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As the second wave of Covid-19 eases, several Indian states have started to prepare for a third wave, with a particular focus on protecting children.
For example, the Uttar pradesh the government plans to identify and immunize parents of children under 10. Since June 15, the state government began distribute free medicine kits composed of cough syrup and chewable tablets for children through its network of Certified Social Health Activists or ASHAs and other frontline workers.
Jharkhand has prepared a manual detailing its treatment plans and management of the children during the third wave, and estimated that more than 6,000 beds would be needed for them. It says at least 14 lakh children in the state would be at risk for Covid-19 in wave three, even though those under 14 made up just 5% of total cases between March and April this year .
In Karnataka, the government has set up a task force to create additional pediatric wards and Covid care centers for children in all districts.
But what scientific evidence are these initiatives based on? What do we know about the third wave and which demographics will it affect the most?
Not enough, said scientists and doctors who spoke with Scroll. In. “At present, it is very clear that there is no scientific or epidemiological evidence that the third wave would disproportionately affect children,” said epidemiologist Chandrakant Lahariya.
A report prepared by The Lancet‘The Indian working group of the Covid-19 Commission also comes to the same conclusion. So far, most children infected with Covid-19 have remained asymptomatic while mild infections were predominant among those with symptoms, the report says.
Without any evidence, states were reacting “instinctively,” the scientists said. “It’s lucrative for states to put these things in place,” Lahariya said. “States are procedural and want to give the impression that they are following the process.”
Third wave and children
How exactly did the theory of the third wave affecting children come about?
Scientists had no response but pointed to an editorial in The time of India May 12. It was written by Dr Devi Shetty, cardiac surgeon and head of the Karnataka Covid-19 task force to prepare for the third wave.
Since vaccines are only allowed for people over the age of 18, Shetty, in the editorial, urged authorities to vaccinate parents quickly and claimed that the third wave was “likely to primarily attack children. “.
“In the first wave, Covid mainly attacked the elderly and the untouched young people,” he wrote. “The second wave is attacking a large number of young breadwinners. The third wave is likely to attack children, as most adults are already infected or immune.
He argued that treating children and babies in intensive care units was different from treating adults. “Even though we assume that only 20% of them are infected and 5% of those infected need intensive care, we need 1.65 lakh of pediatric intensive care beds,” he said. .
Shetty did not respond to Scroll. Ine-mail queries regarding the scientific basis for its claims. But a few weeks after his editorial, the Indian Academy of Pediatrics issued a statement on May 22 that it was highly unlikely that the third wave would affect children exclusively. “A very small percentage of infected children can develop moderate to severe illness. If there is a massive increase in the total number of infected individuals, a large number of children with moderate to severe disease can be observed, ”he said.
On the other hand, when asked about the scientific evidence determining its decisions, Jharkhand health officials said the state only developed the manual to prepare for the unexpected.
“Our state is the only state to have taken comprehensive action,” said Dr Shantanu Agrahari, chairman of the state’s committee to prepare for the third wave. “We have prepared this manual in case there is a third wave. If there is no third wave, we will not implement this manual. “
In Uttar Pradesh, the state started distributing 18 lakh medical kits to children and plans to distribute a total of 50 lakh kits, said Dr DS Negi, director general of the medical health and welfare department. family of the state government. The kits were divided into different age groups for children under the age of 18 and would include paracetamol tablets, cough syrup, chewable multivitamin tablets and drops, oral rehydration solution tablets, and ivermectin, he said.
Negi did not disclose the state’s expenses for this initiative. “We order all of these drugs in bulk, so we can’t calculate how many were purchased for the kits,” he said.
Scientists said, however, that the distribution of these kits had no preventive value. “In a sense, this is no different from the distribution of Baba Ramdev’s Coronil,” said Vineeta Bal, immunologist and professor at the Indian Institute of Scientific Education and Research, Pune.
“The only useful thing to do is mask and distance, as well as vaccination [for adults], “she said.” Cough syrup and all that are just superficial efforts to show they’re doing something. “
“Trying to predict the unpredictable”
Very little information remains on what India’s third wave of Covid-19 might look like.
“In a way, we are trying to predict the unpredictable because we barely understood the virus,” said Dr SP Kalantri, professor of medicine and medical superintendent at the Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra.
“The virus doesn’t believe in these mathematical steps,” Kalantri said, rejecting the hypothesis that children would be the only vulnerable group left if the third wave hits. “The virus is like someone who is deeply drunk, they don’t know where their next step is, and we are trying to predict that next step.”
While there is no indication of when the third wave will occur, scientists said the theory that it could primarily affect children depended on several variables. “The number of people available to be infected is the main determinant,” said Vineeta Bal.
It also depends a lot on the degree of immunity of the population – that is, the number of vaccinated adults who could protect children, said Jacob John, professor of community medicine at Christian Medical College in Vellore.
“There is no reason to believe that children are more likely to be affected,” he said. “The only other thing I can think of is that adults will be vaccinated and as they are vaccinated there will be fewer adults who will be infected.”
But Kalantri was skeptical about this possibility due to the pace of vaccination in the country, considering that as of June 13, only 25.3 crore doses have been administered in the country of a billion people and more, with only 4.8 crore being second doses.
“I don’t know if this theory will really hold up because we don’t have enough resources to immunize our population,” Kalantri said. “It could take at least a year before we can cover even 80% of the population,” he said. “It all depends on how aggressively we vaccinate. It is a difficult task, even for the government.
Multiple variables and “no data”
Other scientists said that the hypothesis that children would be affected at a higher rate depended on the timing of the third wave. Bal speculated that if the third wave occurs in the next three months, it would be children as well as other unvaccinated adults who would be affected, given the current vaccination rate.
“If this happens later and later, it’s likely that only children will be affected if most adults are vaccinated,” Bal said.
Adding another caveat, she said if the third wave were postponed until June or July of next year, and assuming vaccine-related immunity does not last longer than a year, it would make it more d adults susceptible to the virus next year.
“So there is no single answer that only children are affected,” she said. “But if we had serology data from across the country, then we would know what proportion of the Indian population is infected and protected. But we don’t have any data.
Even if children were to be affected, evidence showed that their death rate was much lower, according to a study published in The Lancet in March. The study analyzed infant mortality rates in seven countries, including the United States, United Kingdom, Italy, Germany and South Korea.
“Overall, there was no clear evidence of an increasing trend in mortality throughout the period up to February 2021, but additional deaths clearly occurred in children and women. young people during periods of strong community transmission, ”he says.
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