Protecting children from COVID-19

Close to 35,000 children contracting COVID-19 infection in Assam over the past three months in the second wave of the pandemic has set the alarm bell ringing for health authorities and parents. Altogether 34 of the infected children have succumbed so far in the state that has devasted their families. With some experts sounding caution that children could be infected more in the third wave, if and when it strikes, the prevailing situation calls for a comprehensive review of the paediatric care system in all hospitals. The Ministry of Health and Family Welfare issued guidelines on June 18 for COVID-19 management in children. The guidelines include advisories for parents and other family members. In the case of child patients with asymptomatic infection, while infants and younger children should stay under the immediate care of parents/guardians in home isolation, children with mild symptoms should stay in home isolation or Covid care centres. Family members have been advised to stay connected with children through phone, video calls to keep them in a jovial mood and parents and caregivers have been advised to contact the doctor in case of appearance or deterioration of symptoms. Children with moderate and severe symptoms must be admitted to COVID-19 hospital and having child-friendly paediatric wards with adequate beds and oxygen and a critical care support system is important. The State Health department has activated the paediatric care units but the rise in the percentage of infected children in the second wave sounds like a caution against any complacency. Data made public by the state Health Department reveals that children accounted for eight per cent of total COVID positive cases in the first wave while it has increased to 12 per cent of total cases of the second wave to date. As the state is trying to gradually unlock and relax the restrictive norms to allow economic activities on a regulated scale infection is poised to rise if people stop adhering to COVID-19 appropriate behaviour. The adult population and elder members of the family must be made aware that any irresponsible behaviour of the adults will only raise the risk of more children getting infected. While adults can be protected with the vaccine shield, infants, minor children, adolescents, and teenagers below 18 years are without any such protection to date. Hence, the larger responsibility of protecting the children from COVID-19 infection must be shouldered by the adult population in the society including their family members. This calls for raising the awareness level on COVID-19 symptoms in children and management. Decoding the Guidelines issued by the Health Ministry in a combination of text and pictorial messages easily comprehensible for parents and other members of the family in as many local languages can ensure timely hospitalization and critical care support to prevent fatalities among infected children. The guideline has also listed recommendations on wearing masks by children to clear the doubts that often grip the parents and elder members in society. Masks have not been recommended for children aged 5 years while children aged 6-11 years may wear a mask depending on the ability of the child to use a mask safely and appropriately under the direct supervision of parents/guardians. Children aged 12 years and over should wear a mask under the same conditions as adults and such awareness need to be spread across the state through mass media and social media messaging. The state Health Department has imparted training to health workers on how to care for children infected by the virus, but it is equally important to assess the level of awareness among the parents in rural and inaccessible areas. Recruiting and training volunteers as temporary healthcare workers to reach out to parents in remote areas which do not have an adequate number of health workers will go a long way in protecting a large number of children out of reach of formal healthcare systems. Transparency on the actual number of hospital wards, beds, critical care units, dedicated hospital staff and arrangements for children and parents or caregivers in Covid care centre can reduce anxiety among parents. The readiness of the state to handle a surge in infection among children must be seen from perspectives of the peak in the waves and not by declining positivity rates. Special attention is needed to take care of the mental health of infected children as well as other children. The vaccines for children are still in trial stages and detection of the Delta plus variant of COVID-19 as a variant of concern in India is a grim reminder to remain prepared for all eventualities. Some experts have discounted the apprehension of higher transmissibility of the new variant, but the country must not be caught unprepared for a third wave as in the second wave. Pressing the panic button is not advised but staying alert is essential to protect the children.