Children and the Second Wave of COVID-19

Overview

India witnessed the first wave of COVID-19 in 2020, and by the first week of March 2021, we are facing the second wave of the pandemic. While researchers witnessed no significant change in the affected age groups during these waves, a slight increase has been noted recently in children, including the younger age groups. However, more than 70 per cent of COVID-19 infected individuals are under the age of 40 years in both the waves and, the elderly still remain more vulnerable.

Read more to understand why there has been an increase in children testing positive in the second wave; what symptoms do the children usually show; and what precautions can parents take?

Why is the Second Wave Impacting More Children Compared to the First Wave

Experts say that the second wave can potentially be more severe for younger age groups. In the second wave, children have also developed severe symptoms. In the first wave, children and adolescents were affected, but in the second wave, even infants are infected, exhibiting severe symptoms.

Medical experts say that a new double mutant variant and a combination of other strains tend to infect children. The double mutation, known as the B.1.617 variant, was first detected in the samples of around 10 states across India. The variant has both mutations (E484Q and L452R). It is also found in the UK, the US, New Zealand, Australia, and a few European countries.

Experts opine that the double mutant variant has immune escape phenomena. This new variant masquerades as our own body system and later escapes our immunity protection. This is one of the reasons for more and more children contracting COVID-19.

Kids are also getting infected from other members of the family who go out of their homes and are lax in maintaining COVID-19 appropriate behaviour.

What are the Symptoms of COVID-19 Infection in Children?

In the second wave, it was observed that COVID-19 symptoms are not limited to just the respiratory system. Most common COVID-19 symptoms observed in children include:

1. High fever
2. Cough
3. Chills
4. Shortness of breath
5. Sore throat
6. Loss of smell
7. Mucocutaneous inflammatory signs
8. Myalgias

However, in the second wave, many COVID-19 positive children may have atypical presentation such as:

Gastrointestinal symptoms:

1. Diarrhea
2. Nausea or Vomiting
3. Abdominal pain
4. Loss of appetite

Cutaneous symptoms:

1. maculopapular, urticarial, and vesicular eruptions and transient livedo reticularis
2. COVID toes: Reddish-purple nodules on distal digits

What are the Possible Complications of the Infection?

Unfortunately, there can be some very severe complications, including those that are life-threatening. This is due to secondary conditions, such as ARDS, respiratory failure, septic shock, sepsis, and/or multiorgan failure. In rare situations, children can develop severe hyperinflammatory syndrome (cytokine storm syndrome) a few weeks after the infection.

How To Keep Children Safe?

The best way to really keep children safe is to prevent the infection in the first place. Since the COVID-19 affects people of all ages, it is best not to ignore the regular preventive measures. Here are some tips to do that.

1. Make sure your child wears mask at all the times he/she is out of home or is exposed to people.
2. Ensure your child carries an alcohol-based hand sanitizer, if he/she has to go out
3. Teach your children to sneeze into their elbows
4. Encourage your children to stay indoors
5. Teach your children to maintain social distancing
6. Discourage visitors at home
7. Maintain your, as well as your child’s personal hygiene
8. Disinfect frequently touched surfaces and objects at home

Frequently Asked Questions (FAQs) 

What can we do for the protection of our children?  

We can isolate our children from others and get them to follow COVID-19 guidelines. Ensure that children abide by certain rules, such as not sharing food and water with their friends and so on. 

Can Children get COVID-19? 

Yes, children of all age group, even below 1 year may become sick with COVID-19. Most of the children do not get as ill as adults and a few may not show any symptoms. However, with the new wave of COVID-19 in India, children are more symptomatic compared to last year.  

Are children at lower risk of COVID-19 than adults in India?  

Children experience lower infection rates. There is growing a evidence that shows that COVID-19 affects children differently compared to adults. However, the second surge of COVID-19 puts children and younger adults in India at high risk. 

What to do if I suspect my child has contracted the corona infection?  

You should call your pediatric physician and tell him/her in detail about the symptoms from which your child is suffering. If a child develops symptoms consistent with COVID-19 infection, seek medical attention immediately. The treatment can be done at home or in the hospital, depending on the severity. 

What is the long-term effect of COVID infection in children?  

Even if children develop only mild symptoms initially, eventually, they may suffer long-term effects even after recovery. MIS (Multisystem Inflammatory Syndrome) is one of the most serious long-term effects of COVID-19 infection in children, and it can be fatal.

Which children are at risk of serious disease?

Those children with pre-existing major disease… heart, kidney, liver disease, etc., or children with low immunity such as cancers, immunity diseases from birth, etc., obese children are at high risk of serious disease.

What is home remedy that I can use for my child?

Record temperature and oxygen saturation with a pulse oximeter if available at home, every 6 hours.

• If fever is >100°F, give paracetamol 10–15 mg/kg/dose.
• Give plenty of liquids. Give soft and light diet.
• Maintain hygiene.
• One may give vitamin C, zinc to boost overall health and immunity.

What about medicines such as azithromycin, ivermectin, doxycycline, hydroxychloroquine (HCQ), ayurvedic, homeopathic, etc.?

There is no scientific evidence to use these drugs for treatment of COVID in children. Few of these drugs are used when adults are hospitalized with serious disease. There is no role of these drugs in home treatment.

When do I consider my child serious?

This is very important to know and following five symptoms or signs need to be monitored at home.

1. High fever lasting beyond 4 or 5 days

2. Decreased oral intake by child

3. Child becoming lethargic

4. Increasing respiratory rate

5. Oxygen saturation dropping below 95% at home (ensure proper recording with good displayed waves).

 In such situation, you should rush your child to facility with COVID care.

My child has tested positive 1 week ago. He is due for his vaccine after 2 weeks. How do I go about?

Routine immunization can be continued 2 weeks after child is asymptomatic (of COVID infection). If child needs some higher medications such as high-dose steroids or tocilizumab which suppresses the components of immunity of patient, immunization needs to be deferred for 3 months after the medication.

Safe breastfeeding / milk expression

• Mothers should perform hand hygiene frequently, including before and after breastfeeding and touching the baby.
• Mothers should practice respiratory hygiene and wear a mask while breastfeeding and providing other care to the baby; they should routinely clean and disinfect the surfaces.
• The collection and transport of expressed breast milk to the baby should be done carefully to avoid contamination.

Multisystem inflammatory syndrome temporally related to SARS COV-2 in children

Incompletely understood 

Condition diagnosed in children who had infection previously and also among those with active infection. 

Possible mechanisms

1. Immune dysregulation
2. Antibody enhancement
3. T-cell mediated damage or enhancement of inflammation