WILL COVID-19 WAVE THREE ENDANGER CHILDREN IN INDIA?

Following the first and the second wave of the 2019-SARS-CoV-2 virus that has ravaged India, the third wave speculated to lash on the country later this year is likely to be more dangerous that will affect the country’s child population, writes RAJENDRA T NANAVARE


The CoViD-19 pandemic is perhaps the greatest healthcare challenge of a generation. It is a new pathogen that is highly contagious, spreads quickly, and capable of causing enormous health, economic and societal damage. Health experts have predicted that the third wave of the virus is likely to hit India later this year. They have categorically warned that children would be badly affected, more than adults.

India has already bore the brunt of the first two waves. In wave one, it was lives over livelihood. In wave two, it was economy over lives. The third wave would, however, not be as severe as the second one, but is likely to be little bigger than the first. Going by expert predictions, if wave three of the virus infects minors, families will crumble. Hence, well before the third wave lashes on, we should ramp up our vaccination drive and adhere to the CoViD control norms on a war footing to mitigate its devastating effect.

According to expert predictions there is high probability children will be widely affected in the third wave of the CoViD-19 pandemic in India (Picture courtesy: Getty Images)


PANDEMIC WAVES

A pandemic generally comes in waves. These waves are the curves of outbreak of new cases of a disease, which reflect the rise and fall of the number of positive cases over a defined period in a particular geographical area or location. In a pandemic a wave sets in when a sustained rise in the infection peaks and subsides when the virus has been contained and the rate of fresh positive cases start falling exponentially.

Epidemics of respiratory disease in the past 150 years have shown that the peak of the waves differ. For example, the 1889-92 influenza epidemic had three waves with varying degrees of virulence. The Spanish Flu in 1918 hit the world in three successive order. The first wave had death rate of 6/1000 population and the second wave it was 25/1000 and in the third wave had a casualty of 12/1000 of the population. The Spanish Flu affected two-thirds of the world’s population before the virus died out.

But we are not sure if CoViD-19 would walk the Spanish Flu path. No respiratory viral infection has been as deadly as the Spanish Flu. Data from the United Kingdom show that of the three waves that struck the planet, wave 2 was more deadly and long-lasting than the first and the third ones.

We saw when the first wave of CoViD-19 struck, it infected the aged, sick and the immuno-compromised – the most vulnerable sections of the population. The second wave of CoViD-19 spread out over the general population who may have been saved from contracting the infection in the first wave and have not developed the protective antibodies against the pathogen.

WHY MULTIPLE WAVES

The well-known reason for multiple waves is the mutation in the genetic code of the coronavirus. Viruses constantly transform. Their genetic code is prone to changes called mutations that can change how a virus looks or affect its hosts. If we cannot ramp up vaccination, the virus would get more time to mutate and find ways to evade or trick antibodies. Scientists and public health experts believe that herd immunity is impossible because the virus is changing too quickly. New variants are developing and spreading fast. Therefore, mass vaccination, as fast as possible, is the only medicine to drive away this life threatening pathogen.

VACCINATION

Vaccines have prevented mass deaths, disability and suffering than any other medical discovery or intervention. A vaccine helps the body’s immune system to recognise and fight the viruses or bacteria, and helps to keep us safe from the diseases they cause. India started its vaccination drive just before the second wave set in. Healthcare, frontline workers and senior citizens above 45 years of age with comorbid condition have been vaccinated. Now people between 18-44 age have started getting vaccine. Yet, till now, a mere 11% of the country’s population has been vaccinated with, at least, the first dose. Despite alarm bells for the third wave have already been sounded, India’s daily vaccination targets are barely crossing the 4-5 million mark.

Currently, there are only two vaccines available in the Indian market. But neither of them has data on trials on children. While Bharat Biotech is set to start Phase 3 trial of its vaccine for the 2-18 age group, AstraZeneca is conducting trials for its vaccine in the 6-17 age group. There is, however, no data yet.



PREDICTION OF THIRD WAVE

Principal Scientific advisor K Vijay Raghavan and other experts have already raised the possibility of a third wave in the CoViD-19 pandemic. Several countries have already been lashed by the fourth wave of the Coronavirus. Europe is undergoing its third wave of infections right now, while the United States is in its fourth wave. Japan, Singapore and a few other Asian countries are also experiencing the third hit by the virus. As waves are inevitable in a viral outbreak, and India is struggling hard to contain the deadly second wave, public concern is mounting when the third wave will fall in.

