While we still can

Recently, India joined the league of nations that has decided to vaccinate children below the age of 18 years. Several countries including the UK, the USA, Canada, France, Germany, Japan, Norway and Chile have officially announced to commence vaccination programmes for Children in the period between May-June. The socio-economic conditions, risk levels and vaccination levels are different across all countries and cannot be measured with the same yardstick. In the case of India, the first wave was limited to a particular age group. This belief turned into a myth after the second wave spread its tentacles over the younger populations — and to its relish, the virus found other age groups largely off guard. Now that the imminence of the third wave is being flagged, there is also apprehension in major pockets, including the government, that the newer strains of the virus could affect the children who have suffered the least from the direct impact of the virus. This conviction, however, lacks scientific evidence, and its genesis is vague.

Panic is the last thing that could help us; it will only worsen the situation. We have experienced that the newer strains are capable of attacking newer age groups and children have already been under immense indirect negative impact of the first two waves.

To put it simply, the impact of the COVID-19 on children has been multi-layered all throughout the pandemic — ranging from mental trauma to societal distress. As per the 2021 UNICEF-ILO report, in 2020, the pandemic increased the number of children in income-poor households by an estimated 142 million, adding to the 582 million children already in poverty in 2019. This estimate could be much higher in the year 2021, more so for India. Millions have fallen victim to child trafficking, child labour, child marriage etc. The debate around the third wave and its potential impact on children should go far beyond the direct impact of Covid. The 'may-be' third wave has provided us with an opportunity to club all the problems together and look for a holistic solution. To do so, we need to first retrospect how aware we are of the problem; and how willing we are to rise up to the challenge?

Clinical impact

As has been the case till now, the direct impact of COVID-19 has been at a very limited scale — both in terms of the number of cases and the severity of Covid symptoms the children observe. A panic situation seems to be created in certain pockets because the children appear to be more affected in the second wave of the Covid. This, however, should be seen in proportionate terms in the context of the high number of overall Covid cases recorded during the second wave. Speaking to MillenniumPost, Sanjeeva Reddy, consultant paediatrician and neonatologist at Manipal Hospitals, clarified: "Although the absolute number of children affected in the second wave was much higher than the first wave, recent evidence shows that as a percentage of total cases reported, the numbers are similar to the first wave."

Further, the severity of Covid in children is limited to gastroenteric symptoms and mild fever. These could be treated with normal drugs like paracetamol. The need for hospitalisation is felt in a minuscule number of cases. However, if symptoms include pneumonia and are more severe, consulting and visiting a doctor becomes crucial.

The natural question is how worse the third wave is going to be — which may come. This would largely depend upon two factors — the introduction of a new variant and our preparedness against the virus in terms of vaccination for children. The virus, by its very nature, is mutating and tends to find a 'less resistant body'. Since most of the adults may be vaccinated in the coming months, and vaccines for children are still in the initial trial phase, they may provide the required ground for the virus to operate. He told MillenniumPost: "Children are going to be more vulnerable to catch the infection in any subsequent wave of infection as there is no approved vaccine option at present. However, the severity of infection is likely going to be the same unless there is a new variant of the virus which might affect the severity. As in the second wave, 2-3 per cent of affected children will likely need hospital admission and treatment."

Given that, we have around 43 crore children. Even these seemingly small percentage figures could translate into big numbers if preparedness against the third wave, particularly concerning child safety, is not made.

Covid-related illnesses

Covid-related illnesses have come out more threateningly as these can potentially force children to long spells of physical and emotional suffering. Multisystem Inflammatory Syndrome in Children (MIS-C) and Pediatric Multisystem Inflammatory Syndrome (PIMS) have emerged as major causes of concern these days. These affect the blood vessels and other internal body organs. Inflammatory diseases affect the circulatory system in a major way and can cause damage to the heart as well. The disease is often likened to 'Kawasaki due to similar symptoms, but recently it has been observed that MIS-C is affecting even children aged above 13 years of age, something very different from what 'Kawasaki' does; it affects children below five.

These complications are rare but their mysterious linkage with Covid is problematic. 'Kawasaki' was first spotted in the 1960s and is known to occur in a situation when the body tends to build resistance against some contagion. If there is a large number of Covid Cases in children during the third wave and these have a direct bearing on MIS-C and PIMS, even a meagre percentage could mean a lot. "It is not exactly known why some children develop the multisystem inflammatory syndrome. Genetic factors might play a role in how the immune system responds to a virus, but there are no known genes identified as of now. Prevention of infection with safety precautions is currently the best defence against covid and related complications", added Dr Reddy.

There clearly is a lack of research on this front. Apart from other investments in the health sector to minimise the impact of any imminent Covid wave, investment in research around these issues is extremely important and beneficial. It will save our delicate children from undue suffering and, at the same time, save the costs that may be incurred on these illnesses at a later stage.

