The upcoming wave of COVID-19 is expected to hit children largely. While many say that we are prepared to tackle the challenge, who knows what spanners the new wave will throw in the works. MUSBA HASHMI speaks with doctors about whether it is too early to claim that we are all set up and ready

Not too long after the deadly second wave of the COVID-19 pandemic ended, the forthcoming third wave became the talk of the town. Several States started prepping up for the equally dangerous, if not more, third wave, which is expected to hit children big time.

However, a matter of discussion is what preparation are we even doing, for who knew the first wave will result in COVID pneumonia in the patients and that the second will become synonymous to oxygen scarcity. Hence, the question remains what does the third wave hold for us, especially the children?

Will there be neurological problems or a whole lot of digestive issues or a totally new set of complications and symptoms? While this may sound too unrealistic, given the continuous mutations of the virus, it can happen sooner than expected.

But, Dr Sumit Gupta, Senior Consultant, Paediatrics, Columbia Asia Hospital, Ghaziabad, has a different take and believes that in the coming days, COVID-19 may start behaving like any other common cold virus.

“In the next few days, COVID-19 may behave like other common cold coronaviruses and mostly young children may be at risk who have not yet been vaccinated or exposed to the virus. Also, there is no concrete evidence yet showing that children with the COVID-19 infection will have severe disease in the third wave. However, in the absence of a vaccine for children, we can protect them by making them aware and asking them to follow all COVID appropriate behaviour. But, this doesn’t mean that the rest of us can put our guards down,” says Gupta.

The infection, he says, may happen in the form of cold. “Even now, we have been seeing about 15 kids every week with symptoms like cold, fever or chills, shortness of breath and body or muscle ache,” says Gupta.

Dr Shuchin Bajaj, Founder-Director, Ujala Cygnus Group of Hospitals, says that the rising number of cases in Kerala continue to be a stress for all of us because that points towards a trend that the third wave may hit us towards the end of August or early September as it has been feared.

“Our only hope is that with the high zero positivity rate already present in North India, and with the increasing pace of vaccinations, we may be spared of a lethal or a very high morbidity wave and we may see a mild wave like in the UK. However, we may see a variety of symptoms including gastrointestinal, conjunctivitis, headache, fatigue, loss of appetite, in addition to the symptoms that we have seen in the previous year. So we should be careful and we should watch out for any such symptoms, especially symptoms like diarrhoea and vomiting,” says Bajaj.

Dr Abha, Paediatrician, Sharda Hospital, says that fortunately, children have been relatively less  affected so far due to several  factors. The most important being the less expression of specific receptors to which this virus binds to the  host and also their immune system. “A very small percentage of infected children may develop moderate to severe disease in the third wave. But, if there is a massive increase in the overall numbers of infected individuals, a larger number of children with moderate to severe disease may be seen. It is very difficult to comment on which presentations would predominate in children because so far we have seen variable symptoms and complications in children that include the involvement of gastrointestinal, respiratory and neurological system,” she says.

Another entity known as Multisystem Inflammatory Syndrome ( MIS-C) may also be seen due  to immune dysregulation and  some of these cases may also turn severe. “However, the silver lining is that it’s a treatable condition  with a good outcome, if diagnosed early,” Abha tells you.

Dr Nidhi Rawal, Senior Consultant, Paediatric Gastroenterologist, Madhukar Rainbow Children’s Hospital, agrees with Abha and says that so far, a lot of varied symptoms were seen in children.

“They can range from mild flu-like illness with fever and cough to severe complications such as MISC. So we as doctors and healthcare providers will have to have a low threshold to evaluate and treat a child for COVID-19, if standardised treatment approach fails,” says Rawal.

She adds that children tend to have more digestive tract symptoms such as abdominal pain, bloating, nausea and diarrhoea. “GI symptoms are seen in 20-30 per cent of children and are usually mild but can persist for about three months after the patient has tested negative for COVID. It usually requires supportive care with some diet modification and use of probiotics and most kids recover well,” opines Rawal.

In such a scenario, where doctors believe it is not incorrect to look for other treatments if standardised approach fails in the third wave, is it right to say we are all-prepared?

“All efforts are underway to make sure that our children are and will be safe. All major hospitals in the country are putting in place the required infrastructure in case the third wave affects children drastically. We have also set up paediatric intensive care units (PICUs) at our hospital,” Gupta tells you.

EXPERIENCE MATTERS

With that being said, it is a no-brainer that the experience of handling the first and second wave will help the healthcare providers fight the virus more effectively.

“We all know that the second wave posed a big challenge and there were many fatalities due to the deadly infection as authorities failed to prepare adequately. We cannot predict the challenges or consequences of third wave clearly but strong measures and the experience of first and second waves will help in avoiding fatalities,” says Gupta.

Dr Garima, Paediatrician, Sharda Hospital, too believes that the doctors, during the first and second wave, has learned a lot about COVID-19 illness from our shared experiences in adult medicine. And as for children, various guidelines on the management of COVID are in place.

“The paediatricians have been sensitized and trained on COVID management. We are ready for a  more significant number of patients seeking consultations and will work towards educating the parents regarding the illness and warning signs on different platforms, and also arranging more  COVID wards for children with more special  wards such as high and intensive care units (ICU). high dependency units (HDU),” she tells you.

Rawal says that while the previous experiences of understanding the effects of COVID-19 virus on our body as well as new devised treatment plans will definitely help us managing children and adults in the third wave, but we have to understand that children are affected differently than adults. “Hence, they might require a completely different treatment and guidelines,” opines Rawal.

LACK of vaccine big challenge

SARS-CoV-2 virus continues mutating and a new variant that could be worse than Delta can emerge. In such a scenario, there is no vaccine for children yet and this sets alarm bells ringing over their safety during the upcoming third wave. A lot of schools are reopening as parents and the Government are also concerned about the future of children and there is no solid proof, yet that third wave will specifically target children. The lack of vaccine is, of course, a big challenge and schools and colleges can avoid the risk by opting for online classes and ask students to follow all COVID protocols in case they need to come in person. Children in primary classes should ideally stay at home, advises Gupta.

Bajaj agrees with Gupta and mentions that lack of vaccine for children is a red alert. “It goes without saying that vaccine stays important for both adults and children. The reason why many experts are predicting that the third wave will hit children is because of the lack of a vaccine for them. The complications might differ, there can be several mutations, but we need to have a vaccine for the younger population as soon as possible. Several companies, including Pfizer, are conducting vaccine trials on children below the age of 12 and the data will be available by the end of this year, most probably. So, until then, we would like to again emphasize on the fact that masks, sanitiser and social distancing are here to stay, at least for this year, to say the least. Whether the cases are low or high, make sure that you and your children are following COVID appropriate behaviour at all times. With that being said, vaccine or no vaccine, don’t put your guards down already,” he concludes.