Highly unlikely for third COVID-19 wave to exclusively affect children: IAP

Though children remain susceptible to COVID-19 infection, it’s highly unlikely that the third wave will predominantly or exclusively affect children, says the Indian Academy of Paediatrics (IAP). It said there was no evidence to suggest that most children with COVID-19 infection will have severe disease in the third wave.

The IAP, in its advisory on Saturday, said almost 90% of the infections in children so far has been mild or asymptomatic. “The most important reason is the lesser expression of specific receptors to which this virus binds to enter the host, and also their immune system. A very small percentage of infected children may develop moderate-severe disease. If there is a massive increase in the overall numbers of infected individuals, a large number of children with moderate-severe disease may be seen,” it said.

“In the first wave, the severe disease occurred primarily in the elderly and individuals with co-morbidities. In the second wave, large number of younger age group (30-45 years) individuals have developed severe disease as also those with co-morbidities. After the second wave is over, if we do not continue following COVID appropriate behavior, the third wave, if it occurs, is likely to infect the remaining non-immune individuals, that may include children also.”

The advisory highlighted that children are as susceptible as adults and older individuals to develop infection, but not severe disease. As such, it said that it’s highly unlikely that the third wave will predominantly or exclusively affect children.

Dr Umesh Vaidya, a member of IAP’s COVID task force, who is also in charge of the neonatal intensive care unit of KEM Hospital in Pune, said parents had no reason to be disproportionately scared, but asked them not to be careless as well. The advisory asked parents to watch out for mental health issues in children, and be alert to prevent instances of child abuse and violence.

“The spectrum of illness is likely to be much less severe in children than adults. There is only a remote possibility of children being more severely affected than adults in the next wave. As per data collected in the first and second waves, even severe COVID infections in children are less likely to require ICU admissions. However, we need to be watchful about how the mutant strains will behave,” it said. “Severe disease occurs in children, but there is no evidence indicating that most children with COVID-19 infection will have severe disease in the third wave.”

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The IAP advisory pointed out that COVID pneumonia in children is uncommon as compared to adults. “In some cases, after two to six weeks of asymptomatic or symptomatic COVID-19 infection, MIS-C may be seen due to immune dysregulation with the incidence of one or two cases per lakh population.” Some of these cases may also be severe, but it is a treatable condition with a good outcome if diagnosed early.