Q. What is the possibility of a third wave of Covid-19 in the coming months?
A. Pandemics tend to occur in waves, and each wave causes a large number of cases. Eventually, most of the population may get immune by asymptomatic or symptomatic infections (herd immunity). Over time, disease may die out or may become endemic in the community with low transmission rates.
KEY MESSAGE: There is a possibility of a third wave, but it is difficult to predict its timing and severity.
Q. Are children at greater risk in the third wave as being discussed in media these days?
A. After the second wave is over, If we do not continue following Covid appropriate behaviour, the third wave, if it occurs, is likely to infect the remaining non-immune individuals “ that may include children also.
The latest serosurvey (Dec 2020, Jan 2021) showed that the percentage of infected children in the age group of 10-17 years was around 25%, the same as adults. This indicates that while children are being infected like adults, they are not getting the severe disease.
KEY MESSAGE: 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.
Q. Are children likely to suffer from severe disease as being witnessed in the adult population in the current wave?
A. Fortunately, children have been relatively less affected so far due to several factors. The most important reason is the lesser expression of specific receptors to which this virus binds to enter the host and also their immune system. A very small percentage of infected children may develop moderate-severe disease. If there is a massive increase in the overall numbers of infected individuals, a larger number of children with moderate-severe disease may be seen.
KEY MESSAGE: Almost 90% of infections in children are mild/asymptomatic. Therefore, the incidence of severe disease is not high in children.
Q. So you are not ruling out the possibility of severe disease in children in third wave?
A. As explained, the spectrum of illness is likely to be much less severe in children than adults; there is only a remote possibility of children being more severely affected than adults in next wave. As per data collected in waves 1& 2, even severe Covid infections in children are less likely to require ICU admissions.
KEY MESSAGE: Severe disease occurs in children, but there is no evidence indicating that most children with the Covid-19 infection will have severe disease in the third wave.
Q. We have heard that severe disease due to Covid-19 is already occurring in children; what you have to say about it?
A. Yes, a severe illness related to Covid-19 is known to occur in children. This includes pneumonia and MIS-C. However, Covid pneumonia in children is uncommon as compared to adults. In some cases, after 2-6 weeks of asymptomatic or symptomatic Covid-19 infection, ‘Multi-system inflammatory syndrome (MIS-C),’ may be seen due to immune dysregulation with the incidence of 1 2 cases per 100,000 population; some of these cases also may be severe.
KEY MESSAGE: Yes, children occasionally get severe disease and may need ICU care, both during the acute illness and after 2-6 weeks due to an immune condition (MIS-C) caused by Covid-19. But majority are likely to recover, if treated in time.
Q. What would be the preparations in case the 3rd wave comes and affects children?
A. Most affected children get a mild disease with fever and need supervised home care with monitoring. We have learned a lot about Covid-19 illness from our shared experiences in adult medicine in the last 15 months. IAP guidelines on the management of Covid in children are in place, and Paediatricians have been sensitised and trained on Covid management.
Please note that preventive behaviours are the same for children. Parents should also be ideal role models to their children regarding mask etiquette, hand hygiene, and social distancing. Children above the age of 2 to 5 years can be trained to use a mask; however, the adults have to follow the Covid appropriate behaviour.
IAP has also set guidelines for the safe reopening of schools for the safety of the children.
KEY MESSAGE: We need to be prepared with more in-patient beds and intensive care beds for children.
Q Are we not reactive in our approach to now consider vaccinating children?
A. So far, the global data shows that compared to children, older adults are a thousand times more likely to die from Covid-19 disease. So it has been a priority to vaccinate the high-risk elderly age group first. When there is the remote possibility of children getting affected, some countries consider vaccination in children and adolescents. The same vaccines being used in adults can be used in children only after adequate trials. One of our India-made vaccines will soon undergo trials in children, and if proven immunogenic and safe, it could be fast-tracked for mass vaccination in children.
KEY MESSAGE: Children do get the severe disease, even if it is small in numbers.
(Issued by the Indian Academy of Pediatrics Covid Task Force 22 May 2021)
Using Ivermectin for Covid
treatment unscientific: Doc
MAPUSA: Stating that recommending Ivermectin as a line of treatment for Covid was 'unscientific practice', President of Indian Academy of Paediatrics (Goa Chapter) Dr Dhanesh Volvoikar said. "It was unwise to use the prophylaxis, especially when the current wave was already on its way down."
“It is unscrupulous, unscientific and unethical to use Ivermectin to treat patients for Covid. The WHO and ICMR have advised against the policy of use of Ivermectin as mass prophylaxis. Instead, the money could be utilised for obtaining vaccines since global tendering is allowed now,” said Dr Dhanesh Volvoikar
Continuing, Dr Volvoikar said the Preventive and Social Medicine department of Goa Medical College and Hospital has also not proposed this line of treatment.
He said, instead, the money could be utilised for mass vaccination programme and to set up a robust health monitoring system.
