Is there going to be a third wave of the pandemic affecting children? An expert answers

Covid-21 is definitely different from Covid-19. What we mean is that the Covid-19 in 2020, was milder in many aspects. People got infected and though it killed many, households were spared, if they practiced masking and social distancing. This second wave in 2021 (that’s why I call it Covid-21–though it is not an officially recognized word) has left parents looking for information on protecting their children and the steps to take if their child, or a family member, has symptoms of the viral infection.

Because even if one person has been infected, virtually ALL members of the family have been infected this time around, suggesting high infectivity. As a practicing pediatrician, I am seeing 20 to 30 positive kids per, as the virus continues to evolve. Most of them have symptoms like cough, fever or chills, shortness of breath or difficulty breathing, muscle or body ache, sore throat. These symptoms are very similar to adults and often confused with seasonal flu, which used to be very common around this time of the year.   But do we realize that all this is an indication that the third wave is not waiting to happen; it is already here. Unlike the first wave, entire households today are becoming infected with the virus and are likely to impact children too. 

Can children get Covid-19?

In the first wave, we all said that Covid-19 doesn’t infect children, because they have less of ACE2 receptors in their lungs, but it is important for parents to know that it is possible for anyone, of any age, to contract Covid-19—including children. If anyone could have predicted a pandemic, we wouldn’t have had a pandemic. Also, pandemic behaviour and mutations of the virus is left to anyone’s imagination. Generally speaking, pandemics in the past have lasted for close to two years before it stops causing agony.

As the cases continue to rise, children with the infection may be asymptomatic, mildly symptomatic, moderately sick or severely ill. Asymptomatic children are usually identified, while screening. Such children do not require any treatment except monitoring for development of symptoms and subsequent treatment according to assessed severity. In such cases, other than a lot of fluids, paracetamol should be the immediate remedy for fever. Children with mild disease may have a sore throat, diarrhea and cough with no breathing difficulty. 

Few children may have gastrointestinal symptoms like severe stomach pain. Most children ie. 99% get mild infection and don’t require any treatment. However 1 percent or even less of children get serious disease – unlike adults where 5 to 6 percent of people are known to get serious disease. Serious diseases in children are generally less common, because they don’t have many comorbidities unlike adults like diabetes, COPD, cancer, hypertension, heart disease etc.

Precautions: What should parents do?

Infection in kids is generally not common because they have less ACE2 receptors. But it doesn’t mean they won’t get the infection. But the kind of infection we are seeing in senior people like gasping for oxygen is unlikely to happen in kids. However, they are known to get multi-system diseases which are still rare.  In April-May 2021, Maharashtra reported nearly 29,00,000 new cases and 99,000 were children among them, belonging to less than 10 years of age, (accounting for 3.5 percent of total cases).

Gujarat saw a similar trend and many newborns were noted to be affected. What it means is in this second wave we are already seeing newborns and children being affected – and see the first and second wave – we followed exactly 1.5 to 2 months after the USA and UK, and the same happened with the second wave. Now, with vaccinations and other preventive measures, plus with the UK and USA returning to normal life – why will we have a third wave? 

This is just “prediction overboard”, because we were ridiculed for not predicting the second wave. Parents need to know that children  react to how adults behave. Kids are already suffering from mental illnesses, because of solitude, anxiety in parents, lack of interaction with other kids, absence of school and so on. The last thing we need is creating more anxiety and fear in them to scar them for life. 

Let us be sensible and get vaccinated , so that the kids won’t get the disease if the adults are protected.

• Always maintain a physical distance and stay home as much as possible, unless going out for medical treatment or urgent supplies.
• Wear masks (preferably N95 mask without valve) when you are outside, and make sure the face mask is covering your nose. Children above two years of age can also wear a mask.
• Continually wash hands with soap, or use a sanitizer with 70 percent alcohol, making sure the whole surface of the hands is covered.
• Avoid attending public functions, social gatherings, and group play.
• Discuss, demonstrate, and reiterate the importance of Covid-19 Appropriate Behavior (CAB) with your children.

When to get a test for your child?

Get your child tested for Covid-19 if:

• Family members that your child has been in contact with, test positive for Covid-19.
• Your child has symptoms of Covid-19.
• Your child has a fever that has continued beyond three days

Always remember, do not panic. If you have a family member with a positive report, you need to be isolated immediately, in a separate room from the rest of the family (if possible). Children should be shifted to a different room or different house (may be of a friend or a relative).  If by any chance, the child develops fever, it is difficult to know the difference between a common cold/fever and Covid-19 without a test. This could also be a signal that every case of fever or cough in your child may or may not-be the virus — especially if a family member is suffering from Covid-19 or has recently recovered from the virus. However a test is mandatory. 

Parents or the caretaker should maintain a monitoring chart including counting of respiratory rates two to three times a day when a child is not crying. Look for any discoloration of the body, cold extremities, urine output, oxygen saturation monitoring (hand held pulse oximeter) and if feasible, check fluid intake and activity level, especially for young children. 

In a small baby, one can use monitors like raybaby to monitor the baby’s breathing. When out and about in public, adults and kids should wear a mask that covers both nose and mouth, especially in situations outside the home where physical distance isn’t possible. Parents should help younger children practice wearing masks before returning to school, so kids are comfortable wearing them in class. Kids should wash their hands after using the bathroom, sneezing, coughing or blowing their nose, before eating (even snacks) and immediately after coming inside from playing outdoors.

Last but not least, even though there is no evidence that there will be a third wave affecting only children, we should prepare for the worst until this pandemic is over – which will be declared by WHO and no one else. What we need to remember is that the adult population remains at higher risk of moderate to severe disease and children get infected from adults.