All scientific and epidemiological evidence from the Covid-19 pandemic suggests that in all the waves, children (0-18 years) have been at relatively low risk of developing moderate to severe disease. Yet, contrary to all the evidence, both social and mainstream media are abuzz about how children are either already getting severely affected or likely to get severe disease in the third wave. Any mention of children and Covid-19 together is taken as confirmation of this conjecture. Singapore closed schools and in India, this was seen as proof that children are getting affected by the new strain.
But let’s look at available data which clearly indicates that amongst the hospitalised Covid-19 cases in India, in both the waves, 2-5% were from 0-18 age group, which constitutes nearly 40% of population. Adults have 10-20-fold higher risk of moderate to severe disease and death than children. There is no evidence from any part of the world that a third or any subsequent wave will affect children disproportionately. While the mutations and resulting new strains of SARS CoV2 have shown higher transmissibility, this has not altered the potential to cause severe disease in any age group. These facts have been stated by nearly every expert who understands Covid-19 disease epidemiology as well as by the professional association of pediatricians in India.
Yet many continue to trivialise data through oversimplification. As an example, let’s take a news story that was played in a loop on TV which said that in April and May 2021, Maharashtra reported 99,000 Covid infections in children 10 years or younger, claiming that this means a 3.3-fold increase. Another news report said that in Ahmednagar district, in May 2021, a total of 8,000 new Covid infections were reported in 0-18 years. All this has been used to conclude that children are already getting increasingly affected and create panic among parents since kids are unvaccinated.
However, even an early career epidemiologist would tell you that to draw the correct inference, one needs to know both numerator and denominator. In April-May 2021, Maharashtra reported nearly 29 lakh new Covid cases. Therefore, 99,000 new cases in the 0-10 age group is 3.5% of total cases, while this age group makes up nearly 24% of total population. Overall daily new Covid-19 cases in India in the second wave were nearly four times more than at the peak of the first wave; therefore a 3.3-fold increase in 0-10 age group is still less than rates for the older age groups. In Ahmednagar, Covid cases in 0-18 constituted 10% of the total 80,000 cases reported in that month while this age group constituted 40% of total population. So, while children do get infected — various sero-surveys have reported a similar proportion of children getting infected as adults — they have relatively under-developed receptors which SARS CoV2 needs to affect lungs and make the person ill. That’s why even after infection, children do not develop severe disease.
It is also important to note that a majority of children who required hospitalisation for Covid-19 already had some underlying illnesses. The multi-system inflammatory syndrome in children (MIS-C), which now regularly features in news stories, is a rare condition that occurred even before this pandemic.
Even states seem to have fallen for this half-baked theory floated by some individuals.
In a knee-jerk response, a few states have set up a separate Covid task force for children, a step that could even be detrimental since an effective pandemic response requires a single integrated task force that makes all technical decisions.
What these developments do is show how India’s Covid-19 pandemic response continues to be influenced more by opinion than scientific evidence. To win against the pandemic, governments need to pay attention to scientifically sound advice and not get swayed by the noise. They need to desist from setting up even more committees and focus on developing a detailed road-map to strengthen the health system with time-bound and measurable performance indicators, such as how many hospital beds or human resources or laboratories will be added to prepare for the subsequent waves. Covid data needs to be analysed by age, gender and other stratifiers, with comparisons between two waves, and made public. That will help in both formulating evidence-informed strategies and dispel such speculation.
The most specious of all the arguments is that even if there is no evidence to conclude that children will be more affected, we should prepare for the worst and increase Covid-19 ICUs for children. What we need to remember is that the adult population continues to be at 10-20-fold higher risk of moderate to severe Covid than children. The only assured way to be prepared for any subsequent Covid wave in India is to strengthen the entire health system and meet the health needs of all age groups.
Dr Lahariya is a medical epidemiologist and co-author of Till We Win: India’s Fight Against The COVID-19 Pandemic
