Children have been affected more in the second wave of Covid-19, compared to the last one. Pediatricians across the city say that the effects of the virus on children have changed.
“One reason for increased virality in children may be that the elderly have gotten vaccinated. The virus is smart enough to seek out the more immunocompromised population. Additionally, a lot of young people who were infected by the virus have passed it on to their young children,” says Dr Yogesh Kumar Gupta.
He adds that the mutated virus may also be a cause for increased cases in children.
Dr Sujatha Thyagarajan, pediatric intensive care specialist, says that most children who are coming in, are part of large family clusters.
“There is quite a lax when it comes to enforcing mask wearing for children,” she notes. Dr Mayuri Yeole agrees and adds that even when masks are worn, children tend to rub their eyes and touch their faces after touching other surfaces. “To add to this, as compared to the last wave, people are relaxed and have been travelling more often,” she says.
Dr Ramu DS says most children don’t need intensive treatment and that the symptoms are fairly constant from the last wave. “A negligible number require anti-viral drugs and special care like ventilators,” he says.
The others don’t agree. “In the first wave, children required oxygen support. This age group is now requiring ventilators. Even children younger than a year are requiring such treatment,” says Dr Sujatha.
Low mortality
Dr Mayuri adds that while morbidity is higher, mortality is not as severe. “Even with an increase in severe cases, it’s much less than the number we’re seeing in adults,” she adds. Dr Sujatha adds that cities like Mumbai and Delhi have seen more severe cases in children. “We’ve only begun noticing this trend in the last week but we expect it to get worse,” she says. Dr Yogesh says that most children come in with mild to moderate symptoms.
“They have a headache, cold, cough and fever that persists for five days,” he says. Diarrhoea, vomiting, and dehydration are also commonly reported symptoms. He cautions that children with other comorbidities tend to have a more severe prognosis if infected.
Dr Mayuri says that most children, even those whose respiratory systems are compromised are responding well to treatment. Unlike adults, the go-to drug is not Remdesivir.
“It’s a new disease. There is limited data on how different drugs act on different people, but the standard practice is to not use Remdesivir for anyone below 13. Trials have begun on the usage of the drug for younger children, perhaps the guidelines may change in the future,” says Dr Yogesh.
Dr Sujatha says that experience from the first wave has helped streamline their approach.
“Steroids and antibiotics are the most commonly used. Zinc, Vitamin C, and other drugs have been eliminated,” she says. Dr Mayuri says her hospital follows the guidelines given by the Indian Academy of Pediatrics. “If there is a severe infection we treat it with Tamiflu and steroids. Zinc and Vitamin C are used as supportive medication,” she says.
Are there enough pediatric Covid wards in the city to cope with the demand? The doctors say that all hospitals with a pediatric ICU have transformed them into Covid wards.
“Our non-Covid work has come down which means we have enough resources to direct towards children who require Covid-related treatment,” says Dr Sujatha.
If the number of cases exceeds beyond what hospitals can handle, then there is a challenge.
“Setting wards for children in hospitals that don’t normally have them can be a challenge. Not only do you require space and equipment, but there would also be a shortage in manpower as well,” adds Dr Mayuri.
Post covid complications
Dr Yogesh says that a big worry last year was the post covid complications that developed in children. “We have yet to see an upward trend in this but it only tends to surface past the peak. We’re hoping that’s the case this time too, as this would relive the pressure on the healthcare system,” he says.
Multisystem inflammatory syndrome in children or MIS-C is a severe complication that may occur, says Dr Sujatha. Dr Mayuri explains that these complications can be attributed to Bengaluru being an allergic zone and the disease attacking children’s lungs. “When a part of your lung is infected, your immunity level comes down. Thus when the next season of weather changes come about then the severity of allergic episodes will be worse. We are expecting it to happen this wave as well and are already on our toes,” she says.