Dr. Rakesh Lodha, Professor and Incharge at the Pediatric Intensive Care Unit of AIIMS, New Delhi, is among the best-known pediatricians in the country. In an interview with Swimmi Shrivastava, Dr Lodha talks about how Covid -19 has affected children.
Q. It has been reported that children were affected more during the second wave of Covid-19. Why was it so?
A: During the second wave of the pandemic, the overall number of Covid-19 cases was high. Therefore, the absolute number of children who tested positive also increased. In the previous wave, the data suggested that of the total number of people who had tested positive, around 11 to 12 per cent were below 20 years of age. This proportion did not change during the second wave. So, the children were not disproportionately affected and it is unlikely that children will be disproportionately or more severely affected in the future waves. The available data also suggests that of all children who tested positive, only about 5 to 6 per cent needed hospitalisation. And most children who were hospitalised had some underlying disease such as chronic kidney disease, chronic lung disease, liver disease, malignancies, or hematological problems. So, essentially when children get exposed to the virus, they get infected, but they usually remain asymptomatic or display mild symptoms. As compared to adults and the elderly, the infection is less severe in children. The only concern is that post–Covid, in rare cases children develop a potentially serious condition called Multisystem Inflammatory Syndrome (MIS-C). So, since the total number of cases was high, the number of MIS-C cases also went up. And a large proportion of these children were RTPCR-negative but showed antibodies for Covid-19. We need to be prepared to treat more cases of MIS in the future.
Q. Can you elaborate more on Multisystem Inflammatory Syndrome? What proportion of children with Covid-19 is susceptible to developing MIS-C?
A: It is an immunologically mediated condition, which can affect multiple systems such as the heart, liver, kidney, etc. It may manifest as high fever, rashes, conjunctivitis or the redness of eyes, severe abdominal pain or poor perfusion. There are well-defined criteria to diagnose it. It could be life-threatening in a subset of children, especially in those in whom it affects the heart. But if it’s diagnosed in time, it can be treated effectively. The average age of affected children is around 9-10 years; however, younger and older children may also develop MIS-C. In the West, about 1 in 1000 children with Covid19 developed this syndrome.
Q. How do we treat children with Covid-19?
A: Children with asymptomatic and mild Covid can be managed at home. For asymptomatic pediatric patients, we don’t recommend medicines, but we do recommend that they should be isolated and monitored. One person should provide care to the children, and he/she should also stay in isolation. In mild cases, symptomatic treatment for fever or body ache should be given. Children should be treated under regular medical supervision. They may take telemedicine support. Some children with underlying illness and mild Covid-19 may require hospitalisation. However, children with moderate to severe Covid need hospitalisation for supportive care, including oxygen therapy/ respiratory support. Some may need steroids.
Q. Does the country have enough pediatric care units to deal with serious pediatric patients?
A: The country has a large number of pediatric ICUs but these are concentrated in urban areas. Besides, a majority of intensive care facilities are in the private sector, so accessibility and affordability could be an issue. In addition, there are challenges relating to trained manpower to manage pediatric illnesses. The authorities across the country are working hard to augment the healthcare facilities and manpower for pediatric care. Besides, we need to prepare hospitals in a way that parents can stay with children, particularly younger children, suffering from Covid. The parents would have to take precautions in terms of adequate masking, other appropriate protective gear, etc.
Q. How important is it to vaccinate children against Covid-19?
A: Trials in children have been initiated to study the antibody response of some of the available vaccines. These are likely to be completed over the next few weeks, and if the vaccines are found to be immunogenic, they will be approved for use in children. Having said that, it is also true that children are less likely to develop symptomatic disease, and they rarely get the severe disease. The current vaccines reduce a person’s chance of developing severe disease and mortality and so vaccines should be prioritised for high-risk groups.
It will be appropriate that the high priority groups – the elderly, and those with co-morbidity, those who are at risk of developing severe disease and mortality – should first get the vaccine, and then gradually, when we have sufficient vaccines, we can immunise all children as well. Till the time the vaccine coverage is substantial, and also after that, we all have to adhere to CovidAppropriate Behaviour. This will certainly help protect the children.
Q. The pandemic has been affecting the physical as well as the mental well-being of children. What should be done to minimise its impact?
A: Yes, there are many direct and indirect effects on children. And I feel that the direct effects are not too many and too severe when compared to adults, but there are multiple factors affecting children indirectly. For example, the income of many families would have been affected during the last year and a half, which affects children’s overall growth as it affects their nutrition, education, and so on. The absence of school, limited or no interactions with peers can also lead to a lot of behavioural issues among children. So, it is important for the parents or guardians to provide a cheerful environment to children. Involve them in some form of physical activity at home. Besides, the children who have lost their parent(s), need the support of the government, extended family, and society.