New Delhi, April 23, 2021: Relatively unaffected during the first wave of Covid-19 last year, a high number of children and adolescents are contracting the novel coronavirus in the second wave. A large number of Covid-19 cases in ages more than 10 years and also between 1-8 years are being reported in the fresh surge -- though most are mildly symptomatic.
"If Covid-19 affected 1 per cent of children last year, it is about 1.2 per cent now. But it is a huge increase in terms of numbers in India," Dr Anjan Bhattacharya, consultant pediatrician, Apollo Hospital, told IndiaToday.in. Presently, there is no government data on Covid-19 among children.
While there is no vaccine for kids yet, several companies have started clinical trials among adolescents and young children. India is yet to come up with a treatment protocol for children.
Why are more children testing positive for Covid-19 in second wave? What are the symptoms usually shown by children? What precautions should parents take? What have other countries done to check Covid-19 infections among children? We dissect each question by talking to experts.
Why is the second wave of Covid-19 affecting more children and adolescents?
Experts say the double mutant coronavirus variant alongside a cocktail of other strains have a higher tendency to infect children. Children getting infected from members of family who go outside and are lax in maintaining Covid-19 appropriate behaviour are also part of the spread seen during the second wave.
"The double mutant variant has immune escape phenomena. It masquerades as our own body system and then escapes our immunity protection. This is why more children are contracting Covid-19," said Dr Anjan Bhattacharya.
Dr Jaydeb Ray, Department of Pediatric Medicine, Institute of Child Health, Kolkata, said children were getting infected by Covid-19 in the first wave as well, but most cases were asymptomatic. "But now, we are seeing kids coming to hospitals coming with MISC (Multisystem Inflammatory Syndrome in Children). This time it is showing parallel to an active infection," he said.
However, Dr Sagnik Biswas, Senior Resident, AIIMS, said that given the rapid spread of the virus, the overall number of patients (both young and elderly) is expected to rise, but there doesn’t seem to be any indication that the virus affects younger population more than the elderly. "The percentage of afflicted individuals under 30 years can be placed to around 32% as compared to 31% in the previous wave," Dr Biswas told IndiaToday.in.
What symptoms are children showing?
The second wave has shown that Covid-19 symptoms are not limited to just the respiratory system. The most common symptoms observed in children include high fever, chills, shortness of breath, cough, loss of smell, sore throat, myalgias, and mucocutaneous inflammatory signs. In the second wave, more Covid-19 positive children are showing gastrointestinal (GI) symptoms like loss of appetite, vomiting and diarrhea.
"Case reports are now emerging from several countries saying that Covid-19 may even lead to episodes of pancreatitis and decompensated liver disease, although these are based on clinical experience of few cases," said Dr Sagnik Biswas.
Dr Jaydeb Ray said warning signs such as elevation of inflammatory markers, fast breathing, lethargy and seizures should be monitored by parents for early detection of Covid-19 in children.
Why are Covid-19 positive children showing more gastrointestinal (GI) symptoms this time?
Although respiratory symptoms are more prominently highlighted, gastrointestinal manifestations are seen in up to 40-50 per cent cases, said Dr Sagnik Biswas, Department of Gastroenterology, AIIMS.
"Novel coronavirus uses ACE2 as a viral receptor for entering the GI tract. It is highly expressed in the glandular cells of gastric, duodenal, and rectal epithelia, supporting the entry of coronavirus into the host cells," he said.
Several studies have identified the presence of SARS-CoV-2 in stool samples. "A study comprising 10 pediatric patients evaluated their nasopharyngeal and rectal swabs. Eight children persistently tested positive on rectal swabs even after nasopharyngeal clearance of the virus. Furthermore, a cohort study demonstrated a significant enhancement of ACE2 expression in cholangiocytes as well as liver cells, indicating that the virus can lead to direct damage to intra hepatic bile ducts," Dr Sagnik Biswas said.
What should be done when a child tests Covid-19 positive? What precautions should be taken?
Experts say children showing mild symptoms should be home quarantined for 14 days. "If symptoms are mild and oxygen saturation is greater than 94 per cent, we have to give supportive care, adequate hydration, proper nutrition and paracetamol," said Dr Jaydeb Ray. If CRP (C-reactive protein) and ferritin (blood protein that contains iron) levels are elevated, then children must be admitted to a hospital, he said.
In the absence of any definitive therapy, social distancing, wearing masks, and hand washing are still the gold standard in prevention of disease among this age group, experts told IndiaToday.in.
What has the government said on Covid-19 affecting children?
Union Health Minister Harsh Vardhan told Parliament that children in the age group of 0-14 years were less affected by Covid-19. He said infection among children was mild and most of them remain asymptomatic.
"Hence no specific action plan has been formulated in the current response phase to minimize the adverse effects of Covid-19 on such children," Dr Harsh Vardhan said in a written reply.
Dr Vardhan further said that rarely a severe illness, in form of multi-system inflammatory syndrome, had been identified. This usually happens three to six weeks after the infection, he said. The Department of Pediatrics, AIIMS, is documenting the long-term effect of Covid-19 in children.
Are there any Covid-19 vaccines for children?
No, presently there is no Covid-19 vaccine that can be administered to those below 18 years of age. The Health Ministry has said clinical trials are underway to test the safety and efficacy of Covid-19 vaccines among children.
In February, Hyderabad-based Bharat Biotech had sought approval from the national drugs regulator for Phase 3 clinical trial of its Covid-19 vaccine -- Covaxin -- in children between the ages of 5 and 18 years. However, it was not granted permission since it did not produce efficacy data on adults.
Last week, Pfizer announced that trials of its vaccine in children aged 12 to 15 showed 100 per cent efficacy and a strong immune response, with no unusual side effects. It has now sought emergency approval from the US Food and Drug Administration to use its vaccine in this age group.
The University of Oxford had started testing the Covid-19 vaccine it developed with AstraZeneca in children and teenagers (this vaccine is available in India under the brand name Covishield). However, it has paused the trial following blood clotting issues in adults who received the jab.
Can newborns get Covid-19?
A very small number of cases have emerged where pregnant women infected with coronavirus have passed the disease on to their babies. Infants can also become infected shortly after being born. The US Centers for Disease Control and Prevention (CDC) has said that most newborns who test positive for Covid-19 have mild symptoms or none at all, and recover, but serious cases have occurred.
How have other countries dealt with child Covid-19 patients?
In the US, children represent about 13 per cent of all Covid-19 cases, according to the American Academy of Pediatrics and the Children’s Hospital Association. The National Institutes of Health, which is the US’s medical research agency, has formulated guidelines for treatment of children with Covid-19.
According to the NIH, most children with mild or moderate disease can be managed with supportive care alone. The NIH says Remdesivir can be considered for hospitalised children of all ages with Covid-19 who have an emergent or increasing need for supplemental oxygen. It also suggests that dexamethasone may be beneficial in pediatric patients with Covid-19 respiratory disease who are on mechanical ventilation.
The UK and Israel are planning to start inoculating children within the next six months, reports said. In other countries, specific strategies are being taken to treat severe cases as per the symptoms.