‘Safe for children to go to school in second quarter of 2022’

A healthcare worker checks the temperature of a child during a screening for the Covid-19 pandemic, in a slum area in Mumbai on September 4, 2020. Pic/Getty Images

Experts have been predicting that the third wave of Covid-19 could hit India as early as August/September, with many fearing that it could affect children disproportionately. The common explanation is that since many adults would have had the infection or taken the Covid-19 vaccine by then, in comparison, children would be the most susceptible population.

During the second wave, there was a rise in the number of post-Covid complications in children including multisystem inflammatory syndrome (MIS-C). This concern is coupled with the lack of easily accessible resources such as a list of children's hospitals, ambulances, paediatric staff, ventilators, oxygen cylinders and helpline numbers, leaving the adult/parent population worried and restless. The fact that this is the unvaccinated age group, making it more vulnerable to the virus, it is critical that the administration has a robust plan in place to tackle the impending third wave.

With experts divided on whether the next wave will endanger kids, is the city's health infrastructure ready to face the worst? It was at the second virtual Mid-day for Mumbai Roundtables discussion - Third Wave Challenge to Mumbai's Paediatric Healthcare - that key voices tried to address concerns raised by mid-day.

Also read: 70 per cent parents in Maharashtra won't send kids back to school yet: Survey

Children wearing face masks skate along a road in Mumbai, on July 1, 2020. Pic/Getty Images

The panelists include Amit Deshmukh, medical education minister of Maharashtra; Suresh Kakani, additional municipal commissioner; Dr Jacob John, virologist; Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle; Dr Shakuntala Prabhu, medical director of BJ Wadia Hospital for Children; Janmit Singh, Mumbai-based parent of a six-year-old who was diagnosed with MIS-C; mid-day's Vinod Kumar Menon, special investigations editor; Somita Pal, special correspondent, and Prutha Bhosle, chief sub editor and feature writer.

Wacth: Mid-day For Mumbai Round tables: Third Wave Challenge to Mumbai's Paediatric Healthcare

During the session, Kakani presented a slideshow to highlight the civic body's third wave preparedness.

He said, "We have issued break the chain orders based on positivity rate, and are also identifying high-risk wards, carrying out 100 per cent contact tracing within 72 hours, identifying hotspots and conducting special testing camps, ensuring strict surveillance of international travellers and organising whole genome sequencing to study the behaviour of Covid-19 variants."

Edited excerpts from the interview:

Janmit Singh, Mumbai-based parent of a six-year-old diagnosed with MIS-C

mid-day to Singh: Lack of medical knowledge is what comes in the way of a parent trying to get help for a sick child in the pandemic. What are the initial roadblocks you faced in finding your six-year-old daughter the right treatment when she was diagnosed with MIS-C?
My struggle with Covid was in two parts - first was when my wife, my six-year-old daughter and I contracted the infection. However, that part was smooth as we were prepared. When we started having fever and body ache, we immediately isolated ourselves and got a Covid-19 test done. Unfortunately, two days after our recovery on April 16, my daughter had fever. At that point, we did not anticipate any post-Covid complications. On April 20, when her health deteriorated, we got her admitted. The next day, we were horrified to find out she had MIS-C. We were told that if it goes out of proportion, it could be fatal as the patient can experience cardiac arrest or there could be organ failure. Had we known this earlier, we would have sought hospital intervention sooner. It was the steroid treatment that she responded better to and eventually recovered completely. I feel there is a lack of awareness still in society about many Covid-related complications and the government should amplify such information to the public.

Suresh Kakani, additional municipal commissioner, Mumbai

mid-day to Kakani: The jumbo facilities are capable of handling only the adult population, but have you made any provisions for paediatric care at these jumbo centres? Children require a completely different kind of care, including a paediatric doctor and paediatric staff. How have we prepared to take in a high caseload of children in the third wave?
We already have war rooms that are functional 24x7. It's a toll-free number (1916), which parents can use to get their kids proper treatment. All their concerns will be addressed by the special paediatrics team at the war room itself. This time, we have given important training to paediatricians practising either in small nursing homes or as individual consultants. They can also advise parents of probable patients about what treatment should be given, when to test the kids and how, what all facilities are available, etc. Other than BMC hospitals, there are private hospitals like SRCC that have a paediatric ward. In all the major hospitals like Sion, KEM, NICU, Cooper, etc, beds will be available for positive kids for better treatment. We have 13 peripheral hospitals, they will have 10 ICU beds or NICU beds for positive kids. We have conducted a sero-survey across Mumbai of children below 18 years of age, and 51 per cent of them were found to have antibodies. We do expect MIS-C to act as spoilsport for us, and so we are focusing on that too. Our entire medical fraternity is ready to take on the third wave.

