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Why India needs to redefine management of third wave for children with chronic ailments

By Dr Palash Baruah, DL Wankhar* 

The United Nations’ “Policy Brief: The impact of Covid-19 on children” dated April 15, 2020 was convinced that “Children are not the face of this pandemic.” This was also evident in India when the ‘first wave’ of Covid-19 hit the country. Scientists and experts were convinced that children were less susceptible as compared to adults of advanced age or those with co-morbid conditions.
But as India is going through the somewhat now abated ‘second wave’ of Covid-19, experts are of the opinion that whenever the ‘third wave’ approach it will witness a major transformation when more and more children will be also be impacted, though the severity of the virus on the children is still not clear.
We are at a stage when it became more and more obvious that persons across all age groups are equally susceptible. Specific reasons are unclear. Mutations, variants and strains of the virus has created havoc and it seems unsurmountable at the moment for the health authorities.
It is often said that Indians develop chronic diseases at a younger age, which raises their risk of severe disease and death. That if the vulnerability of children to the virus would characterise the ‘third wave’, then it will require a re-look at the strategies and protocol in Covid-19 management. Equally critical is also the need to pay special and adequate attention to children with chronic, co-morbid and other under-lying conditions.

Empirical evidence

High rate of Covid-19 fatalities of persons with existing chronic conditions or compromised immune systems are being observed not only in India but across the world. Taking care of chronic conditions is critical as Covid-19 raises the risk for people with such underlying medical issues.
There is no publicly available information on the extent of children with chronic ailments infected by Covid-19 virus. But it would be of interest to wade through the available information and data on children with chronic ailments in India to understand how and where we are placed. 
We analysed the data of the 75th Round of the National Sample Survey Organization (NSSO) on “Household Social Consumption: Health, 2017-18” to appreciate the issue at hand. According to this Survey, approximately 3.1 percent of all persons with chronic ailments are children below 18 years of age and it is almost evenly distributed across this age group. Noteworthy is also the fact that, rural areas accounted for 78 percent of children with chronic ailments.
Interestingly, ten States [viz., West Bengal (26.9%), Uttar Pradesh (16.1%), Kerala (10.7%), Rajasthan (10%), Orissa (5.7%), Maharashtra (5.3%), Bihar (4.5%), Telengana (3.3%), Andhra Pradesh (2.9%) and Madhya Pradesh (2.7%)] accounted for 88 percent of children with chronic ailments. In these States too, the rural areas accounted for the larger share of such children, except in Maharashtra and Andhra Pradesh. We depicted this in the form of graphical representation below.
Children with chronic ailments will present a different sets of vaccination issues whenever vaccination is open for children. Moreover, these children faced higher risk of being infected especially from asymptomatic adults. Quarantine would be beset with various obstacles and challenges.
Adhering to Covid-appropriate behaviour would be easier said than done for such children. These factors are likely to increase the risk of Covid-19 related severe morbidity and mortality amongst children with chronic ailments. It present before us a unique and complex Covid-19 management.
Health infrastructure and manpower in urban areas have already been overwhelmed, not only with the increasing number of Covid-19 related cases in the urban areas itself, but also the inflow of such patients from the rural areas. In view of the fact that a large number of children with chronic ailments resides in the rural areas, it is going to present substantial challenges to the already inadequate healthcare resources.
No doubt children with chronic ailments will require a different set of approach in this pandemic but identifying such children is the starting point. States (especially in the ten major States) need to put in place a system to identify and assess risk across age and gender of children with chronic ailments. It then need to work out appropriate and adequate strategies to deal with as and when these children happen to contract Covid-19 virus.

Protocol for testing children

Protocols on Covid-19 testing of children with chronic ailments need to be developed in a manner that such children should not be made to travel far from their place of residence for Covid-19 related treatment or vaccination. This will reduce the discomfort and jeopardize their health further.
Regular monitoring the health status of children with chronic ailments can provide quick and timely response in case of any emergencies. ASHA, ANM, community health workers, etc can be made aware of the best practices and trained accordingly.
Ramping up of health resources, especially in rural areas, is sine qua non for riding the ‘third wave’ to ensure minimization of severity and mortality and this is all the more relevant and critical for children with existing chronic ailments.
Parallel to the Ministry of Health & Family Welfare’s “Protocol for Management of Covid-19 in the Paediatric Age Group”, a separate comprehensive and specific protocol should be formulated for children with chronic ailments.
Adequate, timely and effective communication should be disseminated through visual and print media to create awareness amongst the general public and health workers on the steps to shield, protect and care for children with chronic ailments with special focus and emphasis on Covid-19 pandemic.
The chronic health conditions of children in India is a matter of concern and their vulnerability to Covid-19 cannot be ruled out. Focused, pragmatic, targeted, robust and coordinated policy, especially in those States which have a considerable section of children with chronic ailments, need to be worked out immediately to face the impending ‘third wave’ of Covid-19.
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*Dr Palash Baruah is Senior Research Analyst, National Council of Applied Economic Research (NCAER), New Delhi; DL Wankhar is retired Indian Economic Service Officer. Views are personal

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