Let elderly, children be allowed out with necessary precautions, say experts

Doctors say those who received two doses of vaccine should be allowed to go out with due precautions for physical activities. Pic/Ashish Raje

With the fear of the third wave of Covid-19 (due to the Delta variant) looming large, city-based paediatricians and health experts say it is high time people change their approach and allow children and the elderly to venture out with necessary Covid-19 precautions. This they say, will help them overcome both the physical and mental strain of being confined to the four walls of the house and better equip them to face the situation.

Dr Wiqar Shaikh, professor of Medicine, Grant Medical College and Sir JJ Group of Hospitals said that history has taught us that wave after wave is to be expected until the pandemic finally abates. He said that the third wave of Covid-19 in India is inevitable and should hit the country before the end of 2021. However, it is impossible to predict whether it will be less or more disastrous than the second wave. He also said that there is no evidence yet to suggest that it will affect children more than adults.

Dr Shaikh said the sero survey initiated by the Government of India/ICMR has shown that approximately 2/3rd of the Indian population has developed antibodies to Covid-19. But he claimed that in a viral infection, antibodies have an extremely limited role to play, and that too only at the beginning of the infection. Dr Shaikh added, "It is the T-cells which have a major role against viral infections. The two types of T-cells which are involved in killing viral infected cells inside the human body, are the T-Natural Killers and the T-Cytotoxic cells. I am surprised that a study of T-cell immunity against Covid-19 has not been initiated in India, which would give us a much better insight into the immunity levels for the infection in the Indian population."

Dr Ketan Vagholkar, D Y Patil Medical College

Dr Shaikh added that several schools and colleges across the country have opened up for classes on campus and said he was shocked Maharashtra has not yet opened its schools and colleges. He also expressed deep regret that children and the elderly across the nation have remained cooped up at home due to the pandemic since March 2020. In societies where people can avail of the adequate recreational facilities such as walking/jogging tracks, gardens and indoor/outdoor games, being locked up in the apartment for some time could be acceptable. However, majority of the population, particularly in chawls, slums and rural areas, remains locked up in their homes.

Dr Shaikh said that it is now time to allow children and the elderly to move out of their homes, albeit with Covid appropriate behaviour, particularly the use of masks. He emphasized that all over the country, particularly in Maharashtra, schools and colleges should allow students to attend classes. He also added that kindergarten and primary school students could wait, but high school students should now go to school.

"Recent Covid antibody surveillance studies in Mumbai and Maharashtra among children and adults have shown fairly high levels ranging between 43 per cent-55 per cent. This is suggestive of Covid infection-induced antibodies. But how many of these antibodies are of the neutralising type that will provide protection to these individuals on being re-exposed to a fresh episode of Covid is not clear. While children are less likely to experience serious symptoms of Covid-19, the disease is not entirely benign in them. Children tend to have a much stronger immune response than adults, which is why they can't be given the same dose of vaccine as adults," said Dr Subhash Hira, professor for Global Health, University of Washington-Seattle.

A woman is vaccinated at the Sree Cinema BMC health post, Mahim on Tuesday. Pic/Ashish Raje

"We do have cases of post-Covid syndrome, multisystem inflammatory syndrome, which can be quite severe, bringing kids to the hospitals' intensive care units. Hence, India and the world are waiting for vaccine trials which are under way for children aged 2-6, 7-12, 13-18 years of age. For example, in India, 500 children were recruited in June 2021 for the Covaxin trial in 6 hospitals including AIIMS New Delhi, AIIMS Patna, Nagpur, etc. in three age groups. Each group was given Covaxin in varying quantum of injections or nasal spray in three dose variations. No major side effects were reported after the first doses. They are due for the second dose after 28 days i.e. towards end of July 2021. Their total follow-up will be 208 days i.e. 7 months. The results will be out by January 2022. If results are acceptable, the children's vaccine programme can be launched soon thereafter," said Dr Hira.

