SCHOOL closure and opening January 29, 2022
1. It's a 'Five Years Test Cricket'. 'Covid Health Experts' are batting whose brains are reeling under the pressure of varied pace and spin of the 'Covid team'. In that confused state of mind they scripted controversial advisories like countrywide lockdowns, 'Zero-Covid policies, closure of schools for two years, etc. People had suffered for too long, not from COVID-19, but from irrational and disproportional restrictions in all matters all over the world. Contradictory advisories and shifting strategies eroded the confidence in them. If the restrictions did not restrict Delta and Omicron, it stands to reason that they will not restrict a more transmissible one. However, restrictions and preventive measures based on robust and valid scientific evidence must be followed.
2. The risk of getting Covid disease for school going children is less than that of getting injured in a road accident while travelling to the school.
3. The decision to close schools for that long is out of an emotional reaction to protect children. It is disproportionate and unscientific.
4. Data shows that children have greater immunity and lesser infectivity than adults even when not vaccinated. A Spain study showed that the R-value (rate of virus spread) for school children is very low (0.2 to 1). Sweden didn't close schools.
5. It is plain common sense that school ambience is less crowded, less infective, and more hygienic than the surroundings of homes, or even inside the homes, in India, in general.
6. School closure-related mental health issues prompted the American Academy of Pediatrics to call the mental health crisis among the children a 'national emergency'.
7. Online education is not wholesome education, as children are human beings, not programmed machines. And most of the Indian children and schools have no good facilities for the digital education. A detailed 'Survey Report' (September 2021) showed the disastrous impact of school closures on the literacy of children from lower income groups. We are not talking about the minority of the affluent sections which gets its children educated anyway, schools or no schools.
8. In addition, many Indian children face the problem of malnutrition, being deprived of the free mid-day meals in schools; and the compulsions to go for work as child labourers.
9. Vaccinating all the children with the "hurriedly" approved "emergency" vaccines is another debatable idea. Vaccines will be of immense value when robust and rigorous trials endorse their efficacy and safety in the long run. But, the nod to prioritise children now when even adults are not fully vaccinated defies explanation.
10. India has the ignoble distinction of being among the countries with the longest school closures of about two years during the pandemic. We punished the children for too long. Posterity would not pardon us. Good school life and happy childhood is a constitutional right of children. Schools should be the last to be closed and the first to be opened. Join the 'Chain-for-Children's-Cheer at happy22kids.org and the initiative 'Happy 2022, Happy for Kids Too'.
-- Dr. T. Rama Prasad
. COVID, CHILDREN and SCHOOLS .
RAMA PRASAD T.
Dr. T. Rama Prasad,
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre,
Perundurai, Tamil Nadu, India.
Presently: Director of ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052. drtramaprasad@gmail.com WhatsApp +91 98427 20393 BLOG https://drtramaprasad.blogspot.com
WEBSITE www.rama-scribbles.in Twitter @DrRamaprasadt Facebook T Rama Prasad
Telegram Dr T Rama Prasad
`
A MONTHLY JOURNAL OF MEDICINE AND SURGERYSN
Vol. 118 No. 10 October 2021 ISSN 0003 5998
Indexed in IndMED Email: admin@theantiseptic.in www.theantiseptic.in
Rama Prasad, T. Pages 08 – 18
. Covid, Children and Schools .
RAMA PRASAD T.
Dr. T. Rama Prasad,
Formerly: Medical Superintendent (Special) of RTS & IRT Perundurai Medical College and Research Centre,
Perundurai, Tamil Nadu. Presently: Director of ‘PAY WHAT YOU CAN’ Clinic, Perundurai, Erode District, TN – 638052.
Specially Contributed to “The Antiseptic” Vol. 118, No. 10
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“Children are one third of our population and all of our future.”
-- Select Panel for the Promotion of Child Health, 1981
ABSTRACT
This quote sums up the importance of this topic in relation to the future generations. The long-term health impact of the present Covid infection or vaccination on children or their progeny is unknown. Given the disastrous and unpredictable nature of the SARS-CoV-2 virus during the past 18 months, and the possible long-term impact of this virus on humanity, any decision taken on dealing with the Covid problem in relation to children is crucial and paramount. The prevailing uncertainty is so profound that everybody is in a state of fear and anxiety, especially about sending children to schools and getting them vaccinated. Some of the aspects of this conundrum are discussed in brief in this paper, with the knowledge available around mid-September 2021. In this seemingly unending catastrophe, let’s hope for that fortunate stroke of serendipity which may save the most precious segment of Homo sapiens.
Key words: Covid in children, Covid vaccines in children, Schools reopening
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Introduction
India or even the world is far from being anywhere near the finish line with regard to the coronavirus pandemic. The ‘Delta variant’ which was first found in India has upended further the plans to reopen economy and education all over the world. With the unending wait of more than 18 months, now, in September 2021, schools in India are opening up taking a risk in their stride. The focus now is on ‘Covid, children and schools’. The subjects of ‘Covid, children and schools’ are so inextricably interlinked and too complex that the wooden pedagogy stuck to our conventional ‘reopening drill’ won’t work. The ‘gap effect’ can’t be filled without innovations. Public health authorities, governments, school managements and parents are in a state of extreme concern and anxiety. After a gruelling ‘home quarantine’ of children for one and a half years, a ‘gambling decision’ is taken to open schools, despite the uncertainty about how the ‘second Covid wave’ finally would wind up and how the possible ‘third Covid wave’ could evolve and how it may affect children.
