Is a third wave to be expected? Covid-19 in children & neonates: Current perspectives

August 17, 2021

By Dr. Abhishek K. Phadke

In the midst of the second wave of Covid-19 pandemic in India, there are great many speculations doing the round about a third wave emerging. Parents are worried about their kids getting infected, and have various questions in this regard.

Q1. Is there any possibility of a Covid-19 third wave striking in the coming months?

A: Historically, it is well known that pandemics tend to occur in waves, and each wave affects a large number of people. Eventually, most of the population may become immune through asymptomatic or symptomatic infections (herd immunity). Over time, the disease may die out, or may become endemic in the community with low transmission rates. Yes, there is the possibility of a third wave emerging, but it is difficult to predict its timing and severity.

Q2. Are children at a greater risk in the third wave as being discussed in the media?

A: The first wave primarily affected the elderly and individuals with co-morbidities. In the current (second) wave, a large number of individuals in the younger age group (30-45 years) have also been affected severely, as also those without co-morbidities. After the second wave subsides, if we do not continue following CAB (Covid-19 appropriate behaviour), a third wave, if and when it occurs, is likely to infect the remaining non-immune individuals – that may include children also. The latest sero survey (Dec 2020, Jan 2021) shows that the percentage of infected children in the 10-17 age group was around 25%, the same as that of the adults. This indicates that while children are being infected as much as the adults, they are not being affected as severely as the adults. And it is highly unlikely that the third wave will predominantly or exclusively affect children. However, it is important to prepare ourselves for it with caution, but without panicking.

Q3. Are children likely to be as severely affected by the disease as adults are being affected by it in the current wave?

A: Fortunately, children have been relatively less affected so far due to several factors. A very small percentage of infected children may develop moderate to severe disease. If there is a massive increase in the overall numbers of infected individuals, a larger number of children too might be affected in a similar manner. There are many guidelines available on the modalities to manage Covid-19 among children, which is slightly different from the protocols to be followed for adults. Apart from infection, parents should watch out for mental health issues in children and keep a watch to prevent child abuse and violence. Also, it will be worth limiting screen time and preparing children for taking care of themselves while attending classes once schools reopen.

Q4. Are there any post Covid-19 issues that can occur in children?

A: Yes. In some cases, after 2-6 weeks of asymptomatic or symptomatic Covid-19 infection, ‘Multi-system inflammatory syndrome (MIS-C),’ may set in due to immune dysregulation; some of these cases could be severe. However, it is a treatable condition, and if diagnosed early, the outcome is unlikely to be complicated. Also, most children suffering from MIS-C will not transmit the infection to others. We have so far seen more than 15 such cases in our hospital, and the recovery rate has been 100%.

Q5. What should be the preparations in case a 3rd wave strikes and affects children?

A: Fortunately, most children getting infected may develop only a mild fever, and would only need home care with monitoring. We have learned a lot about the Covid-19 illness from our shared experiences in adult medicine in the last 15 months. IAP guidelines on the management of Covid-19 in children are in place, and paediatricians have been sensitized and trained on Covid-19 management. There is however a need to educate parents on the illness and its symptoms on different platforms. Also, there is a need to set up more Covid-19 wards equipped with high-dependency units (HDU) and intensive care units (ICU) for children. It may turn out to be a challenging task; we just hope the third wave does not occur! Also, please note that preventive behaviours like mask etiquette, hand hygiene and social distancing apply to children also.

Q6. If a woman is diagnosed being Covid-19 positive during or around the delivery time, can she breastfeed her baby?

A: As per World Health Organization, the benefits of breastfeeding outweighs the risks involved. A mother can breastfeed her baby after taking adequate precautions like wearing a mask and sanitizing before and after handling the child, etc. The risk of vertical transmission (transplacentally from mother to baby) is very low.

Q7. Are pregnant and lactating women eligible for Covid-19 vaccine?

A: As of now, lactating women are eligible to get vaccinated as per the MOHFW, Government of India. With regard to pregnant women, the committee and the government are yet to take a firm decision. Moreover, as of now, there is not enough data on the vaccine’s impact on pregnant and lactating women. As per the preliminary studies, the benefits of vaccination surely outweigh the risks involved.

Q8. Please give an updates on Covid-19 vaccines for children.

A: To date, the world over, priority has been to vaccinate those in the high-risk elderly age group as they are considered more prone to the disease than others. Next in the list comes the adult population who are far more vulnerable compared to children. As there is a remote possibility of children also getting affected, some countries have been considering vaccinating children and adolescents also along with adults. However, vaccinating children with the same vaccines used for adults should be considered only after adequate trials. One of our India-made vaccines is already undergoing clinical trials in children, and if proven immunogenic and safe, it could be fast-tracked for mass vaccination of children.

To sum it up, there are no clear indicators to suggest that the third wave will predominantly or exclusively affect children. However, it is always good to be pro-active and prepared for any eventuality. Along with taking adequate precautionary measures, we hope and pray that the third wave just doesn’t occur. I am reminded of a dialogue from my ‘all-time-greatest’ movie, Shawshank Redemption: “Hope is a good thing, maybe the best of things, and no good thing ever dies.”
Please contact phadke18@gmail.com/+91 9945 629 232 for any queries or suggestions.

(Reference: Indian Academy of Paediatrics Covid Task Force 2, 2 May 2021).

  • Dr. Abhishek K. Phadke is a Consultant Neonatologist at Indiana Hospital, Mangalore

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