Dr Hira added, "But a global disaster of the magnitude of Covid-19 is caused by a respiratory infection that comes in waves that are months and years apart, just like the Ebola epidemics of Congo, before and after 2014. I think that Mumbai will reach a point in September-October 2021 when 70% of its adult population above the age of 18 years will be vaccinated. So Mumbai will cross an important mile stone of this pandemic. The community should honestly pledge to three main barrier methods i.e. use of proper masks, hand and other sanitizations, and physical distance of 6 feet for the future. In such a case, Mumbai will have won the ‘pandemic lockout preparedness status' and can get a go-ahead for a proactive lockout with fewer restrictions. Soon after January 2022 when vaccine study results of children are out, and if they are effective, school reopening can be tried out cautiously."

"Currently no one can predict the course of the third wave. Through the research until now, one thing we can say surely that vaccination and presence of antibodies in our bodies protects us from serious Covid illness. Some get a serious infection but they are very few. Also, children generally have good immunity and from our past experiences we can say that children won't get serious symptoms commonly," said Dr Santosh Bansode, Head of the Department, Emergency Medicine, Wockhardt Hospitals, Mumbai Central.

Dr Wiqar Shaikh, Grant Medical College

"Now more and more people are getting vaccinated and the number of sero surveys show that many people already have antibodies. From these numbers we can say that even if the third wave arrives, there is a high chance that the number of serious patients will be less and there will be more stable patients with less severe symptoms. For almost one and half year, the elderly people and children are trapped in homes for precautions. The elderly have started getting other illnesses due to little physical activity and psychological problems as they are not allowed to go out. We must think about this and now those who received two doses of vaccine and those who have antibodies should be allowed to go out with due precautions for physical activities as they were doing in the pre-Covid era," Dr Bansode added.

"We must think about childrens' mental condition also. Physical activity in open spaces and grounds is important for the mental health of children. So with consent of parents and by taking full precautions we must start reopening schools. We can begin with higher secondary first and then slowly primary if everything goes well. Once we start vaccinating children we can take bold steps to normalize their lives. We must reassess situation periodically and take decisions and change directions accordingly," Dr Bansode said.

Dr Ketan Vagholkar, professor of Surgery at D Y Patil Medical College said, "Children and senior citizens continue to be vulnerable to the delta variant though children were relatively unaffected during the first and second waves. Good immunity is the best protection for children. This comes with good exercise which is only possible with outdoor activities at school accompanied by good nutrition. Closure of schools has led to physical inactivity and increased consumption of unhealthy fast food. This has led to decreased immunity which predisposes children to increased infection. Graded reopening of schools is essential to regain children's health and wellbeing."

"Senior citizens too are badly affected both physically and psychologically. Lockdowns have led to lack of physical activity thereby compromising immunity. Commencement of outdoor physical activity in vaccinated individuals is necessary. However, Covid appropriate behaviour is a must at all times," added Dr Vagholkar.

Dr Fazal Nabi, director, Paediatrics, Jaslok hospital, said, "It is difficult to predict the exact course of the third wave of the Covid 19 infection, but whatever cases we are seeing in the past few weeks are self-limiting with mild symptoms. These minor infections require only symptomatic treatment and mostly without antibiotics. Complicated cases are rare."

Dr Nabi added, "It has been seen that to fight this infection which is not troubling children much, parents are going through a lot of physical and mental stress. Family members with grandparents who might have chronic issues like diabetes, high blood pressure and heart disease are getting destabilized due to this stress. The whole family is suffering due to this infection wave. It's like burning the whole jungle to kill an ant!"

"It is time for us to change our approach now, so children and other family members can have a better and healthier life. The physical development of children is good but they are lagging in social and behaviour development for their age. Cases of autism, ADHD and other behavioural issues may increase. We should encourage outside exposure for the child and take all Covid precautions," said Dr Nabi.

"At the same time, we must encourage parents and grandparents to get vaccinated and continue their normal and healthy routine. Even re-infection in an already vaccinated individual is seen to be mild and self-limiting, and does not require a very strict and modified lifestyle. Just as to prevent road traffic accidents we don't restrict ourselves on roads, we should not bound ourselves at home to fight this infection, which could affect us for years. Immunisation of the whole family including all age groups and Covid-19 safety precautions will prevent severe infection in them in the third wave, if any," Dr Nabi concluded.