Hospitals witness rise in admissions as COVID-19 strikes kids aged 3 to 15

Bollywood actor-director Satish Kaushik, 65, and daughter Vanshika, 8, recovered together at Kokilaben Hospital’s isolation ward last month. Pic/Sameer Markande

It was March 15. Bollywood director-producer Satish Kaushik experienced relentless muscle pain and headache. All he wanted to do was lie down, hoping the pain would go away. "When the film industry began to bounce back late last year, I was back at work. I remember having a bad cough once back then. But it wasn't anything serious. This time, however, my throat felt different, strange even. I was almost sure I had contracted the virus," Kaushik tells mid-day. On March 17, an RT-PCR test confirmed he was positive, along with three other staff members. His wife, Shashi, tested negative. But a day later, their eight-year-old daughter Vanshika's reports confirmed that she too had caught the infection.

Father and daughter went into isolation in the same room of their Versova home. "She [Vanshika] was excited. She said we will watch movies and chat all day. She didn't have any symptoms, so I was relieved. But my condition worsened by March 19. I was admitted to Kokilaben Hospital," he tells us.

Satish Kaushik, 65, got admitted to Kokilaben Hospital after he complained of severe cough and body pain. A few days later, his eight-year-old daughter Vanshika, who was in home isolation, started showing symptoms, too. Doctors suggested that she be taken to a hospital in Parel, but Kaushik refused to leave her alone in the isolation ward. He convinced Kokilaben authorities and got her admitted to his room, where they recovered together. Pic/Sameer Markande

Vanshika, who was born via surrogacy when Kaushik was a cool 56, was now separated from daddy and alone in home quarantine. She was struggling to cope. "I want to sleep next to mom, I want to hug her," she would weep, every time Kaushik's PPE-clad manager left a meal by her bedside. By March 23, her fever began to fluctuate.

After medical consultation, it was decided that she would be admitted to a children's hospital in South Mumbai. "While there is a facility for COVID-19 positive children at Kokilaben, all the beds were occupied," he remembers. And, some suburban hospitals had beds for critical children, but they lacked paediatric staff. "They need special care. It was pathetic. The only children's hospitals I was told could manage to offer treatment were SRCC in Mahalakshmi and Wadia in Parel. But since I was recovering in a separate isolation room, I suggested that Vanshika be allowed to share it with me and the hospital agreed."

Dr Zirak Marker and Dr Rajesh Parikh

While Vanshika was admitted on March 25, Kaushik was discharged a day later. He comes across as a concerned helpless father when he says he cannot imagine how other parents have come to terms with having to leave their children alone in isolation wards and ICUs. "Hearing her weep as she would be taken away for tests would break my heart. I'd cry with her," Kaushik says.

Just as India had begun celebrating the success of the world's largest vaccination drive, the second wave of COVID-19 was hitting us. And this time, children too are caught in the net. Several hospitals are reporting a sharp rise in the number of patients - kids aged one to 13. According to the health ministry data, in the five worst-affected states - Maharashtra, Chhattisgarh, Karnataka, Uttar Pradesh and Delhi - 79,688 children have been infected by the virus between March 1 and April 4, 2021. In Maharashtra alone, 60,684 children tested positive between March 1 and April 4.

SRCC Children's Hospital in Mahalakshmi has a total of 16 beds - six in ICU and 10 in the kids isolation ward. A parent or guardian is allowed to stay with the child in isolation as long as they wear PPE gear for safety. Pic/Bipin Kokate

Dr Amin Kaba, consultant paediatrician at Byculla'a Masina Hospital, says, "The second wave has caught everyone off-guard. It's different from the previous one as it seems to be more infectious, and this time, involves children. While the first wave had very few paediatric patients, this time the numbers are high. Paediatric care is struggling across the city, but the situation is worse in suburban Mumbai, where treatment options are limited."

When this writer made a call to 1916, BMC's COVID-19 war room, enquiring about the availability of beds for COVID-19 positive kids in the R-North ward, she was redirected to a landline number. There, she was told to call back the next morning as the hospital staff was swamped with cases.

Delhi-based French teacher Anisha Pillai [name changed on request] had to run from pillar to post to find a bed for her 12-year-old daughter, who tested positive last week. "I have been shuttling between my mother and sisters' homes in Goregaon and Bandra for the last few months that I have been in Mumbai. Last week, my daughter developed a fever, but the dengue and typhoid test came negative. Two days later, when her face was flushed, I knew something was wrong." The waiting list for an RT-PCR test was a couple of days, so she decided to get a CT scan. Doctors suggested she get admitted to SRCC, a hospital she says she didn't know existed. A day later, she was shifted to the ICU when her test results were positive.

Dr Soonu Udani and Dr Amin Kaba

Pillai regrets not doing the COVID test early on. "Parents live in denial. You don't want to be away from your child. The thought of sending her to an isolation ward didn't let me believe she had caught the virus. There is a severe lack of awareness among guardians about how the infection could affect their children." Pillai lived in the ward with her daughter, and says the fear of testing positive herself was the least of her worries.

Experts say that a child infected with COVID-19 poses unique challenges. "The paediatrician needs to have a high degree of suspicion to reach a diagnosis. Secondly, it's near impossible to isolate the child without the caregiver. What's scary for adults is unimaginable for children. Add to this the petrifying experience of an ICU setup," Dr Kaba explains.

