|Year : 2021 | Volume
| Issue : 5 | Page : 477-478
COVID-19 – Receding Second Wave: Concerns about Pediatric Third Wave
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||13-Jun-2021|
|Date of Decision||16-Jun-2021|
|Date of Acceptance||19-Jun-2021|
|Date of Web Publication||02-Aug-2021|
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banerjee A. COVID-19 – Receding Second Wave: Concerns about Pediatric Third Wave. Med J DY Patil Vidyapeeth 2021;14:477-8
Rising and falling trends is the natural course of most pandemics before they vanish into the blue. For the first time in recent public health history, humans resorted to unprecedented measures like lockdowns to contain the course of a pandemic. Once the dust settles, we will know whether these measures were effective or the remedy was worse than the disease.
In the interim, as the second wave seems to be receding, there are concerns that the third wave would impact the pediatric population. The logic being that as adults get vaccinated, children will be the target for the virus. To add to the concern, hospitals during the second wave had more children admitted for COVID-19. This naturally will give the impression to clinicians managing these cases that in the next wave, children will be affected most.
At present, there is no evidence for this apprehension. The rise in pediatric hospital admissions in the second wave was not because the virus predominantly attacked children but due to a rise in absolute case counts across all age groups. Among the admitted cases, the proportion of children was between 2% and 5% in both the waves.
Bhopal et al. analyzed pooled data from seven countries summarizing children mortality from COVID-19 and compared it with all-cause mortality. They found 44 deaths during the study period spanning 3 months, out of 42,846 confirmed cases of pediatric COVID-19. This gives a case fatality rate of 0.1%. If we correct for asymptomatic cases which can range between 20 and 30 for every confirmed case, the infection fatality rate would be around 0.005%. As against this, there were 13,200 deaths among children in the same period. The main causes of child mortality were accidents: 1056; lower respiratory infections: 308; and influenza 107. The authors concluded that even during the height of the pandemic, 99.67% of all deaths in children were due to other causes.
The Swedish experience offers more insight into the severity of COVID-19 in children. Sweden was an outlier being the only nation which did not close schools during the pandemic. Ludvigsson et al., in a study of severe COVID-19 among Swedish schoolchildren, found it to be rare with only 1 child in 130,000 being treated in the intensive care unit (ICU) during the 4 month of monitoring. Pediatric ICU admission for severe COVID-19 was 15, out of which 7 had multi-inflammatory syndrome, which has been attributed to COVID-19. Out of these, four had other underlying conditions. None of the child died. The median time in the ICU was 4 days.
Besides severity in children, other concerns are that children may act as super spreaders infecting other adults in the house or triggering high-intensity community transmission. Lee et al. summarize the evidence on these. They conclude that within families in majority of cases, children developed symptoms after adult members in the household fell sick, suggesting that the child was not the source. Children frequently acquired infection from adults. The authors also, on basis of available evidence, concluded that transmission among schoolchildren is less important in causing community transmission than earlier feared. On the other hand, transmission of influenza among schoolchildren has been known to lead to community outbreaks.
Given the evidence, policymakers should consider reopening schools to prevent long-term educational, social, and psychological problems among schoolchildren.
| References|| |
Bhopal S, Bagaria J, Bhopal R. Children mortality from COVID-19 compared with all deaths and other relevant causes of death: Epidemiological information for decision-making by parents, teachers, clinicians and policy makers. Public Health 2020;185:19-20.
Ludvigsson JF, Engerström L, Nordenhäll C, Larsson E. Open schools, COVID-19, and child and teacher morbidity in Sweden. N Engl J Med 2021;384:669-71.
Lee B, William VR. COVID-19 transmission and children: The child is not to blame. Pediatrics 2020;146:E2020004879.