Dr C Pradeep Kumar
An early cause for the hope within the coronavirus disease 2019 (COVID-19) pandemic was the observation that children are much less likely to experience severe illness than adults. and many recent studies suggest that the Third wave of COVID’19 can attack particularly children in the coming days and it’ll be more dangerous than the previous two waves and currently colleges school began to re-open. On the opposite side Covid remains spreading and move thousands of positive cases and many deaths per day. Hence it is important for us to understand the disease and to know How to protect our self and our children from such attacks and what are the steps and preventive measures to be followed
Key words : Covid-19, children, schools, preventive strategies, vaccine
The world is facing Coronavirus Disease-2019 (COVID-19) pandemic that is inflicting an oversized range of deaths and burden on medical care facilities by Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) originating in Wuhan, China. It has been seen that fewer children contract COVID-19 and among infected, children have less severe disease Understanding in pathophysiological mechanisms of less severity in children could be important for devising therapeutics for high-risk adults and elderly . Prompt closing of schools, colleges and day-care centers led to less frequent exposure and hence, lower infection rate in children. The expression of primary target receptor for SARS-CoV-2, i.e. angiotensin converting enzyme-2 (ACE-2), decreases with age. ACE-2 has lung protective effects by limiting angiotensin-2 mediated pulmonary capillary leak and inflammation. Severe COVID-19 disease is associated with high and insistent viral loads in adults. Children have strong innate immune response due to trained immunity (secondary to live-vaccines and frequent viral infections), leading to probably early control of infection at the site of entry. Adult patients show suppressed adaptive immunity and dysfunctional over-active innate immune response in severe infections, which is not seen in children. These could be related to immune-senescence in elderly. Excellent regeneration capacity of pediatric alveolar epithelium may be contributing to early recovery from COVID-19. Children, less frequently, have risk factors such as co-morbidities, smoking, and obesity. But young infants and children with pre-existing illnesses could be at high risk groups and need careful monitoring. Studies describing immune-pathogenesis in COVID-19 are lacking in children and need urgent attention.[1,2]
COVID-19 in babies and children:
COVID-19 pandemic was the observation that children are much less likely to experience severe illness than adults. This remains true, but has created a perception that children are less susceptible to infection and do not play a substantial role in transmission. However, emerging research suggests greater caution is needed. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is generally characterized by mild illness. Only a minority of children require hospitalization and the case fatality rate is very low (≤ 1%), although a small fraction of children can experience a severe post-infectious multisystem inflammatory syndrome. Although limited cases in children were reported at the beginning of the pandemic, this may have been because strong infection control measures in China halted the epidemic there before it could spread widely in this age group. Children are less susceptible to infection than adults, but may alternatively reflect shielding. In india schools are closed in March, this helped in our country spreading among children robustly.
Why do children fare higher than adults?
Children of all ages will become sick with coronavirus disease 2019 (COVID-19). But most children who are infected typically don’t become as sick as adults and some might not show any symptoms at all. Children are very much adapted to respond to new viruses, even when they are infected with SARS-CoV-2, children are most likely to experience mild or asymptomatic illness. Another clue that children’s response to the virus differs from that of adults is that some children develop COVID-19 symptoms and antibodies specific to SARS-CoV-2 but never test positive for the virus on a standard RT-PCR test. Children’s immune system see the virus and “mounts this really quick and effective immune response that shuts down, before it has a chance to replicate to the point that it comes up positive on the swab diagnostic test.[3,4]
How likely is it for a child to become sick with COVID-19?
While all children are capable of getting the virus that causes COVID-19, they don’t become sick as often as adults. Most children have mild symptoms or no symptoms. However, some children become severely ill with COVID-19. They might need to be hospitalized, treated in the intensive care unit or placed on a ventilator to help them breathe, according to the Centers for Disease Control and Prevention (CDC). In addition, children with underlying conditions, such as obesity, diabetes and asthma, might be at higher risk of serious illness with COVID-19. Children who have congenital heart disease, genetic conditions or conditions affecting the nervous system or metabolism also might be at greater risk of serious illness with COVID-19.
How are babies affected by COVID-19?
Babies below age 1 might be at higher risk of severe illness with COVID-19 than older children. This is likely due to their immature immune systems and smaller airways, which make them more likely to develop breathing issues with respiratory virus infections.
Newborns can become infected with the virus that causes COVID-19 during childbirth or by contact to sick care givers after delivery. If you have COVID-19 or waiting for test results due to symptoms, it’s recommended during hospitalization after childbirth that wear a cloth face mask and have clean hands when caring for newborn. Keeping newborn’s crib by bed while mother in the hospital. But it’s also recommended that maintain a reasonable distance from the baby whenever possible. When these steps are taken, the risk of a newborn becoming infected with the COVID-19 virus is low. However, if mother is severely ill with COVID-19, mother might need to be temporarily separated from newborn.
Children and adults experience similar symptoms of COVID-19, children’s symptoms tend to be mild and cold-like. Most children recover within one to two weeks. Possible symptoms can include:
- • Fever or chills
- • Nasal congestion or runny nose
- • Cough
- • Sore throat
- • Shortness of breath or difficulty breathing
- • Fatigue
- • Headache
- • Muscle aches or body aches
- • Nausea or vomiting
- • Diarrhea
- • Poor feeding or poor appetite
- • Loss of taste or smell
- • Abdomen pain
If the child has symptoms of COVID-19 and he or she might have COVID-19, call child’s doctor. Keep child at home and away from others as much as possible, except to get medical care. If possible, have the child use a isolated bedroom and bathroom from family members. Follow recommendations from the World Health Organization (WHO) and government regarding quarantine and isolation steps as appropriate. [4,5]
Is there a COVID-19 vaccine for children in India?
