus. The phase-wise introduction of the pneumococcal vaccine—which prevents pneumonia among children—by the Government of India into its national immunisation programme could be a step in the right direction.

We must also treat this time as a window of opportunity to ride home the message of health education with an emphasis on nutrition, water, sanitation, hygiene, to better prepare our vulnerable population to deal with epidemics, as a preventive measure. We must initiate efforts to build the capacity of frontline workers to provide treatment for uncomplicated cases of children with SAM at the community level, including training on watching out for fever/dry cough symptoms and providing social messages on COVID-19.

Children have been regarded as the nation’s supremely important asset. They already suffer from the public health crisis of malnutrition and pneumonia and COVID-19 endangers them further. It is our responsibility to act and mitigate the hidden adverse impact that this pandemic threatens our children with for their brighter future.

Nina Badgaiyan is Senior Consultant and Vedeika Shekhar is Associate, Health and Nutrition Vertical, NITI Aayog.

The views expressed above are the authors' own. They do not necessarily reflect the views of DH.