Amit Deshmukh, medical education minister of Maharashtra

mid-day to Deshmukh: Maharashtra health minister Rajesh Tope said experts have warned that the impending third wave could be bigger than the second with 60 lakh people getting infected. This could also push up the medical oxygen requirement from 2,000 MT to 4,000 MT, he added. In the previous wave, there was a dearth of oxygen cylinders, among other resources. Have we learned from our mistakes and increased oxygen capacity this time to protect our children?
Under the leadership of our dynamic Chief Minister Uddhav Thackeray ji, this government has been working 24x7 as far as Covid-19 is concerned. As rightly said by my administrative colleague Mr Kakani, the work done in Mumbai has been noted world over. For the third wave, we have emphasised on building captive oxygen generation plants. The health authorities are making it mandatory for hospitals, whether government or private, that have a capacity of 50 beds and above to have their own oxygen generation plants. We have also come out with a scheme for industrialists, that when they invest in oxygen manufacturing plants, we would give them a whole lot of incentives. This policy has been conceptualised by the CM and Maharashtra Cabinet Minister Subhash Desai. As medical education minister, I have given a lot of inputs. Tope also has assessed the requirement that we have. But let's hope we don't get to 60 lakh cases, and I hope the third wave is much milder than the second. The plan is to make Maharashtra self-reliant in terms of health resources. Our captive oxygen plants will solve a lot of issues. We have learned our lesson in the previous wave. I would appeal to everyone to be safe and not let the virus get to you. Wear your mask, follow physical distancing and get vaccinated.

Do you think it is time to open schools in India, after almost 18 months, since kids are sufficiently sensitised to Covid protocol and it has been proven that their increased immunity helps them fight the virus better?
Schools are opening worldwide. In India and Maharashtra, we must be the first ones to get our children back into school. If all the stakeholders in schools like non-teaching staff, teachers, bus drivers, etc, are 100 per cent vaccinated, and they maintain a chain, then we can take parents into confidence. Academically, students are losing out on outdoor activity, and eight hours in front of the laptop screen is proving to be a challenge for them. I am confident that Maharashtra may become the first state to allow its students back into schools and colleges. We are working on it.

Dr Shakuntala Prabhu, medical director of BJ Wadia Hospital for Children

mid-day to Dr Prabhu: How is Wadia Hospital prepared to tackle the third wave? How many Covid beds, ICU beds, ventilators and oxygen cylinders would be made available at the time the crisis hits the city's paediatric group? How many paediatric emergency ambulances do you have plying in the city?
The CM has started the paediatric task force. We at Wadia Hospital have 22 Covid care beds, and we have made plans to increase our capacity to 200 beds. Of these, 70 beds are critical care beds for both paediatric and neonates. Since we have the support of the BMC, we will be able to take in 200 children. Children with comorbidities will have to continue their care, and we have facilities for them too. MIS-C is seen in children, and so we have created awareness among our paediatricians to look for post-Covid symptoms like skin rash, red eyes, and persistent fever. We have a post-Covid OPD also running in the hospital for MIS-C patients. We offer RT-PCR test facilities, with a turnover time of five hours. We also conduct RAT, which can help diagnose critical children early. We are also encouraging flu shots for children with high risk. Once cases start coming in, we would be allowing at least one parent, usually the mother, to be with the child so it is easier to manage him/her in the ward. We have one ambulance for transfers, but Mumbai city has the 108 helpline for more ambulances which can cater to critical kids.