Expert opinion is much divided on this matter. According to some projections, the ‘third wave’ is expected to ‘peak’ next month in October 2021 with greater ferocity than the ‘second wave’ with newer mutants, while some feel that the ‘third wave’ may just be a slow transition into an endemic state with a few ups and downs here and there.16 Equally divided is the opinion about the possible involvement of children in the expected ‘third wave’.16 Some pundits have been airing that children would be the most affected by the ‘third wave’ contrary to the view expressed (perhaps, based on the data of serosurveys and the fact that children do not have well-developed ACE-2 receptors in the lungs that enable the virus to enter) by Soumya Swaminathan, Chief Scientist, World Health Organization (WHO). She expressed that children are unlikely to be at a greater risk. But in the US, Covid infection rates for children aged 5 to 17 had been as high as in adults, with over five million children (the US has a population-size of 1/4th of that of India; Indian children constitute 7% of the 3.33 crores of Covid cases in the country) being affected by COVID-19, and States with low vaccination cover like Texas and Florida recorded surges on school reopening. 75% of the eligible Americans were vaccinated so far (only about 17% of the eligible adults have been fully vaccinated in India, as of mid-September 2021). At present, the main risk to the humankind seems to be from the ever-evolving mutants. How long more can the children wait at homes, to the detriment of their future ? We have already earned the ignoble distinction of being one of the few countries which have not yet fully opened schools, while over 175 countries have opened schools across the world. Schools are to be opened up for safeguarding the future of the children and the country.
Only at the end of October 2021, we may have a clearer idea of the ground reality, sometime after the schools reopen and after crossing the predicted ‘peaking’ of the ‘third wave’. Exposing children is a calculated risk amidst uncertainty about the future course of the Covid pandemic. There seems to be no alternative to opening of schools, especially as the recent (August 2021) surveys (SCHOOL survey and ASER 2020 Wave 1) concluded that the prolonged closure of the schools has had “catastrophic consequences” on children’s education, health and their very future.1 It is found that 37% of poor rural kids didn’t study at all during the period of ‘lockdown’ of schools and that a mere 8% of students in rural areas had access to online learning. Many of them had to switch over to manual labour.
Roadmap for school reopening
Reopening of schools is not like reopening of a shop or a park, in the prevailing epidemiological situation. It needs a lot of wisdom in formulating an ideal roadmap of action, in the context of Covid’s ‘world of uncertainty’. It’s a nascent subject. One may be right or wrong. Arguments largely reflect the biases of those with strongly held points of view on both sides. The following is a brief note of one option which is recommended by the veteran Indian virologist of international repute, Dr. T. Jacob John.2 (1) As a pilot study, open a few PRIMARY SCHOOLS (5 to 10 years of age) in a few districts for two weeks. (2) If there is no worrisome evidence of viral spread, open more primary schools. (3) If there is no significant spread of the virus, open more and more of primary schools until the entire State is covered in six weeks. (4) Then and only then, if there is no problem, open a few MIDDLE SCHOOLS (11 to 15 years of age) in a few districts for two weeks. (5) If there is no problem, open all the middle schools in the State in another two weeks. (6) If there is no problem, open a few HIGH SCHOOLS (16 and 17-year-olds) in a few districts for two weeks. (7) If there is no problem, open all the high schools in another two weeks, and move on. The entire process takes three months. If any problems are encountered, the local health authorities would take care of them. And strictly follow the advisory of the local health authorities for opening schools including the mandatory vaccination for all who come into contact with children.
The rationale and the benefits behind this roadmap are these: (1) The lowest risk of the disease is in the primary school ages of 5 to 10 years among those below18 years of age who are currently ineligible for vaccination. (2) Thestaggered opening gives a chance to test the waters before plunging. (3) The two weeks’ interval covers two incubation periods of the virus. This roadmap objectively assesses risks and provides time to adopt mitigation strategies. It can be improved by (1) monitoring (antibody test and RT-PCR or rapid antigen test) 10% of the middle and high school students for at least four weeks; (2) prioritizing districts with higher immunity / seropositivity. The objective data and the evidence from the sequential plan of the road map would let us know how safe is school reopening. It is important, as safety should always come first in matters concerning children.
Prioritise primary schools
Younger children, typically in the 6 to 14 age group have the lowest risk of moderate or severe COVID-19 disease, while this is also the cohort that needs good foundational teaching. Given this fact, it may be prudent to give priority to open schools for younger children. But what is happening in many countries is to the contrary – opening first for higher grades. This may jeopardize the nascent return of schooling.
Schools closed for too long
“Seropositivity levels in children are comparable to those in adults – keeping children at home has not served the purpose of keeping them from becoming infected. This is a point whose importance has been insufficiently stressed: if children are as likely to pick up an infection from the community while staying at home, there is little reason to keep them out of school. Given the state of the Indian epidemic as well as the likely possibility that COVID-19 will transition into endemicity, there seems to be little reason to continue to have schools closed.”3 On the other hand, there had been a humongous loss in multiple ways (long-term consequences of disruptions in learning and socialization, etc.) by the closure of the schools which can’t be compensated in a lifetime. In our overzealous attempt to protect children, we had ended up depriving them of educational, developmental, social, emotional, physical and mental well-being by closing schools for too long. In around 175 countries across the globe, schools were opened in some capacity even four months ago, adhering to the advisory of the European Technical Advisory Group -- smaller classes, wider spaces between desks and staggered breaks at school.
