Will there be a third wave of the pandemic affecting children?
By Dr Kishore Kumar  Covid-21 is definitely different than Covid-19  meaning the Covid-19 in 2020, was milder in many aspects. People got infected and though it killed many, households were spared if they practiced masking and safe distancing. This second wave in 2021 (thats why I call it Covid-21  though it is not an officially recognised word) has left parents looking for information on protecting their children and the steps to take if their child, or a family member, has symptoms of COVID-19, or tests positive. Because once one person has got infected, virtually all members of the family have been infected this time around, suggesting high infectivity. As the virus continues to evolve, as a practicing pediatrician, I am seeing 20 to 30 positive kids per week  with symptoms like cough, fever or chills, shortness of breath or difficulty breathing, muscle or body ache, sore throat. These symptoms are very similar to adults and often confused with seasonal flu which used to be very common around this time of the year. All this is an indication that the third wave is not waiting to happen, it is already here. Unlike the first wave, now entire households are becoming infected with the virus and is likely to impact children too. In the first wave, we all said that Covid-19 doesnt infect children because they have less of ACE2 receptors in their lungs, but it is important for parents to know that it is possible for anyone, of any age, to contract COVID-19  including children. If anyone could predict a pandemic, we wouldnt have had one. Also pandemic behaviour and mutations of the virus is left to anyones imagination. Generally speaking, pandemics in the past have lasted for close to 2 years before it stops causing agony. Also Read | Protecting kids in the pandemic: A doctor answers some FAQs  As cases continue to rise, children with COVID-19 infection may be asymptomatic, mildly symptomatic, moderately sick or severely ill. Asymptomatic children are usually identified while screening. Such children do not require any treatment except monitoring for development of symptoms and subsequent treatment according to assessed severity. In such cases, other than a lot of fluids and paracetamol, if they have fever should be the immediate course of remedy. Children with mild disease may present with a sore throat, diarrhoea or cough with no breathing difficulty. Few children may have gastrointestinal symptoms like severe stomach pain. Around 99 percent get a mild infection and dont require any treatment. However 1 percent or even less than 1 percent of children get serious disease unlike adults where 5 to 6 percent of people are known to get serious disease. Serious diseases in children are generally less common because they dont have many comorbidities unlike adults like diabetes, COPD, cancer, hypertension, heart disease, etc. Infections in kids are generally not common because they have less ACE2 receptors. But it doesnt mean they wont get an infection. But the kind of infection we are seeing in senior people like gasping for oxygen is unlikely to happen in kids for various reasons, including less ACE2 receptors in lungs and less morbidity like absence of heart disease, hypertension, obesity etc. However, they are known to get multi-system diseases which are still rare. In April-May 2021, Maharashtra reported nearly 29,00,000 new cases and 99,000 were children among them belonging to less than 10 years of age (accounting for 3.5 percent of total cases). Gujarat saw a similar trend and many newborns were noted to be affected. In this second wave we are already seeing newborns and children being affected. In the first wave, everyone predicted that we are a country with BCG being given, which is why we are not being affected, but it still happened. Parents need to know that children react to how adults behave. Already kids are suffering mental challenges because of solitude, anxiety in parents, lack of interaction with other kids, absence from school and so on. The last thing we need is to create more anxiety and fear in them to scar them for life. Let us be sensible and get vaccinated so that the kids wont get the disease if the adults are protected. Always maintain a physical distance and stay home as much as possible, unless going for medical treatment or urgent supplies. Wear masks (preferably N95 mask without a valve) when you are outside, and make sure the face mask is covering your nose. Children above two years of age can also wear a mask. Continually wash hands with soap, or use a 70 per cent sanitiser, making sure the whole surface of the hands is covered. Avoid attending public functions, avoid social gatherings, and avoid group play. Discuss, demonstrate, and reiterate the importance of COVID-19 Appropriate Behavior (CAB) with your children. Get your child tested for COVID-19 if:  Family members, who your child has been in contact with, test positive for COVID-19. Your child has symptoms of COVID-19. Your child has a fever that has continued beyond three days. Always remember, do not panic. If you have a family member with a COVID-19 positive report, you need to be isolated immediately, in a separate room from the rest of the family (if possible). Children should be shifted to a different room or different house (may be of a friend or a relative). If by any chance, the child develops fever, it is difficult to know the difference between a common cold/fever and COVID-19 without a test. This could also be a signal that every case of fever or cough in your child may or may not be COVID-19, especially if a family member is suffering from COVID-19 or has recently recovered from the virus. However a test is mandatory. Parents or the caretaker should maintain a monitoring chart including counting of respiratory rates 2-3 times a day when child is not crying, looking for chest in drawing, any discoloration of body, cold extremities, urine output, oxygen saturation monitoring (hand held pulse oximeter) if feasible, fluid intake, activity level, esp for young children. In a small baby one can use monitors to check the babys breathing. When out and about in public, adults and kids should wear a mask that covers both the nose and mouth, especially in situations outside the home where physical distance isnt possible. Parents should help younger children practice wearing masks before returning to school so kids are comfortable wearing them in class. Kids should wash their hands after using the bathroom, sneezing, coughing or blowing their nose, before eating (even snacks) and immediately after coming inside from playing outdoors. Even though there is no evidence that there will be a third wave affecting only children, we should prepare for the worst until this pandemic is over, which can only be declared by WHO. What we need to remember is that the adult population remains at higher risk of moderate to severe disease and children get infected from adults. So preventive measures are the best measures you can take to protect your children but without causing mental stress and anxiety in them. (The writer is Founder Chairman & Neonatologist, Cloudnine Group of Hospitals, Bengaluru. He is also a healthcare delivery graduate from Harvard Business School.)