In an exclusive interview with Greater Kashmir Correspondent Zehru Nissa, Prof. Jan discusses how the Third Wave will affect the children and what we can do to protect them from SARS-CoV2 in times to come.. Excerpts from the interview:
ZN: How will the Third Wave affect children?
MJ: The first wave that hit the World in 2020 affected the elderly and those with underlying illnesses the most. The mortality was also high in that age group. The Second Wave that hit in 2021, a year after the first wave, affected the younger age group, particularly 30-45 year olds, even those without any co-morbidity. As of today, we have a huge proportion of our population that has recovered from the infection or that has been vaccinated, so we expect them to have immunity. There is no vaccine that is available for children till date, at least not in India. So, what is the susceptible population as of today? It is the children and pregnant women. It is difficult to predict exactly, but as per epidemiological analysis, there is a possibility that the Third Wave will hit this vulnerable population more.
In the first wave, children were 10 percent of the affected. Of these, 7 percent were 10-18 years of age and 3 percent below 10 years of age. That’s a very small proportion and it tells us that most of the children who have been spared in the first and second wave are without antibodies against the virus and at high risk.
ZN: In terms of percentage, we are saying more children will be hit. Will the Third Wave also increase the absolute number of children that will be affected?
MJ: The viruses keep on mutating and the way they affect humans keeps on changing. Recently, Indian variant, that we are now calling Delta variant B.1.617.2 hit us. This virus turned out to be more infectious that the previous strain and the numbers suddenly escalated. Suppose there is another mutation within the next three four months, the kind that could prove to be more dangerous in terms of numbers, we need to keep that in mind.
In the first wave and second wave both, we had 10 percent of children getting affected. But the second wave was much bigger than the first wave and if we had 10 percent of 100 cases in the first wave in a day, in the second wave, we had 10 percent of 1000 cases per day, a number 10 times more.
On the same lines, if we had one percent of the infected children critically ill, we had one child ill. In the second wave, one percent of the infected meant 10 children severely sick. The numbers automatically increase when waves are bigger. The number of children that will get affected will also depend on the strength and severity of that wave.
ZN: How many children were affected in the Second Wave?
MJ: In the first wave we were only admitted severely sick children. At that time we had 19 children, all of whom survived. However, we saw Multi-system Inflammatory Syndrome in Children (MIS-C) increasing last year. We saw 52 children with MISC-C. This year, we have already seen 65 children with Severe and Acute COVID. Post COVID19 complications take a few weeks to develop but we are apprehensive that we will have more children with MIS-C in weeks to come.
ZN: Did we lose any children?
MJ: In the first wave we had three deaths of children; in the second wave we already have lost seven children to COVID19.
ZN: How can we protect children?
MJ: The most important thing is COVID19 appropriate behavior. That is going a long way to protect our children. We still are not following COVID19 appropriate behavior. Masks are still on the chin in some people, social gatherings, especially indoors are still taking place. Before the second wave hit, we had so many avoidable gatherings.
Secondly, it is very important to identify the cases and contain the spread. That can be done by frequent testing.
The third - vaccination. Everyone who is above 18 years of age must go for vaccination. Vaccination of adults will reduce the chances of children getting affected. My appeal to everyone reading this, please follow COVID19 appropriate behavior and get yourself and your adult family members vaccinated. This can save our children in the Third Wave.
If and when schools open, everyone working in the school must be vaccinated – the teachers, the management, the driver, everyone.
ZN: Do we have just three months to prepare for the Third Wave?
MJ: If the Third Wave comes late, we would be better off because, most likely, we will have some vaccine available for children by then. We already have the Pfizer vaccine approved in some countries for children over 12 years of age. In Canada they are doing it already. AstraZeneca is doing trials on 6 year plus children in the UK. The next three or four months are crucial in the sense that if we are able to have some vaccines for children by then, we may be able to protect more children.
In any pandemic there are waves. We can never say for sure how many waves are going to come. Many parts of India and even the USA are reeling under the third and fourth wave. We don’t know when the Third Wave will come, how big it will be or how small it will be.
But before that, we have what we have – our diligence and behavior to protect children.
ZN: What is being done in terms of healthcare infrastructure to manage sick children in the Third Wave?
MJ: We have planned to give a major boost to COVID19 management in the pediatric age group. It is being done at primary, secondary and tertiary care level. We have planned to have primary level facilities at district level for managing cases. In addition, in the Kashmir division, we have JLNM Hospital, in Jammu we have Batra and Narayana Hospital - the secondary care level. All these will have oxygen beds and other facilities. All medical college hospitals across J&K, GMC Srinagar and Jammu, SKIMS Soura and SKIMS Medical College Hospital Bemina, GMCs at Baramulla, Anantnag, Kathua, Doda and Rajouri will provide tertiary level care.
In addition, two DRDO Hospitals are in the process of completion in Kashmir and Jammu division. The bed strength can be increased as per the need.
ZN: What should people look out for in children in case they are infected by SARS-CoV2?
MJ: Many people often ask, when should they bring the child to hospital in case he or she has COVID19 infection. These are some pointers that can help the parents decide:
· If the child has had high fever for more than three days
· If the child is lethargic, drowsy or groggy
· If the child has stopped feeding
· If the child has breathing difficulty
There would be three types of infections – mild, moderate and severe. Mildly sick kids can be managed at home with anti-pyretics. Moderately sick children with Oxygen Saturation between 90 and 94 may need hospitalization. Saturation below that, are critically sick and need intensive support.
ZN: Can a mother continue to feed her child if she has taken the vaccine?
MJ: Yes, vaccination should not be a reason to stop feeding. A mother must continue to feed the child before and after vaccination. In fact, all lactating mothers must get vaccinated. This will protect their children from infection.
Even if the mother has tested positive and has a breastfeeding baby, she should continue feeding. She should wear an N 95 mask, wash hands and continue to feed the child. It is important.