No evidence children will be exclusively affected if third wave hitsChild health experts say preparation is key, but no need to panic over predictions on unfounded claims. Everyone is at equal risk since the vaccination coverage is low.
With a third wave of Covid-19 predicted, concerns now have grown if it could affect more children, as the number of those between 0 and 9 years and 10 and 19 years contracting the virus had sharply risen when the second wave was at its peak.
Issuing a circular on June 5, the Ministry of Health had asked all hospitals to allocate 20 percent beds for children, saying that they could be affected more if a new wave hits the country.
Even though the new coronavirus cases have receded, a third wave is imminent, given the prediction in India by a group of experts.
Doctors and child health experts, however, argue that when it comes to risk of infections, the entire population is at risk, and saying that children would be affected more by the third wave is a mere conjecture.
“We do not have any scientific evidence to back the claims that children will be affected more if the third wave hits the country,” said Dr Rita Hamal, a consultant pediatrician at Om Hospital and Research Centre. “We do not know on what basis the Health Ministry said that children will be affected more in the third wave.”
It’s not just in Nepal where this misinformation has found traction among the public and officials. Even in India, some have argued that a third wave could pose more risks to children. There too, experts have said there is no basis to make such a prediction.
In Nepal’s case, the number of children affected during the second wave was more compared to the first wave. But the rise in infections among children was attributed to the government’s reluctance to close schools on time.
Last year, the entire country went into lockdown quite early–from March 24 when there was just one active case. The lockdown continued until July 21. But schools did not open immediately, as the number of cases had crossed the 17,000 mark despite the lockdown. After the infections reached a peak in October, the country, however, started to witness a dramatic decline in the number of new daily cases.
Complacency grew. Authorities went into a chest-thumping mode, projecting the decline in cases as their victory over the virus. The public too became careless. Everyone behaved as if the pandemic was over, and schools too started regular classes.
When India was hit by a more lethal second wave, it did not take long for the virus to take hold in Nepal. It was during that time when many children were affected, but experts had advised not to panic, saying children would respond to regular medications.
The second wave, however, exposed Nepal’s fragile health system, as hospitals ran out of beds, ventilators and oxygen. Against this backdrop, the Health Ministry could have issued a circular regarding 20 percent beds for children in all hospitals.
“There is nothing wrong in being prepared,” said Dr Bikas Devkota, secretary at the Health Ministry of Lumbini Province.
According to Devkota, a child health expert who also served as Health Ministry spokesperson in Kathmandu during the first Covid-19 wave, most of the health facilities are not prepared to deal with a surge in infections among children.
“If hospitals have been told to keep aside 20 percent of beds for children, it should be taken as part of preparations,” Devkota told the Post.
There, however, are concerns if all the hospitals can allocate 20 percent of beds for children only since not all hospitals are equipped to treat and provide care to children.
“Placing infected children in all hospitals proportionally could also mean increasing the death rate,” said an official at the Health Ministry who did not wish to be named. “Forget other hospitals outside Kathmandu, even all central hospitals do not have facilities to provide paediatric care.”
Though the number of children contracting the coronavirus was high in the second wave, there is not a big difference in comparative figures.
According to the data provided by the Health Ministry, 27,673 individuals of 18 years and below have tested positive for the coronavirus from April 21 until Sunday. As many as 33 individuals from this group have died of the virus.
In the first wave, 21,523 individuals of 18 years and below had tested positive and 38 had died.
The second wave, however, stoked fears for two reasons, experts say. First, the number of cases among all age groups was rising at an exponential rate and second, schools were open.
As Nepal stares at a third wave, it is but natural to be worried, say doctors, as the country’s vaccination rate has been dismal, with no signs of additional doses arriving anytime soon.
Experts say there is no denying that preparing for the worst is a good move, but making predictions without scientific basis does not help, as they could spread fears in society.
“Where is the study? When there is no proper study on the overall coronavirus situation in the country, how can we say which group will be affected more and which group less,” said Dr Baburam Marasini, a former director of the Epidemiology and Disease Control Division. “Authorities should have carried out preparations internally rather than issuing a circular.”
A recent seroprevalence study carried out by All India Institute of Medical Sciences and the World Health Organisation shows that exposure of children to the coronavirus has been similar to adults, which means a possible third wave of infection could not disproportionately affect the children.
Authorities in Nepal, however, have not performed such large scale seroprevalence studies–neither among adults nor among children.
Authorities’ failure to pay attention to preparatory measures and tendency to take ad-hoc decisions have been criticised in the past too. It has been exactly a year and a half since Nepal recorded its first coronavirus case. Authorities’ poor preparations were exposed badly when the country was hit by the second wave.
Officials should make science- and evidence-based assessments rather than trying to predict the unpredictable, doctors and experts say. According to them, the Health Ministry may have issued the circular after seeing a sharp rise in infections among children during a certain phase during the second wave.
“In Nepal, less than three percent of the population has been fully vaccinated, hence people of all age groups are vulnerable if a third wave hits the country,” said Hamal, the pediatrician. “No one actually knows the status of infections among children in the current wave.”
When the government will be able to acquire vaccines–and from where–is not clear yet. Chances of getting the jabs from India are slim, given the coronavirus crisis it has been dealing with and a third wave predicted by October.
The government has been working to buy vaccines from China, but the plan appears to have run into controversy.
COVAX, an international vaccine-sharing scheme backed by the United Nations, which has committed to providing around 13 million doses, is struggling to secure vaccines.
In such a scenario, authorities should focus on ramping up testing and preparing to deal with the surge in cases while making efforts to get vaccines instead of engaging in making prophecies, say doctors.
Health Ministry officials admit that there is no scientific evidence to say a third wave will affect children more.
“As preparations were more focused on the adult population in the first and second wave of infections, one of the objectives of the circular is to alert the agencies concerned to be prepared to treat children as well,” Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post. “The risk is high for children as making them comply with safety protocols is not easy and they could be exposed to infection at school.”
Since the vaccine coverage is low, everyone from all age groups is at equal risk, Adhikari admitted.
Amid third wave warnings in India and concerns raised by some that children could be affected more, the Indian Academy of Pediatricians last month said in a statement that it was highly unlikely that the third wave would exclusively affect children.
“A very small percentage of infected children may develop moderate-severe disease. If there is a massive increase in the overall numbers of infected individuals, a large number of children with moderate-severe disease may be seen,” said the statement, according to the Indian Express.
Dr Sumit Agrawal, a consultant pediatrician at the Kanti Children’s Hospital, said that his experience during the first and second waves has been that among the children infected with the coronavirus, most showed mild to moderate symptoms.
“Several asymptomatic children whom I examined in the outpatient department tested positive later and tests were performed on recommendations,” Agrawal told the Post.
Doctors concur that there is a need to prepare but not to panic. They say prophesying that a certain group of people, like children, will be exclusively affected is tantamount to creating panic.
There are several factors that need to be taken into consideration, according to Hamal.
“Only by reinforcing health infrastructure, we cannot deal with such an unpredictable virus. We need trained human resources as well,” said Hamal. “As far as children are concerned, they rarely need intensive care and ventilator support even if they are infected. Unless they have comorbidities—cancer, heart disease, renal problems and others—they may not get serious. We, however, need to prepare ourselves to deal with the situation.”