While the second wave of COVID-19 continues to wreak havoc, doctors and experts are predicting the onset of the third wave, a killer for children. MUSBA HASHMI reports on how, in the absence of a paediatric vaccine, children can be protected. But for that a robust paediatric healthcare system is crucial

We are stuck right in the middle of what appears to be a very lethal second wave of COVID-19. With not less than 3.5 lakh cases per day, the curve seems to not flatten any time soon. However, the horror doesn’t end here. Doctors, scientists and experts have started predicting the third wave of COVID-19 which is expected to wreak further havoc. More so, because it may hit children in a hard way.

While this is a major cause of worry, the question here is how prepared are we to tackle the upcoming third wave? The answer might not be what we want to hear.

“Viruses hunt for a susceptible population. With schools closed presently, children will be that group once the educational institutes reopen. This will bring on the third wave which will hit children big time,” Dr Arvind Taneja, MBBS, MD (Paediatrics), Diplomat of the American Board of the Paediatrics, Fellowship — Infectious Diseases and Chief Advisor-Senior Consultant, Paediatrics, Rainbow Children’s Hospital, tells you.

In the absence of an effective vaccine for children, they become the most susceptible group and masking and sanitising is the only way out.

“When 70 to 85 per cent of the population is immunised ‘herd immunity’ kicks in to protect people, especially children. Till then masks, social distancing continues to be the norm for children too,” he advises.

The need, he says, is to speed up vaccine trials in children. “If adults vaccinated are safe so should children be. We have experienced this with polio, measles, mumps, rubella live viral vaccines for 60 years and viral influenza for 40 years in infants as young as months old,” Taneja adds and tells you that pediatric trials of vaccines are expected to be completed by October-December.

“However the onset of the third is wave unpredictable,” he says.

The disappointing fact is that we haven’t emphasised enough on paediatric care and as a result we are lacking in it.

“India’s preparation for paediatric COVID-19 is woefully inadequate. We have very few paediatric hospitals in the country, very few paediatric critical care specialists and pediatric trained nurses. In order to be prepared for the third wave, each major and medium sized city in India should have at least one dedicated children’s hospital to care for this fragile population so that we are ready when and if catastrophe such as COVID-19 strikes. This is expected to happen in the third wave,” he tells you.

However, the silver lining is that we may expect a decline in cases by May end, as per the doctors.

 “According to a study, we may expect a decline in cases by the end of May in most States. There could be one or two more peaks of Coronavirus cases but they may not be as huge as the current wave. Different States may see peaks at different times. The prediction is that we may see a declining trend by end of this week in India all together. But if we are to check as a nation, with all cumulative figures, we are either at our peak or are very close to it. Different states will have different trajectories,” Dr Yash Javeri, Critical Care, Anesthesia and Emergency Medicine, Regency Superspecialty Hospital, Lucknow, tells you.

The third wave, he says, may hit a few States in the next two-three months.

“If we put strict measures in place, the third wave may not happen at all places or might not be as huge as the second wave. It depends on how effectively control measures are implemented at the local level in the States, districts and cities everywhere. In a few months, when the naturally developed immunity of people or the one with the help of vaccination fades, the virus can strike again. The only thing that can stop the virus from bouncing back is how people are guarding themselves,” Arya opines.

He adds that if people follow COVID-appropriate behaviour in the coming months which includes  double masking, using hand sanitiser, maintaining social distancing and avoiding going out unnecessarily then we can probably cut the peak.

“If we are  able to vaccinate a majority of population then the magnitude of third wave will be decreased,” he says,

However, Dr Animesh Arya, Senior consultant in Respiratory Medicine, Sri Balaji Action Medical Institute, is of the opinion that it is hard to predict the declining trend. “There is no definite answer as to when we can expect a decline in cases, but epidemiologists feel that with all peaks there will be a fall after two to three months so decline is expected in June. But we can be way off our predictions as in the past,” he says.