Children not sacrosanct
There has been a prevailing perception of gain in immunity by children through subclinical Covid infections during the ‘first two waves’. This hubris was elevated by the ‘favourable’ results of serosurveys (which included children) and the arrival of vaccines.4 Even so, the epidemiologists and advisers to the government had dilly-dallied with the issue of opening of schools in India, especially as the Covid cases and the Delta variant have been spiraling in Kerala State and some newer variants like ‘C.1.2.’ and ‘Mu’ seem to be on the horizon. As the ‘sages’ were proved to be not infallible in the ‘second wave’, they are now ready with Covid beds for children. Children are not sacrosanct, but may be less vulnerable than adults. What is said and written about Covid is mostly applicable to children also. Various aspects of Covid were discussed in my 12 articles published over the previous 12 months in The Antiseptic, a journal of Medicine and Surgery, and in Health, a journal devoted to healthful living.5,6,7,8,9,10,11,12,13,14,15,16
Mandatory vaccination for children
Soon, Covid vaccines will be available for children in India. Then, parents may be indirectly coerced into having their school children vaccinated on the pretext of ‘saving the nation’, just as is being done for adults. There is scientific evidence to say that normal children, by and large, are not susceptible for serious Covid disease. By juxtaposing this fact with another fact that there is no robust evidence of long-term (or even short-term) safety and benefit of the currently available Covid vaccines in children, one can say that it is unscientific and immoral to mandate (or even to recommend overwhelmingly) the Covid vaccination for children – immoral if it is only to protect elders at home. Again, there is no substantial evidence of the transmission from schools to elders at home. Moreover, the ‘mRNA’ vaccines that are currently being used in some countries for children are of a new gene-based technology which has no history of known safety. Any of the Covid vaccines, irrespective of the technology, should not be given without well-informed consent of the parents. There is ‘too much’ to write about the ‘too little’ evidence of benefit and safety of Covid vaccines in children that the space here doesn’t permit to print. Was not the ‘swineflu’ vaccine, Pandemrix, withdrawn after a long time for causing ‘narcolepsy’ in children ? Was not Dengvaxia, a vaccine against Dengue, withdrawn after 19 children died of possible ‘antibody-dependent enhancement’ (ADE) ?28 ADE is most unlikely to occur with Covid vaccines as ‘N’ (nucleoprotein) antigen is not used, only ‘S’ (spike protein) antigen is used.29 Manufacturers have now become clever by demanding ‘zero liability’. Most of the apprehensions on reopening of the schools in India are based upon alarmist and evidence-bereft high-decibel discourse projecting that children would be the main target of the ‘third wave’. But the evidence is to the contrary -- the Indian Council of Medical Research (ICMR) 4th National Serosurvey showed that more than half of Indian children had already gained immunity (seropositive) to the Covid virus even before August 2021.4 It means that more than half of the children were already infected though they didn’t go to schools. We missed to see the disease in these children since severe Covid disease is very rare in children. As such, parents have to think twice before opting to give their children the Covid vaccines of unknown safety and of unproved benefit. In no other disease, the ground realities are so different from theoretical projections. During the past 20 months, did we not project numerous advisories and taken them back on various aspects including the origin of the virus, treatment protocols and preventive measures ?
Covid vaccines for children
The latest surprising news as on September 6, 2021 was administering Covid vaccine to children as young as two years. In a world’s first, Cuba started vaccinating children in the 2-11 age group in the central province of Cienfuegos with its home-grown vaccines (not recognised by the WHO), Abdala and Soberana. Cuba aims to inoculate all its children before reopening the schools that have been closed for the most part since March 2020. What a crucial (or cruel ?) decision !
On the other hand, at about the same time, on September 3, 2021, the UK’s vaccine advisory body (Joint Committee on Vaccination and Immunisation – JCVI) did not recommend Covid vaccines for healthy children aged 12–15 years citing lack of sufficient evidence of benefit and the concern over the occurrence of myocarditis with the Pfizer-BioNTech vaccine. The JCVI noted that the picture of risk/benefit ratio is not yet clear, while the US, Israel and some European countries have recently rolled out Covid vaccines to children. What is clear is that there is an equally divided opinion about vaccinating children on grounds of prioritization and safety as well. Some countries stopped using the Astra-Zenecavaccine due to the rare side effect of blood clotting.
Israel, the czar of Covid vaccinations and the ‘poster child of a quick return to pre-pandemic norms’ is inoculating all aged above 12, and is even mulling administering a 4th dose of vaccine to its population after the booster (3rd) dose. A recent (September 13, 2021) expert review published in The Lancet does not recommend ‘booster doses’ for the general population at this stage of the COVID-19 pandemic.23 Data from the US suggests that millions of young teenagers were vaccinated and that there were 60 cases of myocarditis for every million of second doses given to 12 to 17-year-old boys (compared to eight in girls). Some studies have shown that the Pfizer-BioNTech COVID-19 vaccine is 100% effective in preventing the infection in children aged 12 to 15 years, and that it is 91% effective in preventing severe illness in people aged 16 years and older.
Studies on the use of the vaccine in younger children are fast progressing. It is hoped that children as young as two years may also be inoculated soon with this vaccine. Once the bridging studies on vaccination in children are completed favourably, ‘Universal Covid inoculation for children’ may be adopted. How about those under two ! And, babies under the age of one year may be at a higher risk when exposed to this virus due to their immature immune systems and smaller airways. Somebody may come out with a vaccine for infants ! All said and done, there is no robust and incontrovertible evidence of long-term safety and efficacy of any of these vaccines in children. Ten years of evidence is compressed into one year !
