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There does not appear to be any substantial evidence to suggest that children will be more affected or have greater severity of the disease as a result of Covid-19 in the predicted third wave, according to a new report.
The Lancet Covid-19 Commission India task force prepared the report after convening a panel of experts comprising leading pediatricians from across the country to examine the issue of ‘Pediatric Covid-19’ in India.
He said the symptomatology of infection in children in India appears to be broadly comparable.
“Most children with Covid-19 are asymptomatic, and among these symptomatic benign infections are predominant. Most children have a fever with respiratory symptoms, and often have gastrointestinal symptoms (such as diarrhea, vomiting, abdominal pain) and manifestations atypical compared to adults. The proportion of symptomatic children increases with age, as does severity in these age groups, ”the report says.
In the absence of a national database on the clinical presentation and outcome of children infected during the two outbreaks observed so far, data from approximately 2,600 hospitalized children, aged less than 10 years (at newborn exclusion), from 10 hospitals (public and private), in Tamil Nadu, Kerala, Maharashtra and the Delhi-RCN region, was collected and analyzed.
According to the data, the mortality rates among these hospitalized Covid-19 positive children under the age of 10 surveyed were 2.4% and around 40% of the children who died had comorbidities.
“Nine percent of all hospitalized Covid-19 positive children had serious illness under the age of 10. The above observations were similar during the two outbreaks of Covid-19 infections that India has experienced, ”the Lancet document said.
Three AIIMS doctors, namely Sheffali Gulati, Sushil K Kabra and Rakesh Lodha, contributed to the study.
Kabra said less than 5% of children will need to be hospitalized in Covid-19 and among them the mortality is 2%.
“Let’s say that out of 1 lakh, 500 children are hospitalized and 2% of deaths are reported among them. Thus, in a lakh, the mortality of only one or two children is observed. In children, as such, the disease is less severe. A very small proportion require hospitalization and a very low proportion of mortality is reported. Mortality is also due to underlying diseases in the form of co-morbidities such as diabetes, cancer, anemia or severe malnutrition. In normal children, mortality is extremely rare, ”he told PTI.
The data was also assessed separately for the periods corresponding to the two outbreaks, March 2020-December 2020 and January 2021-April 2021.
Comparable observations were recorded in a multicenter study that examined 402 children hospitalized in Indian hospitals, 90% of whom were asymptomatic to mildly symptomatic, and 318 cases in which 44% had underlying comorbidities, he said. .
“Based on the available data, there does not appear to be substantial evidence to suggest that children would be more affected or have greater severity of the disease due to Covid-19 infection in the predicted third wave. Studies also indicate that children have milder disease, better prognosis and lower mortality compared to adults, ”he said.
Regarding multisystem inflammatory syndrome (MIS-C) in children, the report says, risk factors for this disease include obesity, asthma, impaired breathing, developmental disorders, heart disease, cancer or immunocompromised children as well as those who have undergone surgery.
Although the figures indicate low rates of death from acute Covid-19 among older adolescents, it appears to be higher among those who are obese. Most published data suggest a mild to moderate predisposition in most cases and low mortality from MIS-C.
“The preliminary review of cases at representative facilities further corroborates the low severity of cases and low overall child mortality rates. That said, the health system must prepare for a pediatric workload with adequate infrastructure, dedicated facilities at primary, secondary and tertiary levels of care, oxygen availability, appropriate equipment, skilled workforce. , drugs and injectables, among others, all of which are specific to children, ”the report says.
National clinical protocols should be followed at all levels of facilities and all properly trained providers, similar to adult protocols.
“The health system must maintain its routine programs such as vaccination and nutrition and identify high-risk patients in advance for better management. Vaccines will be an important part of the preventive strategy for adults and possibly also for children and this needs to be evaluated and implemented quickly.
“Communication for behavior change and media management should be a priority to help relieve panic and anxiety. Schools must be reopened with caution in person, with online access options as needed, but with a firm resolve to bring back normalcy in children’s lives as quickly as possible, ”the report adds.
READ | Second wave of Covid-19 has stronger infection in children: do children need vaccines?
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