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Indian Pediatr 2020;57:
480-481 |
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Impact of COVID-19 on
Children and Pediatricians
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Rajesh K Kulkarni1*, Aarti A Kinikar1
and Ajay Chandanwale2
1Departments of Pediatrics, and 2Dean
B J Government Medical College, Pune Email:
[email protected]
Published online: April 09, 2020; PII:
S0974775591600157
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During the 2009 H1N1 pandemic, we had written
about lessons learnt from the pandemic [1]. After a decade, we are in
the midst of another pandemic due to a respiratory virus(SARS-CoV-2)
[2]; we, herein try to highlight some of the similarities and
differences in the public and government response to the epidemics, and
its impact on children and pediatricians.
Agent, host and
environment decide the course of an outbreak of infectious diseases.
Both pandemic flu and SARS-CoV-2 spread by respiratory droplet, but it
is thought that the mortality is higher in SARS-CoV-2 infected cases.
While pandemic flu caused significant mortality in children, SARS-CoV-2
mainly kills people over 60 and with comorbidities. From the data
published so far, it appears that children account for 1-5% of all cases
and would generally have a milder disease compared to adults [3]. The
less severe presentation may be attributed to less exposure or
sensitivity to COVID-19, different immune response mechanisms, or higher
levels of antibodies to viruses than in adults due to broader exposures
to respiratory infections in winter. There is some interest in the
possible role of measles [4] and BCG vaccine in providing protection
against SARS CoV2; if true, India stands to gain from its recent
Measles-Rubella vaccine campaign. However, we cannot be complacent and
we need to be on the lookout for severe disease in ‘high risk’ children
(immunocompromised, lung or airway disease, long term steroids,
thalassemia, nephrotic syndrome etc.), in addition to continuing their
ongoing management [5]. Seasonality of influenza is largely dictated by
temperature and it remains to be seen how these factors affect
SARS-CoV-2 transmission. Social determinants of health, including health
equity and age-related illness, may play an important role in both
pandemic flu and COVID-19 pandemic.
During the 2009 pandemic,
India reported 27,236 laboratory confirmed cases of pandemic influenza A
(H1N1) with 981 deaths [6]. The first case of the COVID-19
pandemic in India was reported on 30 January, 2020. As of 5th April,
2020, the Ministry of Health and Family Welfare has confirmed a total of
4643 active cases and 149 deaths in the country, with an increase
predicted in coming days.
During the 2009 H1N1 pandemic, few
people in India had access to social media and the primary source of
information was television and print. Information about the number of
cases and deaths worldwide and in India was available but not at the
pace it is available today. In general, there was poor awareness about
how the infection spreads and the simple public health measures that
could be taken to prevent spread. In contrast, there has been a huge
outpour of information and misinfor-mation primarily attributable to the
social media during the current pandemic. It was heartening to see
increase in public awareness about social distancing, hand washing, use
of hand sanitizers, and cough hygiene, and measures to prevent
transmission of SARS-CoV-2. At the same time, a lot of fake news and
videos about the disease went viral on social media adding to the panic
and confusion among lay persons.
During 2009 H1N1 pandemic,
active public participation was limited. In contrast, the COVID-19
pandemic has sparked off a citizen’s movement, with people standing at
the frontline, shoulder-to-shoulder with governmental agencies. Several
industrialists and celebrities have responded with financial
contributions to the government funds and startups have come forward
with innovations and technical expertise.
In 2009, the government
response was much more limited to advisories on prevention of H1N1
through television and print. During this pandemic, the government has
been seen to be very proactive by taking measures like public education
through social media, television, radio, mobile phones and by various
measures like active contact tracing and restrictions on public travel.
The entire country was put into lockdown from 24 March, 2020. This has
implications for children’s physical and mental health. Due to decreased
physical activity and consumption of fast food children from privileged
section of society may become overweight. More importantly children from
less privileged sections of society may become malnourished. Excessive
screen time during lockdown may cause eye strain and behavioral issues
may crop up. Online and domestic child abuse may increase during this
period. ICMR has been quite proactive with updates on diagnostic testing
and management guidelines. Also seen is better coordination between
various government departments like health ministry, law enforcement,
transport authorities etc. Tackling the COVID-19 or any other pandemic,
must not just be a point-in-time solution, but that it must always keep
the larger objective of comprehensive, affordable public health in view.
A robust community health framework is essential if we have to achieve
this objective. There is an urgent need to work on insufficient
healthcare infrastructure and manpower improvement to manage this and
future pandemics. We should also look at indigenous manufacturing of
high quality PPEs, point of care diagnostics and ICU equipment as these
are crucial part of pandemic preparedness.
Finally, the
pediatrician treating the sick child is a susceptible adult and due care
must be taken by all pediatricians while examining children,
particularly those with respiratory symptoms. Use of appropriate PPE,
postponing routine visits (immunization visits can be continued as per
WHO guidelines), allowing only one attendant with the child in the
clinic, frequent sanitizing of the clinic, educating the clinic staff
and parents accompanying children, appropriate use of telemedicine,
avoiding throat examination, spacing out appointments,
hydroxychloroquine prophylaxis are some ways in which pediatricians can
minimize the risk to themselves. For pediatricians serving in ICUs,
following strict guidelines issued by IAP [7] and government is of
utmost importance.
Funding: None; Competing of interest: None
stated.
REFERENCES
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