Many scientists, infectious diseases experts and people from economics and modelling background are trying to predict the third wave, but from a scientific point of view which is based on the previous outbreak of severe epidemics especially Spanish flu, the expectations are all in the press and it may be in September-October. “It is also being assumed children in the age group 12-15 are likely to be affected largely in the third wave as they are naive and the new mutant strain is very potent and it challenges the immunity of people not naturally protected or partially protected by immunisation,” Arya explains.

He adds that as we all know building infrastructure of tertiary healthcare is essential to treat sicker patients and prevent mortality, we must not forget that primary aim to contain disease by early detection, extensive testing of all levels of contacts, isolating them and treating them well ahead of time of going into serious complications and mortality remains the key.

With that being said, there are several doctors who believe that children might not get affected as badly as it is anticipated, because all these predictions are based on statistics. Hence, parents need not angst too much. However, this doesn’t mean we can put down our guards. All precautions have to be in place, both in the presence or absence of a vaccine.

“There is no evidence that the third wave will hit children. It can happen, but these are only predictions. Though, the symptoms in children are usually mild till date, but this doesn’t affect the importance of vaccination for them. We can’t anticipate if the symptoms will turn severe in the third wave. However, in the absence of a paediatric vaccine, the only way out is to take precautions. Immunity is another important thing. Children should be given nutritious food, including lots of green leafy vegetables and fruits in their diet. Keep them hydrated. Coconut water, twice a day, can do the job. Avoid junk at all costs. And last, but not the least, increase their Vitamin C intake,” Dr Swetha Reddy P, Consultant Paediatrics, Apollo Telehealth, tells you.

Though several States Governments like Maharashtra have already started prepping up for the third wave by setting up paediatric centres, the need is to increase the number of paediatric hospitals, ICU beds and care centres to tide over the third wave with less fatalities and more recoveries.

“To curb the impact of the third wave, the need of the hour is to increase the number of ICU beds and hospitals for children, get more paediatric nurses on board and also to make sure there are ample doctors to attend to children. Our healthcare infrastructure basically needs a revamp, which is definitely not possible at this hour. Hence, now focus should be on building a robust healthcare system, well-equipped with proper staff so that doctors and nurses don’t have to deal with fatigue. The strategy should be to vaccinate 100 per cent children before the third wave hits. Also according to observations the mutants have been severely affecting the children,” Dr Aashish Chaudhry, Managing Director and Senior Consultant, Dept of Orthopaedics & Joint Replacement, Aakash Healthcare Super Speciality Hospital, Dwarka, says.

One of the many ways to prevent children from the risk of getting infected is to get the parents vaccinated quickly. “It is not the children that carry the virus, it is their parents or families who pass on the virus. There are no reports to back the fact, but this is an observation that is made during the first and second wave. Hence, in order to prevent children from catching the infection, the elders need to get vaccinated with both doses quickly. With the shortage of vaccine, this might seem a Herculean task, however it is the only feasible option to reduce the impact of a possible third wave,” Dr Gitali Bhagawati, Consultant and Head, Department of Microbiology and Infection Control, Dharamshila Narayana Superspeciality Hospital, tells you.

And apart from the rest of the measures, we need to prepare an army of young nurses and doctors on standby to move from one city to the other based on the COVID wave, to support busy hospitals. For this, we need to motivate and encourage them largely, because money alone, won’t motivate young people to risk their lives in COVID ICU wards.

And lastly, mildly symptomatic patients should be isolated immediately, in order to reduce the risk of them spreading infection. “In order to flatten the curve and reduce the exposure to vulnerable population of children who are at the higher risk due to lack of herd immunity or passive immunity, mildly symptomatic patients should be provided isolation facilities till they get infection free since the infection rate this time is high,” Arya tells you.

Youngvaccine

• While many companies like Bharat Biotech and Pfizer have started the second and third phase vaccine trials on children from two to 18 years, there is still a long way to go for the vaccines to be available in the market for use.
• The Drugs Controller General of India  has cleared phase II and III clinical trials of Covaxin COVID-19 vaccine for children from two to 18 years.
• US biotech firm Novavax had also started clinical trials of its proposed Covid-19 vaccine on children.
• Pfizer is running a trial for children 6 months to 11 years old.
• Moderna is also running a trial in the United States and Canada for kids between 6 months and 11 years old.