Vaccines for children in India
While India hasn’t yet begun vaccinating children, ZyCoV-D vaccine manufactured by Zydus Cadila (Ahmadabad, India) was approved for ‘restricted use’ in August 2021 by the Drug Controller General of India (DCGI) for a three-doseschedule (Day 0, Day 28 and Day 56). This is the first vaccine permitted to be used in India for children of the age group of 12 to 17 years. The double delight is (1) that this vaccine is a needle-free vaccine that can be administered with an applicator which ensures painless ‘intra-dermal-jet’ vaccine delivery, and (2) that the manufacturer would shortly apply for authorisation for a two-dose schedule as favourable data are forthcoming. In addition, the platform used in this vaccine, because of its ‘rapid plug and play’ technology, can easily be adapted to deal with mutations in the virus, such as those already occurring. The virus is currently broadening its repertoire into developing more variants like ‘Mu’ (having potential ‘immune escape’ property), ‘C.1.2’ and some sub-lineage versions like ‘AY.4’. This indigenously developed ‘plasma DNA-based vaccine’ may be a game changer in the management of Covid in children. The company had stockpiled about 20 million doses.
Bharat Biotech’s Covaxin may get approval soon for use in children. The ‘BBV 154’ nasal Covid vaccine byBharat Biotech is likely to be available by the end of 2021. This vaccine is projected to be pocket friendly (less than Rs. 200/- per dose) and more effective than the current vaccines.8 The nasal vaccine is being developed for children and is in the ‘Third Phase’ of clinical trials.8 This would definitely be more acceptable (sans needle pricks), overcoming the ‘hesitancy’ and the administering problems, for obvious reasons, and may be more relevant in the context of the ‘third wave’. This month, September 2021, the DCGI has recommended that the single-dose version of the Sputnik V vaccine – Sputnik Light – be tested in Indians. Further trials only will show whether this can be used in children. The single dose is an attractive option for children. Earlier, in April 2021, the two-dose version (Sputnik V) was approved for ‘emergency use’ in adults.
It is hoped that parents would come forward to get their children vaccinated unlike how they moved at a glacial pace in the first quarter for their own vaccination, before overcoming hesitancy; at that point of time, authorities also stumbled over supply issues and finally hit the stride. Though vaccination doesn’t guarantee invulnerability, it is the best (if proved to be safe in the long-term) for children, as ‘masking’ and ‘physical distancing’ are anathema for them.
To Be or Not to Be
The ‘first Covid wave’ began on April 1, 2020 (subsided in September 2020) and the ‘second Covid wave’ on February 14, 2021, in India, assumingly. The ‘Delta’ variant of SARS-CoV-2 was the dominant one responsible for the stupendous calamity during the ‘second Covid wave’.5 We don’t yet know when the ‘third Covid wave’ would start.16 Or, has it already started ? India seems to be standing now between the waning of the ‘second wave’ and an imminent ‘third wave’, the peak of which is predicted to come in October 2021 according to many studies and mathematical models.16 It may touch the base around January 2022.
As of September 2021, there are straws in the wind of some glad findings of opening of schools. At least 14 States, despite the possible havoc on unvaccinated children by the ‘third wave’, have tempered caution with calculated risk and opted to reopen schools. But we don’t know the consequences, especially as ‘cases’ are rising in Kerala, Maharashtra and some other places, and as the ‘festival season’ is approaching – a good recipe of a ‘starter’ for the ‘third wave’.16
Everyone, right from a layman to a luminary of virology, is talking now about the possibility of children contracting the Covid disease in schools and passing it on to elders at home. This fear and the love for children have ganged up to puncture the enthusiasm of parents to send their kids back to schools. The heavy irony is that the parents are engaged with the titular Prince Hamlet’s soliloquy “To Be or Not to Be” (“to send or not to send children to school”) ! But how long more to hide children at home ? Until January 2022, going by graphs of predictions by mathematical modelling ?16,27
School hesitancy
Covid has been both a health and educational disaster. In children, it is closely related to opening of schools. Most of the schools in India are in the ‘opening activity’ in September 2021. One week after schools reopened in Tamil Nadu, about 30 students and teachers had tested positive for COVID-19 at different parts of the State. It is reported that “several states have observed a rise in Covid-19 cases among children, shortly after the reopening of schools.”17 The publication of the news of such incidents across the country, though of an insignificant number, is bringing a new version of hesitancy akin to ‘vaccine hesitancy’ – ‘school hesitancy’, especially among those, albeit not many, who thrived well with remote learning and acquired more knowledge through the ‘screens’ than what they could have possibly got through the conventional schooling over the past one year. Give them a syllabus and three months; they can easily crack a graduate examination even before graduating from the school ! With their experience of learning during the long school break, some of them feel that school education is a colossal waste of time, purely from the point of view of time management in academics. Of course, such brilliant students form only a minuscule fragment of the student population.
Bitter reality
On the flip side are the poor rural kids who have no digital access and who didn’t study at all during the past 18 months and destined to become child labourers. If the ‘third wave’ strikes severely, millions of such children would be pushed into the unorganized labour market permanently – right now, many are there temporarily losing their health. A study had shown that a mere 8% of students in rural areas had access to online learning.1 Such is the inequity of the online education of the Covid times. It is in the context of this crippling absence of education for millions of children in the country, alacrity to limit the damage by a ‘hybrid mode’ (combining physical and digital) of imparting instruction may be considered at least until there is a clarity about the impact of Covid. A survey by a Coimbatore-based NGO (Education Development Committee) revealed that 50% of the college students didn’t rejoin colleges for financial reasons and fear of Covid infection. And 25.2% of them turned labourers.
With a student population of over 250 million, putting them back in schools is a crucial issue. Already, there has been a yawning disconnect between schools and children jeopardizing their health and future. All of us have a moral – not to mention economic and medical –obligation to get this right. The subject of reopening of schools has become a nightmare for public health experts. Resumption of ‘regular’ schooling remains a dilemma. The approach should be caveated: risk based, dependent upon local prevalence of the disease, and ensuring good ventilation, physical distancing and face masking. Good ventilation is the best preventive tool. Covid would have been a nonentity, if ventilation had been good all over the world – ventilation had been “bad” in rich countries and affluent sections in other countries because people there mostly live in fully air-conditioned “boxes / mansions” with no natural ventilation. This may be one of the reasons why Covid severely affected affluent countries. It would be a good idea to have school classes in shaded ‘open air’ areas, for the present.