Dr T Jacob John, virologist

mid-day to Dr Jacob: There is a growing concern about MIS-C post-Covid. If the third wave was to hit Mumbai before a vaccine arrives for children, what are the many complications they will face this time?
It is very good to be alert and prepare for facing a third wave, whether or not it actually comes. But fear is not what we need now. Cold-blooded planning is what we need and that is what Maharashtra seems to be doing already. All information shows children may not be vulnerable and that they were not badly affected in the second wave either. About 5-6 per cent of Covid cases in the community are borne by children, this includes MIS-C cases as well. We need to know how many people in Maharashtra are infected by the virus. I don't think it will be more than 50 million. Whereas, the population is 113 million. So Maharashtra is now in an endemic phase of the infection. However, there may be a third wave of concentrated diseases we have neglected so far like diphtheria, measles, whooping cough, TB, etc. We have to be watchful for that and whatever infrastructure we create now should be utilised in treating diseases other than Covid. Maharashtra has a reputation of ‘aikave janache, karave manache'. Janachi are experts like me and the central government in Delhi. Maharashtra will listen to them but in the end, the state will decide for itself.

With rise in misinformation spreading in the pandemic, how does one deal with fake news? Should the government be looking into this?
I grew up in an agricultural family. I've learned that if you don't tend to the field for a long time, the next year it will be full of weeds. That's exactly what is happening with misinformation right now. Print media has been publishing only reasonable and reliable information. It is social media that has been spreading all sorts of fake news about Covid. For the future, India needs to prepare a methodology by which information will be filtered at the government level, and later packaged into what people will understand and give it to them repeatedly. When a new message comes in, add that to the old one to avoid any contradictions. Only authentic data should be given out by the right agency empowered by the authorities.

Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle

mid-day to Dr Hira: Children aged two to six years participating in the clinical trials for Covaxin will likely be administered the second dose of Bharat Biotech's Covid-19 vaccine soon. With the emergence of the Delta Plus variant in a few countries and its threat looming large over India's 150 million children, how do you think India has fared in terms of vaccine development?
Our country has done remarkably well in terms of developing vaccines. There are more than 30 crore adults in India who are already vaccinated. And the question now is whether kids, who are not vaccinated, have the possibility of getting infected. While Mumbai's sero-survey says that 51 per cent of children have antibodies, how much can one rely on them? And so, Covaxin has started doing clinical trials in six hospitals with 500 children. Children are 35 per cent of India's population. And so, we are talking of a large proportion of our future that is not yet protected. These vaccines are effective and have been protecting adults, so they will protect children too. By the time results of these trials come in January 2022, it will provide information on whether the injectable vaccine is as good as a nasal spray vaccine. But for these to be delivered, it will take another three to four months. Maybe by April to June 2022, kids will start getting vaccinated and that's when they will be safe to go to school. It is not a hopeless situation.

Sickle cell disease (SCD) in tribal children is prevalent in Maharashtra, Gujarat, Orissa, and Chattisgarh. It appears with painful joints, respiratory syndrome, infections, etc. Does this morbidity present a separate challenge during vaccine trials or during the third wave?
Nobody comes up with questions about looking at tribal health. There are studies that point to a six times higher death rate of Covid in patients suffering from sickle cell disease. It's true that Maharashtra and other states have special programmes for tribal health. But let's not forget the fact that the state has around 10,000 children that have sickle cell disease. The government has a month to get going and protect these people.

Chief Sub Editor and Senior Features Correspondent, mid-day; (right) Somita Pal, mid-day's special correspondent

mid-day to Somita: In a time of crisis, first respondents are usually the men manning helpline numbers. Desperate and worried parents may want to know whom or where to reach out to get their kids admitted. How well-equipped do you think our first respondents should be to offer valid information to parents of sick children?
When it comes to parents, the first respondents are two people - the family doctor and the government helpline. For the third wave, BMC does look better prepared. They have war rooms manned 24x7 by medical practitioners. BMC has tied up with private practitioners on how to manage emergency calls. They know how to spot a red flag when parents get in touch with them.

mid-day to Dr Hira: Is it necessary to continue vaccinating people despite not having any guaranteed protection?
There is no doubt now that these vaccines [of any manufacturer] with good clinical trials are protective. They do protect against hospitalisation and death. And so, getting vaccinated is of utmost importance.