There is no evidence so far to conclude that children face a greater risk of infection or are at greater danger from a COVID-19 infection from an anticipated third wave, according to a report from The Lancet COVID-19 Commission India Task Force. The group consists of paediatric experts from across the country comprising clinicians from top government medical colleges and large private or charitable hospitals.
They were tasked with examining the evidence and recommending practical clinical tools and strategies for providers, and guidance for policymakers and the public to effectively address COVID-19 in children. Though data from India were limited, the mortality rate amongst hospitalised COVID-19 positive children below the age of 10 (excluding neonates) was 2.4%. About 40% of the children who had died had co-morbidities and 9% of all hospitalised COVID-positive children presented with severe illness, all under 10 years of age. These observations were similar during the two surges of COVID-19 infections in India.
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As of May 2021, of all COVID-positive cases in children globally, 0.1-1.9% resulted in hospitalisation. Children comprised 1.3-3.2 % of the total reported hospital admissions. Mortality was also “significantly low” at 0.1% of the total 0.47 million deaths. The mortality rate has also remained the same in both years, at 0.05% of the total annual COVID-19 deaths.
The existing evidence says that while children have milder disease, better prognosis and low mortality in comparison to adults, those with underlying illness could be at higher risk.
For children with a mild infection, the experts recommend management in home isolation, if feasible, and symptomatic treatment with paracetamol .
Also read | Top paediatric body says children not at increased risk for severe COVID-19
A concern with COVID-19 and children were reports around multisystem inflammatory syndrome in children (MIS-C). The manifestation of the condition mimics viral, bacterial and rickettsial infections. The early signs of MIS-C included “atypical Kawasaki disease” (KD)-like presentations in younger children and gastrointestinal manifestations with abdominal pain mimicking appendicitis, diarrhoea and features resembling toxic shock syndrome, rather than acute pneumonia with respiratory symptoms, in older children. However, most published data suggested mild to moderate predisposition in most cases and low mortality linked with MIS-C, they note.
Psychological impact
The experts also highlight the psychological impact of the pandemic. In a recent meta-analysis of 15 studies across 10 countries, describing 22,996 children/adolescents, it was reported that the behaviour/psychological state of a total of 79.4% of the children was affected negatively by the pandemic and quarantine; at least 22.5% of the children had a significant fear of COVID-19, 35.2% complained of boredom and 21.3% had sleep disturbances. Schools ought to be reopened cautiously with options for online access as needed.
“It is imperative to recognise as a society that in our well-meaning attempt to protect our young ones from disease and keep them physically safe, we do not inadvertently impair their minds by curtailing access of expression for their inherent curiosity, creativity, and joy,” the authors underline.
Published - June 13, 2021 09:27 pm IST