HEALTH INFRASTRUCTURE

India has a three-tier basic health infrastructure topped by district hospitals. Tertiary care has been in place for years but neglect and gross underfunding has hollowed it out so much that during the prevailing second wave of CoViD-19, it has majorly failed to come to the rescue of the hapless rural populace. As population has grown, the three tiers – sub-centres, primary health centres (PHCs) and community health centres (CHCs) – have increasingly run out of capacity to handle the CoViD afflicted patients.

Keeping India’s dilapidated healthcare system in mind, health experts are calling for massive preparation to tackle the third wave even as the country is battling the second wave of the Coronavirus. They are of the view, if it is not countered with adequate medical resources, well in advance, then India”s child population will run into grave danger. Experts have categorically predicted that the third wave of CoViD-19 that is likely to hit the country later this year would affect the children more than the adults. They have alerted that the B.1.617 variant of the virus, in its second wave, has affected more minors in India than it did in the first wave.

THE DELTA VARIANT

Worrisome is, new variants of the virus are spreading fast. Mass vaccination, as early as possible is, therefore, the only feasible solution now. A study by the Indian government has found that Delta has become, by far, the most dominant strain in the country.

The Delta variant has multiple mutations that appear to give it an advantage over the other strains. The most important apparent advantage is that the mutations may make the strain more transmissible, which would also make it the most dangerous variant yet. The Delta variant or B.1.617.2 strain, which was first detected in India, is more infectious than the Alpha variant or B.1.1.7, first detected in the United Kingdom, and is also the reason behind the second wave of the Covid-19 pandemic, reveals a study conducted by a team of scientists from different Indian institution.

PREVENTIVE MEASURES

Several states in India have already started taking measures to ensure there are arrangements in place to protect the children. Delhi, Karnataka and Maharashtra, worst hit by the second wave, have already started taking preventive measures. The Delhi government has formed a special task force to protect the children. Karnataka has announced several measures for CoViD-19 management among children. The Karnataka Government is working to setup paediatric CoViD-19 care centres and rehabilitation units for the orphans in all districts of the state. BMC has planned to set up a paediatric CoViD-19 care facility in Mumbai and a network of crèche for children whose parents are in hospital for CoViD-19 treatment.

EXPLORATIVE TREATMEMT

Even as the first two waves of CoViD-19 spread at unprecedented rates, devastating human lives and economy of India, no approved treatment for CoViD-19 has yet come up. Researchers across the world are testing a host of therapies in a desperate bid to save the lives of people. Certain therapies, administered until recently, to be part of CoViD-19 treatment have been rejected by the Indian Council of Medical Research (ICMR) and World Health Organisation (WHO). While ICMR has dropped Plasma therapy, WHO has issued a conditional recommendation against the use of Remdesivir in hospitalized patients, regardless of the disease severity as there is currently no evidence that Remdesivir improves survival and other outcome in the CoViD-19 patients. WHO’s Chief Scientist Dr. Soumya Swaminathan and their Technical Lead on COViD-19, Dr. Maria Van Kerkhove, told the India Today TV in an interview on April 12 of this year that findings from five clinical trials in the past show that the use of the anti-viral drug has not helped in curtailing mortality or reduced the need for mechanical ventilation among hospitalised Corona infected patients.

CHILDREN INFECTION DEMOGRAPHY

In the first wave of CoViD-19 in India, about 4% of the infected were children. In the second wave, this share has increased to between 10 and 20%. Sero-survey results show about 25% of the minors in this country have already been exposed to CoViD-19 during the past 17 months. So 60% of our children are still susceptible to the Corona virus infection. An estimated 20% is likely to get infected in the third wave. Although most of them will be mild, only 2% will develop complications. Despite being in the risk category, children have still not been enlisted for vaccination and it is still not known if they will have that much needed protection against CoViD-19, more so when the third wave is a mere few months away. Till now, children were only considered as spreaders. But, during the second wave, even they contracted CoVID-19. To save India’s minor population we need to scale up our paediatric inpatient infrastructure and also the paediatric intensive care facilities.


RAJENDRA T NANAVARE is a Chest Physician & Chairperson, DRTB Center, Bedaquilin at GTB hospital, Mumbai, Ex-Pharmcovigilance in Drug Safety Monitoring committee for Bedaquilin at I.C.M.R and Ex-Consultant for international union against tuberculosis and lung diseases. He is also postgraduate teacher for Chest & TB in College of Physicians and Surgeons, Mumbai. He can be reached at docrajn1203@gmail.com


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