Caution, anxiety and panic are at an all-time high among parents of children and teenagers. Health experts and interdepartmental committees of the various ministries of central and state governments are pre-empting increased susceptibility for kids and adolescents from the projected third wave of infections sometime around the onset of winter in India. There is no reason to panic as of now, but heightened degree of carefulness will make all the difference between the rate of infections. During late October and early November, most of India is expected to lower its guard during the festive season.
As more and more adults get vaccinated between now and the end of the year, they will organize and attend indoor and outdoor social events. Going back home to children and elderly parents, where the former has not even been administered a vaccine approved for emergency use, requires rational risk assessment and decision making. Most states are readying plans for opening schools during autumn, subject to situational analysis of the overall infection rate in the country in general and their region in particular.
Delta Variant: More Contagious and Dominant
The Delta variant of Covid-19 is twice as contagious when compared to the original pathogen. India’s R-value, according to the health ministry data published last week, was 1.2. This means 100 infected people in India are infecting around 120 people. R is the number of people that one infected person will pass on a virus to, on average. If the R value is higher than one, then the number of cases keep increasing. But if the R number is lower, the disease will eventually stop spreading, because not enough new people are being infected to sustain the outbreak.
According to the Indian SARS-CoV-2 Consortium on Genomics (INSACOG), a consortium of 28 laboratories tasked with genome sequencing by the Ministry of Health and Family Welfare, Delta Plus variant has three worrying characteristics: increased transmissibility, stronger binding in receptors of lung cells, and potential reduction in monoclonal antibody response.
Third Wave Preparedness
A report published by National Institute of Disaster Management has said, “paediatric facilities — doctors, staff, equipment like ventilators, ambulances, etc. are nowhere close to what may be required in case a large number of children become infected”. According to the report, the third wave has already begun, as the R rate has increased from 0.9 to 1, in the last week of July.
Babies under the age of one 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. New-borns can become infected with the virus that causes Covid-19 during childbirth or by exposure to sick caregivers after delivery. Women who get vaccinated during pregnancy develop antibodies which eventually get passed on the child.
Better utilisation of public and private health infrastructure will help to curb the overall impact, but even after the best of efforts, the third wave is imminent. Among their recommendations, the experts have said “a holistic home care model, immediate increase in paediatric medical capacities and prioritising mental health issues among children” are key at the moment. 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 higher risk of serious illness with Covid-19.
A Sliver of Hope
India’s drug regulator has approved Zydus Cadila’s ZyCoV-D vaccine, based on Plasmid DNA technology, for children above 12 years of age; the drive is yet to begin. It is a three-dose vaccine that has to be administered with a gap of four weeks between doses. Zydus expects to manufacture ten crore (100 million) doses of ZyCoV-D in the coming twelve months. The efficacy of ZyCov-D during trials was found to be 67%
Dr Chandrakant Lahariya, India’s leading expert on Covid-19 disease and vaccines shed further light on ZyCov-D. He said, “The plasmid DNA, which carries an identified sequence of spike protein of the SARS-CoV-2, enters the host cell and then its nucleus, instructing the cell to make the messenger RNA. (Essentially, it is engaging human cells to do a task which they do not do on a routine.) Thereafter, the messenger RNA will carry the sequence to where protein is synthesized. The genetic material needs to be read by human cell’s protein-making machinery. Once protein is synthesized (which mimics the spike protein), these need to appear on the surface of human cells. It is at this stage the host immune system gets activated and starts producing antibodies and mounts a cell-based immune response.”