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How Can We Be Better Prepared to Manage COVID-19 in Children?
In India, more children are testing positive in this second wave than the previous one. For children, COVID-19-related complications manifest in the form of a rare but dangerous multi-system inflammatory syndrome called MIS-C. How can we then protect our children against this unknown and widespread disease? In this article, Dr. Sanjay Prabhu discusses how the public and healthcare professionals can better manage COVID-19 in children in anticipation of a third wave of the pandemic.

As the second wave of COVID-19 begins to recede in India, we have seen a worrying new trend – more children testing positive in this wave than the previous one. In May 2021, in the Ahmednagar district of Maharashtra, around 10 per cent1 of all positive cases were children. While most were asymptomatic, this should not be a time to ease precautions. We must continue to ensure that children are well protected amid speculations of a third wave, which is predicted to affect children the most.

This wave also saw more COVID-19-related complications. For children, it manifests in the form of a rare but dangerous multi-system inflammatory syndrome called MIS-C.2 MIS-C is a deadly condition where multiple body organs, including the heart, kidneys, skin, eyes, and gastrointestinal tract, can become inflamed. More than 2,000 cases3 of MIS-C have been recorded in India since the start of the pandemic.

As we look ahead, the public, frontline workers, and medical staff should be equipped with information to help detect and protect children against COVID-19. By doing so, we can better support India and our healthcare system as we prepare for a new wave of infection.

Recognising COVID-19 in Children

Protecting children against COVID-19 starts with identifying the symptoms. The testing infrastructure for children is not as readily available compared to adults. Generally, children are assumed to be positive if a parent, particularly the mother, has tested positive. Moreover, most of the children with COVID-19 are asymptomatic or mildly symptomatic. Only a small percentage will exhibit symptoms that are very similar to that of adults. This includes a fever, cold, cough, diarrhoea, vomiting, and body aches, which can last for 48 to 72 hours.

A small subset of children will experience moderate symptoms including hypoxia and pneumonia, while an even smaller number will develop MIS-C. Symptoms usually manifest two to six weeks after contracting the disease. Symptoms include a fever that can last more than three days, along with a peculiar skin rash, redness in the eyes, inflammation of the tongue and inner cheeks, diarrhoea, abdominal pain, extreme weakness, and hypotension.

Many parents and caregivers mistake MIS-C for other tropical diseases and often delay treatment. MIS-C is critical and requires intensive care. Parents and caregivers must be equipped to detect the signs of MIS-C and seek treatment early at designated COVID-19 care facilities.

For healthcare professionals, being able to diagnose MIS-C is equally important. Certain tests — such as blood tests, chest x-ray, or echocardiography of the heart — may be carried out to look for inflammation or other evidence of disease.

Protecting Children With COVID-19

Since the first wave of the disease, we have seen that majority of children do not require critical care. Therefore, parents and caregivers play an important role in protecting children against COVID-19 at home. As there are currently no approved vaccines for children in India, all adult family members must be vaccinated to prevent the further spread of the disease.

Aside from being vaccinated, there are some simple measures to follow per the guidance from health authorities. Firstly, it is important to continue social distancing. Children should be kept at home and away from group activities or social events with other children and adults. In addition, for children who have tested positive, grandparents should isolate themselves to control the spread of the disease.

Secondly, children above the age of two are encouraged to wear masks when going outside. Masks should be worn covering the nose and mouth and children should be educated on the importance of practising good personal hygiene such as repeated hand washing.

Lastly, having good nutrition is extremely helpful in this pandemic. While no special vitamins or supplements are known to prevent COVID-19, it is good to maintain a healthy diet and remain hydrated to strengthen the immune system.

Treating Children With COVID-19

COVID-19 is still a relatively new disease, and the pace of information discovery continues to accelerate. Currently, the treatment of children is largely symptomatic, and steroids are used only if the child becomes hypoxic. MIS-C, on the other hand, is different from the most common form of COVID. Hence, healthcare professionals must be careful when treating MIS-C as it is more severe and requires critical care.

Evidence-based information is one way we can support the healthcare workforce. During the second wave, the healthcare workforce was stretched thin caring for patients with finite resources and limited time. As speculations of a third wave emerge, we must equip more doctors with access to the right information at the right time — especially in the rural areas of India — to ensure that the quality of care provided is consistent with global and national guidelines, despite existing conditions. This is where technology can supplement the workforce and train healthcare professionals, including non-pediatric doctors. By leveraging point-of-care solutions, healthcare professionals are supported in the assessment, diagnosing, and treatment of the patient to provide the most optimal care.

For the public, who are often prone to widespread misinformation on the virus, having credible and accurate information on the COVID-19 disease is essential. To help, Elsevier has launched the India COVID-19 Healthcare Hub, which provides patients with a single source of accurate data to help curb the spread of misinformation on the disease and its management. The public can also access these resources via a designated WhatsApp channel set up by Elsevier to disseminate timely information about the disease.

Conclusion

Many scientists now term COVID-19 as “endemic,” meaning that the disease is not likely to completely disappear. We will keep getting small waves of outbreaks and evolving strains of the virus. Therefore, we must ensure that both the public and healthcare professionals are kept up to date on the latest developments around SARS-CoV-2 so that we can eradicate misinformation and protect our community.

By providing the public and healthcare professionals with access to trusted information, we will be in a better place to live with COVID-19 and respond swiftly to any changes.

References

  1. Khelkar, P. P. (2021, June 2). Over 9,900 kids test Covid positive in Maharashtra’s Ahmednagar, officials say figure not alarming. India Today. https://www.indiatoday.in/coronavirus-outbreak/story/over-9-900-kids-test-covid-positive-in-maharashtra-s-ahmednagar-officials-say-figure-not-alarming-1809963-2021-06-02.
  2. Centers for Disease Control and Prevention. (2021, February 24). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html.
  3. As India’s coronavirus hell eases, new killers emerge. South China Morning Post. (2021, June 8). https://www.scmp.com/week-asia/health-environment/article/3136487/hearing-loss-organ-failure-fungus-gangrene-indias.
About the Author

Dr. Sanjay Bhagwant Prabhu
Chief, Nutritional Rehabilitation Center and Senior Consultant UNICEF, B J Wadia Hospital for Children, Parel, Mumbai; Director, Neoplus Children Hospital, Mumbai.

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