Experts all over India have repeatedly warned of the possibility of a third wave of Covid-19. Most scientific projections emphasize, that children are at risk from this possible wave. Various statistical models predict a third wave to have anywhere between 25 per cent of the number of fatalities in the second wave to as much as 60 per cent more fatalities than in the second wave. The United Kingdom started witnessing a third wave just 4 weeks after the second wave ebbed. The task force of the Maharashtra state government warns - Maharashtra is at risk of a 3rd wave in the next few weeks. The recent detection of the Delta plus variant of Covid-19 in Odisha is a cause for concern.
Odisha is busy in its war against the ongoing second wave. It is equally important to consider planning and working on strategies to face the third wave at this juncture. The third wave may be nearer than we have predicted. The detection of over 8000 cases of Covid-19 among children in Ahmednagar district of Maharashtra last month is worrying health experts. Sporadic cases of children falling seriously ill from Covid-19 is hitting social media in Odisha too.
Paediatric care in Odisha has remained underdeveloped in the best of times. The infant mortality rate is a sensitive reflection of the quality of paediatric health care. In 2019 before the pandemic, Odisha had infant mortality rate of 41 deaths for every 1000 live births, much higher than the national average of 33 deaths per 1000 live births.
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Covid-19 can jeopardize the functioning of any vital organ system in the body. This requires adequate health infrastructure like hospital beds, ICU, ventilators. More important is the need for specialized trained doctors and nurses. Odisha lacks adequate access to paediatric health care. Children are not miniature versions of adults, their bodies function in unique ways. Paediatric wards, ICU and ventilator facilities are urgently needed in all district hospitals. The administration’s announcement to start dedicated paediatric wards in district hospitals needs to be operationalized soon.
Unfortunately, Covid-19 is testing the limits of paediatric critical care. The recent news of a nine-month-old infant suffering from Covid-19 in Hyderabad is one such case. The lucky infant was saved by being put on an ECMO or an artificial lung machine. Odisha lacking adequate ECMO facilities for adults has a hard task ahead to treat such critically ill children. With reports of infants needing ventilators for Covid-19, Odisha needs to be prepared. Infants need much more delicate and specialized ventilators and ICU equipment compared to older children. Such specialized equipment for infants is likely to fall short in Odisha, unless we act soon.
Most Community Health Centers (CHCs) lack the services of a dedicated paediatrician. Government medical colleges continue to have vacancies in their Paediatric departments. A special recruitment drive to fill vacancies of paediatricians in all the medical colleges is important. Government policy on recruitment for doctors in the state medical services needs a rethink. The only entry system at present is based on the basic MBBS degree. Lateral entry recruitment of specialists into the state medical services, with relaxation of age limit will help ease the shortage of paediatricians.
Paediatric intensivists trained in managing critically ill children in ICUs are extremely rare. The government plans to train paediatricians and doctors in peripheries in critical care and ICU management. With more reports of children and infants needing ventilators, there is an urgent need to train faculty of the medical colleges too. For, unless our trainers are trained in the best practices of institutions like AIIMS New Delhi and PGIMER Chandigarh, we cannot expect the best standard of treatment to trickle down to our peripheral health institutions.
Children and infants have unique minds and special emotional needs. Segregated admission in Covid hospitals on the same lines as adults can be psychologically harmful to the child. The emotional cost of isolating a sick child from his loved ones is devastating. We need a policy designed to ensure safe but effective ways in which parents can be in contact with their sick children admitted to Covid hospitals. This is not merely necessary for the child’s health, it is equally important to reassure worried parents on the progress of their children.
With vaccine trials underway for children, a simple and effective vaccination strategy for children of our state is also essential. Most treatment protocols on Covid-19 have focused on adult patients. Odisha needs a safe and effective treatment protocol for Covid-19 in children. Medicines like Remdesivir, Favipiravir, Hydroxychloroquine are not recommended for children. Most commonly used antibiotics are also best avoided in children. A mass awareness campaign is needed to explain the potentially dangerous consequences of parents treating children with Covid-19 medications meant for adults.
Children are the future of Odisha. Every child’s life is extremely precious to the family and society. Odisha needs to work on a war footing to build up paediatric healthcare infrastructure and manpower. After all, every child’s life counts.
(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same. The author is an Orthopedic Surgeon and can be reached at sidusahu@gmail.com)
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