ZyCoV-D is a DNA plasmid based COVID-19 vaccine developed by India pharmaceutical company Cadlia Healthcare, with support from the biotechnology industry Research Assistance Council. It is approved for emergency use in India. They have been conducted pre-clinical trials and phase I, II & III trials conducted in February 2020 to Jan 2021. Phase III were conducted in 1000 volunteers age group between 12-18 years in July 2021. On 20 August 2021, the subject expert committee of the central drugs standard control organization recommended that the DCGI granted the approval. ZyCoV-D is a 3 dose vaccine given on day zero, day 28 and day 56. Approved for adults and adolescents above age of 12.
The Prime Minister Narendra Modi Tweeted on 20th August 2021 that India is resolutely fighting the Covid battle and the approval of the world’s first DNA based ZyCov-D vaccine is a testimony to the innovative zeal of India’s scientists. 
COVID-19 PREVENTION TIPS.
There are many steps can take to prevent yourselves from getting the COVID-19 virus
- Keep hands clean. Wash hands often with soap and water for at least 20 seconds.
- Cover mouth and nose with elbow or a tissue when you cough or sneeze. Throw away the used tissue and wash hands. Avoid touching eyes, nose and mouth.
- Wash their hands immediately after returning home, as well as after going to the bathroom and before eating or preparing food. Show children how to get the soap between fingers and all the way to the ends of their fingers, including their thumbs and the backs of their hands. Encourage kids to sing the entire “Happy Birthday” song twice (about 20 seconds) so they spend the time they need to get their hands clean.
- Maintain social distancing. Make sure child and everyone in household avoids close contact (within about 6 feet, or 2 meters) with anyone who doesn’t live in home. Since people without symptoms may spread the virus, avoiding in-person contact lowest risk. Can describe this distance to child as about the length of a door or an adult’s bicycle.
- Clean surfaces every day in common areas that are frequently touched, such as tables, doorknobs, chairs, light switches, remotes, electronics, desks, toilets and sinks. Also, clean areas that easily get dirty, such as a baby’s changing table, and surfaces that child often touches, such as his or her bed frame, craft table, and toys. Use soap and water to clean toy that child puts in his or her mouth. Wash child’s blanket and washable toys, often, Dry items completely.
- Wear masks. The CDC recommends wearing a mask in indoor public spaces and outdoors where there is a high risk of COVID-19 transmission, such as at a crowded area. Don’t place a face mask on a child younger than age 2, a child who has any breathing problems.
- Don’t take children to crowded places. Keep them indoors as much as possible.
- Don’t forget to give a nutritious diet with plenty of water. Give citrus fruits (orange, lemon, grape) and vegetables which are rich in vitamin C, vitamin D containing foods (cheese, egg yolks) and zinc-containing foods (legumes, lentils, beans, and nuts).
- Mother can continue breastfeeding if they develop COVID-19 disease but the mother should take due precaution to prevent transmission like use mask, washing hands before and after contact with the child. 
- Scientifically designed and conducted studies as part of the research programs by health professionals objectively conclude that mental health parameters improve significantly with yoga as an intervention. In addition to mental health, yoga will also improve the physical health and boost immunity among children which will also help in reducing the infection rate in children. 
Some evidence suggests that lying on the stomach might help people get more oxygen. This is because lying on the front of the body can stop the heart and stomach from pressing down on the lungs. This then results in the air sacks being able to fully inflate.
There are four positions a person can try:
Lie on the front of the body with the head turned to one side. Fold both arms under the chest and shoulders. A person can also use additional pillows under the shins to provide support to the hamstrings and toes.
Lie on the front of the body with the head turned to one side. Turn the arms out and up next to the head.
Place a pillow under the abdomen.
Lie on the front of the body with your head turned to one side and the leg on the same side bent at 90 degrees.
A person can support the leg with a pillow or blanket and place the arms wherever they feel most comfortable.
Lie on the side and place a pillow under the chest and knees. 
Summary of Healthy Buildings Program risk reduction strategies for schools.
As a forward step we need to know and accept that Covid-19 is not going to end up, it will be as it is in upcoming days hence we need to follow preventive guidelines as advised by the government authorities, and maintaining a healthy nutritious diet to be followed. Avoid going out unnecessarily, and crowded places. Now schools and colleges are started reopening so have to be very cautious by wearing masks and taking up preventive measures to be away from the viruses.
- 1. WHO COVID-19 Dashboard. Available at: https://covid19.who.int/. Accessed 21 Apr 2020.
- 2. Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019ncov/coviddata/covidview/04102020/labs-regions.html.
- 3. CDC COVID-19 Response Team. Coronavirus disease 2019 in children — United States, February 12–April 2,2020. 2020;10.1558/mmwr.mm6914e4[PubMed]
- 4. COVID-19, children and schools: https://scholar.google.https://www.mja.com.au/system/files/issues/213_10/mja250823.
- 5. https://www.mayoclinic.org › in-depth › art-20484405
- 6. Zycov-D,https://www.thehindu.com› News › National
- 7. https://kidshealth.org› parents › coronavirus-child-is-sick
- 8. Pediatric-Pulmonolgy-https://onlinelibrary.wiley.com/doi/full/10.1002/ppul.24885
- 9. Fry-Bowers E. K. (2020). Children are at Risk from COVID-19. Journal of pediatric nursing, 53, A10–A12. https://doi.org/10.1016/j.pedn.2020.04.026
- 10. Kuppusamy M, Ramaswamy V, for children in the new normal Complement Integr Med. 2021 May 6. doi: 10.1515/jcim-2020-0404. Epub ahead of print. PMID: 33962512.
Dr. C. PRADEEP KUMAR
Dept of Paediatrics