Psychological impact

While the Covid and related clinical illnesses remain limited in children, one of the fallouts of those in terms of mental and emotional impact is the real cause of concern. It is a latent threat that could have serious implications not just on the life of the child but also on the social fabric and the national economy of our country for the years to come. In fact, Covid is shaping an entire generation of children who are witnessing immense dread and experiencing unmatched trauma. The grief and agony inflicted by the loss of loved ones surrounded by an ambience of fear, uncertainty and hopelessness is not going to fade away anytime soon. Its dark imprint on the young minds will last longer, maybe forever — creating a dark tunnel that is hard to exit.

Something very bad, very dark is boiling under the surface. Are we aware of it? Surely, we are. Are we active enough to identify it and take a serious note of it? Seemingly, we are not. It is not a part of our public discourse, or for that matter, of our public policy. To a certain extent, there is also a taboo around the issue and is thought to be better avoided as the surface looks calm and children quiet. But, hidden in the calm is a violent storm and, in the quietness of children, a persistent gloom — building up each day.

This apparently softer area could be ignored only at our peril. In the very first place, we need to come to terms that this is indeed a major problem. Then, dear ones need to communicate with the children. In doing so, they must ensure that their aim should be to let them know the reality most subtly. Things are not to be hidden from them; the issue is too big to be hidden. Don't keep them in dark and uncertain terrain. Make it clear what the larger problem is. Their grief has to be shared and the best way is to make them feel that everybody is suffering at the moment and their suffering is part of the larger picture. Rather than shielding them, make them strong.

Social fallouts

The pandemic has changed society for the worst of children. Its social impact on children is largely undocumented. While there could be no distinction among children and all are facing their own set of woes, the ones from the lower strata are forced to face a whole lot of social crimes including child labour, child marriage, sexual abuse, human trafficking etc., to name few.

The lack of documentation around these issues blocks any possible effort to tackle these problems. These issues have been lingering for quite a long time. The pandemic has given these a fresh boost. There is hardly any reliable set of data that can allow us to comprehend, or at least identify, what has been unfolding in these dark lanes all through the second wave. If indeed there is a third wave, things will go for worse in this direction unless something concrete is done on this front. Various non-government agencies are working in this direction and have come out with their own surveys.

The UNICEF in collaboration with ILO has come out with a report on child labour wherein it analyses the impact of the pandemic based on various parameters like education, family income etc. The report reads: "The harmful effects of this pandemic will not be distributed equally. They are expected to be most damaging for children in the poorest countries, and in the poorest neighbourhoods, and for those in already disadvantaged or vulnerable situations."

The situation is very grim for children who, without completely understanding what has been going around, lost their parents and other loved relatives. It takes a lifetime for adults to come to terms with such realities. What about innocent children who may hereafter have to be on their own, largely?

However, the most far-reaching fallout of the pandemic has been the stolen opportunity to get educated. The subject, it seems, is self-explanatory. The education system has been in limbo for around one and a half years roughly. There has to be an intact plan in the third wave to minimise the burden.

Preparedness

Vaccination: The government has emphasised the need for preparations for vaccinating children before the third wave, that may come. There appears to be some apprehension in the air that the third wave will hit children the worst — the basis for this argument is still unknown; neither scientific papers nor past experiences of nations that have gone through multiple waves are evidence to support this argument. Still, the attempts made in this regard deserve appreciation given the uncertain nature of the virus.

There has been a debate in countries like the USA and the UK over whether vaccines should be administered to children or not. Their stated concern, however, is that before vaccinating children — a low-risk group — vaccines should be sent to needy countries where vulnerable populations are fighting for life and death. There is another concern that the children, while not prone to severe covid symptoms, can still be a carrier to the virus — affecting others in the vicinity. In India, however, the case is slightly different. The country can still be said to be recovering from vaccine shortages. It also faces multi-layered vaccine inequity.

There is one more limitation that deserves to be considered. The vaccines used in India are based on traditional methodologies whose resistance against mutative viruses is comparatively less than that of Modern and Pfizer vaccines. Some experts suggest that trials are limited to initial phases as the nature of the mutant is quite uncertain.

Social infrastructure and research: A part of preparation must go in the social direction. There is an urgent need for a thorough investigation as well as research on the social problems discussed above. We need volumes of data and findings to chalk out a resource-effective strategy to help our children come out smoothly and safely out of this long dark tunnel.

Identification of orphaned children who are left to fend for themselves should be identified without delay. Some non-government organisations are doing commendable work in this regard; the government must come forward to appreciate their work; to take help from them in fixing the issues faced at the national level and also to help them in the best possible way. Further, issues like child marriage, child trafficking, and child labour are too deep-rooted and the government response mechanism to these social problems is too feeble. The most important thing, however, remains the communication made by parents and relatives at this juncture.

This is the time that we refrain from panicking; identify and document the problems faced by children in full detail, and channelise the limited resources that we have optimally. A delay at this front could have long-lasting repercussions.

Views expressed are personal