Silver lining
It is the general observation, so far, that children are not severely affected by the Covid. The causes may be many. As children often catch ‘common cold’ caused by common viruses, their systems may be primed to have some ‘cross immunity’ to SARS-CoV-2 virus, thus conferring on them some sort of protection. It is also possible that children’s immune systems may not overreact (like in ‘cytokine storm’) as in the case of some adults. Another factor is that children are mostly indoors during the pandemic. More specifically, children seem to evade the infection by virtue of less concentration and activation of Angiotensive-Converting Enzyme 2 (ACE-2) receptors at the pulmonary level to which this virus binds via spike (S) glycoprotein for gaining entry into the body. With all this and a loss of 500 days of learning, even if the children win the battle now, the pyrrhic victory may not last long to celebrate – this is the flip side.
Unkindest cut
The adversity that struck children due to Covid is fathoms deeper than the disease problem. The ramifications are too many. Unavailability of ‘free mid-day meals’ during closure of schools has its own impact on health and economy. The impact on their education is the most severe. Most of the children got left behind for more than a year, as the Covid shuttered schools. In India, 2.64 crore students could not attend the 15 lakh schools in the country, and many of them would be school dropouts, alarmingly. Girl students had been the most affected victims for reasons like early marriages and pregnancy, forced outdoor and indoor work and domestic violence. Children, especially from socially, economically and geographically backward areas, had been deprived of acquisition at school of many basic life skills, social development, emotional stability and psychological balance.
Not navigating out of this morass will mean we are cheating our future itself. The problem is not just local, it’s global. Though children are deemed to be at low risk of severe infection from COVID-19, the pandemic has impacted their lives in innumerable ways. Globally, 1.5 billion children have been out of school leading to a long-term educational crisis; 370 million children have missed out on free school meal resulting in malnutrition and the associated diseases; 80 million children under one year couldn’t have regular vaccinations paving the path for various diseases.
The Covid conundrum
Children, under the age of 18 years, constitute a big chunk of the population (39%; 472 million). It was thought earlier that the unvaccinated children who stayed mostly indoors since March 2020 might not have been exposed to the virus much and so may not have developed adequate antibodies to thwart the viral infection, and so are more susceptible to be affected by the ‘third wave’.16 But the recent serosurveys (ICMR data of national serosurveys) indicated that a huge chunk of children (65%) was infected.4 And it is opined that the Covid virus can’t enter easily the ‘ACE-2 receptor-deficient-lungs’ of children, and that children wouldn’t be affected much by this virus. Then, did we needlessly ‘confine’ the children, and closed down the schools ?1
Diverse opinions are being delivered about the possible impact of the ‘third wave’ on children.16 The confusion is confounded when more than 100 children died of COVID-19 every week in July 2021in Indonesia which challenges the generally held idea that children face minimal risk from COVID-19. And the recent data show a steady increase of cases in children in India even as the total number of cases were dropping – children accounted for about 10 per cent of the total cases in August 2021. In Odisha State, the cases of children spiked to 17 per cent in September 2021. Most of the knowledge we have about Covid is patchy and cloudy, right from the origin of the virus to treatment to prevention to emergence of variants to vulnerability of children.18 There had been unscientific opinions and amusing attitudes, even by responsible world leaders. A president of a country said that Covid vaccines may convert people into crocodiles !19 To our consternation, he (the Brazilian President Jair Bolsonaro) who is not vaccinated has arrogantly aired that he had decided to attend a United Nations General Assembly meeting in New York next week (September 21, 2021) despite the mandatory requirement of ‘vaccination proof’ for all the attending leaders and diplomats. The irony is that while the UN Secretary General can’t prevent the entry of the unvaccinated president, the Mayor of New York can stop him ! Another president touted for Hydroxychloroquine and entertained us with the idea of injecting disinfectants to control the Covid !20 Nothing seems to be certain about Covid. Even specialists are unable to give a certain opinion on many matters. As such, people have been taking all the ominous signs as lightly as that of a weather forecast.
Kerala lesson
Last month, during August of 2021, Kerala alone accounted for over 51% the nation’s tally of the cases (including children) even while the overall number of coronavirus cases in the country is on a downward trajectory. The State is still grappling with the ‘second Covid wave’. Does it mean that the Kerala’s health care system failed ? No.24 The Kerala State in India had worked diligently to control the Covid transmission and earned immense appreciation as a role model health care system in containing various microbes over a long period of time. The truth, paradoxically, is that the present surge is due to the excellent capability to slow down transmission of the infection during the previous one year which means that there has been a huge susceptible population (not exposed to the virus which is evidenced by the fourth national seroprevalence survey4) in Kerala, more than in any other State, which is now being infected, especially when the Delta variant had emerged.24 Some experts said that the current stupendous surge in Kerala may mostly be due to their ‘extra care’ during the previous two ‘waves’ which prevented many of the people from gaining immunity (herd immunity) from ‘natural’ infection. It is inferred that such ‘protected’ (and so the susceptible) population, including children, is now being attacked. This is akin to the ‘hygiene theory’ -- kids in highly hygiene-conscious affluent countries are more susceptible to infectious diseases than those in economically poor countries with highly polluted environment.10
While this is not to say that non-pharmacological preventive measures are detrimental, attention is drawn to an analogy between the susceptible population in Kerala and the child population in India which has been isolated and insulated for over one and a half years (which made them susceptible, theoretically). I used the word ‘theoretically’, because a national serosurvey of the Indian Council of Medical Research (ICMR) had shown that 65% of the children have Covid antibodies.4 It’s another topic, to discuss about the strengths and weaknesses of the protocols of ‘surveys’ and scientific studies. Of course, much of what we know about Covid is theoretical including the protective value of the face masks, sans physical distancing, in the real world of the ‘India’s second wave’ ! In matters of Covid, 1 + 1 may not be 2 !
