More children are testing positive in the second Covid wave but the infection is mostly mild and the mortality rate low, say experts, citing increased testing and enhanced understanding of symptoms as among the possible reasons for the rising graph.
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Though there is enough anecdotal evidence of COVID-19 catching children -- early teens and younger -- there is little reason to panic, said several doctors and scientists. They also stressed on the urgent need to vaccinate children to stem the spread of the infection.
There is a general increase or shift in infection numbers towards children and younger groups as compared to older people, agreed virologist Upasana Ray.
This could be because the virus had already infected more of the older age groups last year, leading to the development of immunity in those who recovered from various degrees of the infection.
“Eventually, this age group was prioritised for getting vaccinated as well which added to the pool of elderly individuals with immunity against this virus,” said Ray, from Kolkata's CSIR-Indian Institute of Chemical Biology.
“It is also important to note that possibly children with 'now known' symptoms are getting tested more and thus infections in this age group are getting reported as well,” she said.
This was not true last year during the first wave of the pandemic as many of the less common symptoms were not well understood at the time.
“Thus, it is quite possible that children were still getting infected, remained asymptomatic or were having mild symptoms or less common symptoms which didn't progress towards alarming stages and thus remained not-tested or not-reported,” Ray explained.
The senior scientist noted that the understanding of the development of this virus, the diverse symptoms, and the manner in which the infection manifests itself has improved vastly.
“Thus, more people are getting tested as soon as they experience any of the known symptoms. This includes children as well,” she added.
In Ray's view, in the present COVID-19 surge, the virus is infecting those to whom it has more access due to lack of immunity, that is, younger people.
Children account for about 3-4 per cent of hospital admissions, in both India and the rest of the world, Niti Aayog (health) member V K Paul said recently.
Though there are no exact numbers to quantify that more children are getting infected, the Karnataka COVID War Room reported 20,206 Covid infections, including 17 fatalities, among children below 10 years from March 1 to May 15 this year when the second wave hit the state.
The case fatality rate among children is, however, only 0.1 per cent in the state.
CFR is the proportion of deaths from a certain disease compared to the total number of people diagnosed with the disease for a particular period.
There are also concerns over a probable third wave of the coronavirus pandemic making children vulnerable to more infections in the absence of vaccination for the group.
While many countries such as the United States and Canada have approved vaccines for children 12 and above, India is still to give nod for preventives in those aged below 18.
Allaying fears of any worse outcomes for children, the Central government on Monday said there is no indication that they will be severely or more affected in the third wave.
"Data from the first and the second wave shows that children are usually protected from Covid and even if they get it, they have mild infection," AIIMS Director Randeep Guleria said at a press conference.
The Indian Academy of Paediatrics has also said recently that though children appear as susceptible as adults it is "highly unlikely that the third wave will predominantly or exclusively affect children".
Giving the view from the ground, Dr Meena J, a paediatrician at Aakash Healthcare Dwarka in New Delhi, noted that COVID-19 had significantly spared children in the first wave except in high-risk groups.
“However, the second wave in India has shown significantly positive cases in children, mostly in the age group of 10-14,” she said.
“The percentage of positive cases in our settings has been around 5 to 10 per cent with 5 to 10 patients coming positive daily during the month of April, while those requiring hospitalisation are less than 1 per cent,” Meena J added.
She, however, said the number has been declining during the last two weeks.
“Although the actual percentage of cases is yet to be analysed, complicated cases constitute 1 to 2 per cent of all positive cases,” she said.
Dr Gauri Agarwal, a gynaecologist at Yashoda Hospital in Ghaziabad, said her facility has received approximately 5-6 per cent of cases where children were affected during the second wave.
“There can be more but parents are not getting children tested when they see symptoms like fever or stomach ache. So I would ask parents to get their children tested if they come across any such symptoms,” Agarwal said.
She said children who test positive for COVID-19 have symptoms such as fever, abdominal pain, loose motions and rashes and are being given the same treatment as adults.
“The good thing is the mortality rate in children is low, they're becoming Covid positive but are also getting better,” she added.
Meena J added that there are clusters of positive cases seen in different regions but overall mortality and morbidity in children is under reported.
“The second wave definitely has increased positivity rate but severe cases are less.”
The doctors emphasised the necessity for expanding vaccine coverage.
According to Agarwal, viruses tend to mutate if they stay long in an environment.
“That is why the Covid virus is mutating every few days. It is expected that children will be more affected in the third wave which means there can be mortality as well,” she added.
To avoid this, she said, the government should start extend the vaccination programme to children.
“A lot of hospitals do not have neonatal intensive care units and paediatric intensive care units, and if more children start becoming affected, it will be a major challenge as we do not have the proper infrastructure to treat them,” Agarwal warned.
Globally, a substantial number of children have been infected till now with COVID-19.
According to data published by UNICEF in March, around 11 million COVID-19 cases occurred in children and adolescents in 100 countries, which is 13 per cent of the total 80 million COVID cases in these countries at the time.
“Over 6,800 children and adolescents died from COVID-19, which is 0.3 per cent of the 2.3 million COVID-19 deaths in 78 countries,” said the report that calculated the data from January 2020 till March 2021.
In the US, children represent about 13 per cent of all COVID-19 cases, according to the American Academy of Pediatrics and the Children's Hospital Association.