Dr Soonu Udani, medical director, SRCC Children's Hospital, says that more symptomatic kids are coming to the facility this year compared to 2020. "When we saw positive children last year, they were asymptomatic and running around; they were just being happy little kids. This time, the positive ones are really sick. They have pneumonia, many are coming with encephalopathy, so there is dizziness and unconsciousness. They are aged three to 15."

InfoGraphic/ Uday Mohite

SRCC has 16 beds, six in the ICU and 10 in the isolation ward. She says usually at least one parent also tests positive and it's this one, who lives with the child in the ward as caregiver. "In rare cases, when the parent is absolutely fine, and thus vulnerable to catching the infection, we warn them in advance. It is upto them to take the risk of being around the kid." She agrees that only a handful of hospitals in Mumbai, including Wadia and Nair, take in infected children.

At the Jalandhar Civil Hospital, kids are given toys and a carrom board to keep them busy, while at the PGIMER in Chandigarh, they are kept engaged with cartoon shows and drawing sessions. Delhi's Lok Nayak Hospital has set up a play area inside a dedicated COVID-19 ward for children.

The nursing staff plays a pivotal role in this herculean task. "With multiple layers of the PPE suit, it makes the nursing care even more challenging, especially when treating critically ill patients. It often happens that the staff compromise their own safety to take care of the ailing. The paediatric staff is trained to handle children. It's not unusual these days to see a parent looking after the child in full PPE gear. It is traumatic for both. When the parents are away, they keep in touch with the child through video calls. COVID-19 has laid bare the inadequacies of paediatric healthcare. We need to invest more into the care and well-being of our kids," Dr Kaba admits.

Dr Rajesh Parikh, who is the medical research and honorary neuropsychiatrist at Jaslok Hospital and Research Centre in Mumbai, thinks that the greater impact of the Coronavirus on children is linked with its emerging new mutations. "Mutant strains are contributing to the high infection rates among children. Nothing can be done, other than following COVID-appropriate behaviour, till a vaccine arrives for these kids." According to researchers, most particularly, the B.1.1.7 and India's B.1.617 variant are said to be dangerous for children, who more or less escaped the first wave. Eerily, the situation is similar in Britain. Scientists from the government's New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), who are tracking a new variant spreading rapidly in Britain, said it had swiftly become the dominant strain in the south of the country. "There is a hint that it has a higher propensity to infect children," said Neil Ferguson, a professor and infectious disease epidemiologist at Imperial College London and also a member of NERVTAG. Wendy Barclay, another NERVTAG professor and specialist in virology at Imperial, said in a press conference held in December 2020 that among the mutations in the new variant are changes to the way it enters human cells, which may mean "that children are, perhaps, equally susceptible to this virus as adults".

Preschool and school children in Germany have been infected with SARS-CoV-2, the virus that causes COVID-19, three to four times more than reported via PCR testing during the second wave, a study has revealed. Preschool children showed an antibody frequency of 5.6 per cent from October 2020 to February 2021. Among school children who were tested between November 2020 and February 2021, the figure was as high as 8.4 per cent. Overall, the antibody frequency at the end of the second wave (January and February 2021) was about eight times higher compared to the end of the first wave (April to July 2020), revealed the study published in the journal Med. The significant increase is the result of higher exposure to the virus in the fall and winter, school openings and more infectious virus variants, said the researchers.

Dr Udani thinks that some countries are making progress in finding a vaccine for kids, but the efforts need to be fast-tracked. "Kids respond amazingly to vaccines, and now is the right time to roll out immunisation for this age group. Trials are being done in some countries, and we can only hope they reach India soon."
Stanford is launching a paediatric vaccine trial that will include kids as young as six months. For this, American children aged five to 12 years will receive the Pfizer vaccine in a phase 3 study.

But is this where our fight to protect children ends? No, says Dr Zirak Marker, child and adolescent psychiatrist and advisor at Mpower. "Even when you admit an older relative or your parents to a hospital, you want to be with them during surgery. With the COVID isolation, the fear is that you cannot see the infected person. I have consulted children who have come to me for therapy after isolation. For a very large part, anxiety continues to linger. They have psychosomatic symptoms originating from stress, pain and even depression. Their moods fluctuate or they have intense anger issues; sometimes they even have meltdowns. As adults, we need to shield them from all information related to the pandemic. They have had enough of it already. The less they hear about it, the faster will they recover from isolation trauma," he concludes.

60,684
No. of children who tested positive between March 1 and April 4 this year in Maharashtra

Kids and COVID

Symptoms to watch for
. Fever (higher than 100.4 and persistent)
. Cough
. Shortness of breath
. Rashes and red eyes
. Lethargy or sick look
. More than six watery stools a day
. Dry cough, mild fever and runny nose are not serious symptoms

Treatment
Fever: Treat as usual with paracetamol (Crocin/Calpol/Fevago)
Cough Cold: Treat only if symptoms are severe with usual cough-cold medicines
Antibiotics: Are usually not needed
Give: Vitamin C (250mg) and multivitamins to boost immunity

Isolate
Isolate for 10 days after onset of symptoms and take precautions for seven more days. If displaying severe symptoms, get the child checked at a hospital
Source: SRCC CHILDREN'S HOSPITAL