The ‘Delta variant’, first found in India and anointed as the fittest ’avatar’ of SARS-CoV-2 for now, may also be responsible for the huge surge in Kerala. Or, there may be some other variants at work which are yet to be identified.7 Also, infected people with no symptoms or mild symptoms might escape from serious illness even if it is the Delta variant.
Apparent mistakes
When a ‘national lockdown’ was imposed in March 2020 in India, it was scientifically expected that it would break the chain of infection effectively and that India wouldn’t have a big issue with Covid as it had taken the step quite early. But the ‘500 cases and 10 deaths’ in March 2020 had grown to ‘3,000,000 cases and 60,000 deaths’ by August 2020, notwithstanding the ‘lockdown’ !6 Another ‘lockdown’ can really deal a final sledgehammer body blow. Strict‘lockdowns’ (as were done in China) do work very well, but only for a short time (until they are opened) if immunity is not acquired quickly. Right now, China is struggling with a surge of cases. In India, ineffective ‘blanket lockdowns’, needless ICUs with ventilators, ‘experimental’ Covid drugs and nationwide ‘school shutdowns’ might also have played a negative role.20
Orchestrated by ‘big pharma’ and ‘small researchers’, unethical promotion of ‘experimental’ medicines, even in children, and vested interests in treatment protocols, and Covid-related fraudulent research and publication (a write up on the demeaning activity is present in the references 20) have become almost a commonplace of ‘Covid business’. 20 The ‘so-called evidence-based’ bugle blown by ‘mega researchers’ and ‘gigantic barons’ has become the marching tune for the poor countries. How much money was wasted on needless investigations, and drugs of unproven efficacy !20
The latest revelation is about the “plasma therapy.” The CONCOR-1 trial results published on September 9, 2021 in Nature Medicine journal by Canadian researchers showed that ‘plasma therapy’ is ineffective and associated with worse clinical outcomes and serious side effects. 21 Nearly 36,000 people were treated in Maharashtra with ‘convalescent plasma’ which was sold at the rate of Rs. 60,000 per dose. Overall, with no specific drug available for COVID-19 and no respite from the infective ‘waves’, even 20 months after the detection of the virus, it seems that we are back to the drawing board. Some of the wrong things done might be responsible for the evolution of ‘bad’ variants. Variants could reduce vaccine efficacy and thereby extend the Covid-19 crisis.7 Within a very short period, the virus developed variants of worry like Delta, Delta Plus, Kappa, B.617.3 (a sibling of the Delta), B.1.1318, Lambda (C.37), Mu, C.1.2 and AY.4 which may ‘escape’ the vaccines.7
Fussing over figures
A mistake that is still going on is taking the ‘number of cases’ as the yardstick for assessment of the seriousness of the problem, planning containment measures and organizing ‘unlocking’ procedures. It is time to stop fussing about ‘daily fresh cases’ and instead focus on the number of people hospitalised, number of severe cases and number of deaths. After all, the majority of the population including children gets naturally infected and thereby gets immunity, without any symptoms or with mild symptoms only. The world would not have been in the dire straits if it did what was required instead of fussing over figures and ‘locking down’ everything including children and schools. While the ‘case numbers’are of paramount importance in planning, they should not be used for undesirable restrictions and preventive measures like forcing people including children through ‘disinfectant tunnels’ and spraying hazardous disinfectants on them.10 Didn’t we do that ?
The right thing in the wrong way
All such happenings eroded the trust of the people in science leading to the unfortunate phenomenon of the deadly ‘science denial’ in 2020 and 2021, especially when the subject / victim is a child. Tentativeness is the hallmark of science and one must adopt what the philosopher of science Lee McIntyre calls a scientific attitude -- an openness to seeking new evidence and a willingness to change one’s mind. In this context, one may read, even seriously, whatCharles Darwin ‘wrote’ about our Covid scenario and our human race (the letter is in the references 22).22 Had we overreacted and prevented ‘nature’ to do its job of conferring immunity ? Studies have revealed that immunity from infection is better than that got from vaccination. Are we the cause , indirectly through our interventions, for the emergence of the unexpectedly virulent variants ? Did we interfere with ‘nature’ too much – resulting in bringing out viruses from forests and preventing them to do their evolutionary job in the human territory ? 22 Have we done the right thing in the wrong way during the pandemic ? All the questions beg for answers.
Breathing exercise
Scientific studies at universities like Harvard and Stanford showed that ‘deep breathing exercise’ may reduce the impact of Covid, apart from its myriad benefits. In the US, breathing sessions are conducted for school children and soldiers, and ‘Cardiac Coherence Breathing’ is advised for cardio-pulmonary health. In India, we tend to dismiss these as nothing more than rebranding of ancient yogic practices. We glibly claim the legacy of the practices, but hardly practise them. It would be profitable to make ‘deep breathing exercise’ a routine for school children just as they are required to observe ‘masking’ and ‘distancing’. The simplest way of doing the breathing exercise is this: One may take a deep breath and leave it, about 10 times; and repeat it about 10 times a day. One may do it anytime anywhere – outdoor, indoor, classrooms, homerooms, in cars, in buses, etc. Books like ‘Breath: The New Science of a Lost Art’ by James Nestor and ‘The Oxygen Advantage’ by Patrick McKeown are prompting people in the West to include ‘deep breathing’ in their fitness regime, in the wake of the Covid pandemic which affects the lungs most.
MIS-C
Many of the children suffering from ‘Multisystem Inflammatory Syndrome in Children’ (MIS-C) tested positive for Covid antibodies indicating that MIS-C might have been caused in these children by an excessive immune response related to COVID-19. MIS-C is a serious condition in which some parts of the body – such as the heart, lungs, blood vessels, kidneys, digestive organs brain, skin and eyes – become severely inflamed.
Mired down in myths
The world is sinking in its own theories about Covid. That children were not infected by closing schools and keeping them indoors is a myth (65% of Indian children were infected). That children are not affected by this virus much is proved to be a myth (over five million American children tested positive for Covid of whom about 2% were hospitalized and about 0.03% died).25 That ‘national lockdowns’ would cut the chain of transmission to create a Covid-free environment is another huge myth (most of the countries didn’t have a lasting benefit).6 It is the biggest myth that an affluent country can manage to be Covid-free (no country is safe unless all the countries are Covid-free; Insular focus on self-reliance is a costly gamble). That the pandemic could end through mass vaccination has become a humongous myth, with the ever-evolving virulent ‘vaccine-escape’ strains and the demonstration by the Delta variant of its capacity to change the dynamics of viral transmission (booster doses and periodical revaccinations are being planned due to uncertainties and ‘breakthrough’ infections). The Delta variant and the like which may be a threat to children have successfully dissipated the ‘upbeat feeling’ of being secured by Covid vaccines (the celebration is cut short). Eradicating SARS-CoV-2 is a profound myth (endemicity is our fervent hope now). That Covid kills more people than tuberculosis in India is yet another myth.26
The dilemma
Many countries which set the ambitious and unrealistic goal of achieving “Zero Covid Strategy” (zero daily fresh cases) have abandoned the idea as they can’t afford to close the borders and economic activity permanently to achieve that goal. The peculiarity (ever-evolving dangerous mutations) of this virus is that all the known measures (including the currently available vaccinations) to prevent the disease or to eradicate this virus work only for a short time. Another aberration and danger is that those countries which are splurging on excessive vaccination (‘booster’ doses and vaccinations in younger children, without scientific validation) may be haunted by a recoil by new vaccine-defying variants. A greater worry with regard to children is about the yet unknown long-term health impacts of Covid infection and Covid vaccination in this age group. With the support of the limited available data, many countries are advocating vaccination for pregnant women for their safety and that of their future children, as the Covid antibodies may pass on to the to-be-born. But no irrefutable data on the benefits or safety to such children in the long-term are available.
Economic impact
Covid in children has a tremendous but concealed economic impact. According to economists, human capital – skilling, starting with schooling – is more important than financial capital. This human capital is eroded by school closures. This has robbed the masses of gaining the ability to rise in the long-term economy. The potential loss of education of the 1.6 billion children across the globe (UNICEF count) will result in a loss of about $10 trillion in the expected future income of such students. The immediate impact is on the poorer segments – loss of mid-day meals, malnutrition leading to ill-health, expenditure on online learning, loss of social benefits, etc. The loss of 500 days of schooling will have a devastating stunting effect in learning abilities (partly due to automatic promotions), physical growth and future economic achievements, especially of the poorer sections. The hasty, prolonged and needless closure of the schools without debate doomed the entire young age groups to functional illiteracy and economic downfall. After all, children below 12 years of age are unlikely to fall seriously ill due to Covid.
Readiness
Singed by the sharp ‘second wave’, authorities in India are putting in efforts to protect children from the predicted oncoming ‘third wave’. Bracing for the ‘third wave’, task forces are trying to shield children through various proactive measures. At various places in the country, services are geared up to meet the contingency. For example, on the prediction that children are at risk now, exclusive Covid wards for paediatric cases have been opened in government hospitals in Tamil Nadu, and 15,000 doctors and 30,000 nurses have been trained to handle COVID-19 in children. So far, 94,259 children in the age group of 0-12 years have tested Covid positive in the State, with a mortality rate of about 0.16%.
Post that, we have to take heed of the current trends in the US where a record number of children have been infected (over 5 million) and hospitalised as the Delta variant has been surging through unvaccinated populations.25 Let’s hope that such a surge won’t occur in India. If such a wave forms after our schools are fully opened, well, the “SCHOOL WAVE” would – Heaven forbid – kill India !!! Finally, ergo, it is imperative that we should leave no stone unturned. As ever, the gap between preparedness and execution will be tested when the disease peaks. The test would start as schools and colleges – the final frontier – reopen fully. Awareness and action often lie at opposite ends. Educating and involving the community is more important than regressing into a ‘target mode’ to gain a mere data satisfaction – ground reality outcomes often differ from rosy statistics on paper. To make people literate on these matters and to block the ‘school wave’, we need to go literally on a publicity blitzkrieg.
Scenario in the US
All along, during the Covid pandemic, the Covid scenario in the United States had been giving an idea of what’s in store for India. But each country has its own Covid hue. As of mid-September, 2021, the following is the scenario of ‘Covid, children and schools’ in the US. As the schools reopened, the cases, hospitalisations and deaths due to COVID-19 had soared across the US. Contrary to the early period of the pandemic, according to the Centers for Disease Control and Prevention (CDC) of the US, Covid infection rates for children aged 5 to 17 had been as high as in adults aged 18 to 49, and higher than rates in adults over 50 years of age, in recent months. There have been over five million cases of COVID-19 in children since April 2020, according to the American Association of Pediatrics, making up about 15% of all the cases in the US. In August 2021, the number of new cases surged to near-peak levels. States with low vaccination cover like Texas and Florida recorded surges on school reopening. Children under the age of 12 were found to be particularly vulnerable as they are not yet eligible for the vaccination.
Hospitalisations for children with Covid jumped in early 2021 and have remained high. Now, in mid-September 2021, 95% of the ICU beds in a quarter of hospitals in the southern US are occupied due to the Covid surge. This is the catastrophic march of the ‘Delta’ variant which led to the stupendous calamity even as 75% of the eligible Americans were vaccinated. This “pandemic of the unvaccinated” has resulted in sweeping vaccine mandates on even school and health organisations wherever fiscal heft allowed. This could be a swim against the current of “irate anti-vaccine campaigners” who are flat-out on anti-vaccine scaremongering. Dr. Sean O’Leary, Vice-Chair of the American Association of Pediatrics Committee on Infectious Diseases said: “This is a reflection of both the infectiousness of the Delta variants and of what happens to unvaccinated populations as infections continue.”
The way forward
Dr. Sean O’Leary seems to say that a combination of vaccination and prayers to God (to prevent emergence of variants) is the only way forward. People need to come forward to get all the eligible adults vaccinated fast (only about 17% are fully vaccinated), to come forward to observe all the Covid-preventive precautions (which had been boringly repeated for over 20 months, leaving one with a sense of déjà vu), and to come forward to learn to live with the devil which may compromise to become an endemic under the threat of our arsenal of ‘social vaccine’ and ‘pharmacological vaccine’. Our crucial bargain with the virus is that it should not deploy its ammunition of ‘vicious variants’. The mistakes of prolonged blanket ‘lockdowns’ on ‘livelihoods’ and universal ‘shut downs’ on school education should not be repeated – only nuanced and dynamic ‘containment and unlock’ strategy using local epidemiological parameters is to be enforced. No child is safe unless every adult at home is safe. As eradication is out of question, there is no other alternative other than targeting endemicity as the exit strategy. So, let us move on in step with the LOWLY virus which exposed a chink in human’s armour and brought the MAN to this LOWLIEST level !
“Man still bears in his bodily frame the indelible stamp of his lowly origin.”
-- Charles Darwin
REFERENCES
3. https://www.thehindu.com/opinion/lead/the-prognosis-for-school-reopenings/article36236989.ece
5. Rama Prasad, T. Disastrous Second Covid Wave in India. The Antiseptic. 2021 June; Vol.118; No.6; P: 20-27; Indexed in IndMED – www.antiseptic.in
6. Rama Prasad, T. Is the “Lockdown Medicine” too toxic ? The Antiseptic. 2020 October; Vol. 117; No. 10; P: 13-15; Indexed in IndMED – www.theantiseptic.in
7. Rama Prasad, T. Covid Variants. The Antiseptic. 2021 May; Vol.118; No.5; P: 11-14; Indexed in IndMED -- www.theantiseptic.in
8. Rama Prasad, T., Versha Rajeev. The Conundrum of COVID-19 Vaccines. The Antiseptic. 2021 January; Vol.118; No.1; P: 10-17; Indexed in IndMED – www.theantiseptic.in
9. Rama Prasad, T. Covishield or Covaxin ? The Antiseptic. 2021 April; Vol. 118; No. 4; P: 12-16; Indexed in IndMED – www.theantiseptic.in
10. Rama Prasad, T., Versha Rajeev. Antiseptics, Disinfectants and COVID-19. The Antiseptic. 2020 November; Vol.117; No.11; P: 26-28; Indexed in IndMED – www.antiseptic.in
11. Rama Prasad, T. 40+15 Hypoxia Test in COVID-19. The Antiseptic. 2020 December; Vol. 117; No. 12; P: 13-17; Indexed in IndMED – www.antiseptic.in
12. Rama Prasad, T. Mucormycosis and COVID-19 in India. The Antiseptic. 2021 July; Vol.118; No.7; P: 21-26; Indexed in IndMED -- www.antiseptic.in
13. Rama Prasad, T. Vagaries of India’s Covid Vaccination Policy. The Antiseptic. 2021 August; Vol.118; No.8; P: 10-16; Indexed in IndMED – www.antiseptic.in
14. Rama Prasad, T., Versha Rajeev. Tea and Covid. Health. 2020 October; Vol.98; No.10; P: 4-6.
15. Versha Rajeev., Rama Prasad, T. Fear and Covid. Health. 2020 November; Vol.98; No.11; P:31-32
16. Rama Prasad, T. India’s Third Covid Wave. The Antiseptic. 2021 September; Vol.118; No.9; P: 14-20; Indexed in IndMED – www.antiseptic.in
18. https://drtramaprasad.blogspot.com
19. Rama Prasad, T., Versha Rajeev. https://drtramaprasad.blogspot.com/2017/04/covid-crocodiles.html
20. https://drtramaprasad.blogspot.com/2017/04/hydroxychloroquine-hcq-and-coronavirus_29.html
21. https://www.nature.com/articles/s41591-021-01488-2
22. https://drtramaprasad.blogspot.com/2017/04/corona-and-charles-darwin.html
23. https://www.thelancet.com/pb-assets/Lancet/pdfs/S0140673621020468.pdf
26. https://www.thehindu.com/opinion/open-page/a-bad-patch/article31069356.ece
27. https://www.iitk.ac.in/new/covid-19-outbreak-in-india
28. https://www.thehindu.com/opinion/op-ed/should-children-be-given-covid-19-jabs/article36459761.ece
29. https://www.science.org/content/blog-post/antibody-dependent-enhancement-and-coronavirus-vaccines
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Covid is not just a LOCAL problem, it’s a GLOBAL one.
These are from our backyard garden -- the radish vegetables, not the Covid waves !!! -- Dr. T. Rama Prasad, Perundurai, India.
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