Covid-19 in India: Second wave strikes newborns, teens in Mumbai

Last year’s propagated myth that children will be the least affected by the Covid-19 pandemic has been busted amid a fresh, second wave of a more lethal coronavirus variant, which has been billed as a double mutation.

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Mumbai has reported a 65 per cent spike in Covid-19 cases — and clocked 12,390 new infections — only among children since March 1.

India, which has emerged as the second-worst Covid-19-hit country after the United States, is coming to grips with reality, after 9,371 children — between the ages of 0 to 9 — were found to be afflicted with the virus in Mumbai alone.

Dr Soonu Udani, Director, Critical Care and Emergency Services, SRCC Children’s Hospital, which is managed by Narayana Health at Mahalaxmi, Mumbai, said they have 12 children undergoing treatment in the age category of three to 16 years.

“At least three to four children are admitted to our hospital on a daily basis. We saw a spike in cases among children from April onwards,” said Dr Udani.

“Usually, they suffer from pneumonia. At present, three children are on ventilator and four on oxygen, as they are suffering from difficulties in breathing,” she added.

“Besides respiratory complications, they are also suffering from diarrhoea and dehydration acidosis, a medical condition where there is an accumulation of too much acid in body fluids.”

Kawasaki symptoms

Paediatricians cited challenges such as Multisystem Inflammatory syndrome (MIS) in children, who have tested Covid-19 positive.

Doctors shy away from calling it the Kawasaki disease, which was first discovered by Tomisaku Kawasaki in Japan, despite patients from 10-month-old babies to 15-year-old teens displaying similar symptoms such as rashes, red eyes, fever, lethargy and coloured toes.

Dr Udani said five Covid-positive children were found to be suffering from MIS.

“We’ve stopped using the term Kawasaki but instead call it MIS, as it is an overlap. MIS can be observed in Covid-19 positive children after seven and 30 days. We’ve seen MIS in children during the last tapering of the antibodies. We’ve also seen MIS in children who’ve tested Covid-positive after undergoing PCR test. It’s an overlap and not seen after a month of Covid-19 struck India last year,” she added.

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Dr Udani urged parents to look out for MIS symptoms among their children even after they recover from the viral infection. Persistent fever can be a tell-tale sign of the symptoms.

“Usually, the high fever lasts for three days and is prone to cause irritability among children. Rashes, red eyes, a red tongue and red lips are all similar to the Kawasaki disease. These children need a lot of fluids and medication to overcome the shock. Many have acid in their blood. They may get a heart condition because of these symptoms.

“Pulmonary artery disease, cardiac muscle problem, pericarditis and myocarditis can be the side-effects among children because of Covid-19,” said Dr Udani.

New trends

Dr Bakul Parekh from the eponymous Bakul Parekh Children’s hospital and Multispecialty Paediatrics Centre at Ghatkopar, Mumbai and national president, Indian Academy of Paediatrics, said, “From March 1 onwards, I’ve come across 37 children who have tested Covid-19 positive.

The age group varied between two to 14 years, and there were two newborns as well.”

Dr Parekh said MIS is a cause for concern and cited that a handful of cases were reported after the recovery among patients during the first wave of the viral outbreak last year.

“During the first wave, we got antibodies positive, but now we’re getting positive cases after the PCR test. Out of 100 children, 10 will have these symptoms. At least, two babies were found to be lethargic and listless with fever. This trend is commonly seen in high-rise buildings in Mumbai,” he added.

Dr Amin Kaba, consultant paediatrician, Masina Hospital at Byculla, Mumbai, too, stressed that they were getting a lot of MIS cases, which presents Kawasaki disease-like symptoms.

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“After a month, the child’s body starts fighting against its own organs. We’re likely to come across MIS among children over the next two weeks as a consequence to the second wave of the viral outbreak that struck Mumbai in mid-March,” said Dr Kaba.

He pointed out that intensivists and nephrologists take charge of such children, when they are admitted to an intensive care unit (ICU) of a hospital.

“It becomes an autoimmune syndrome where the body starts fighting and antibodies are produced against its own organs and start damaging them. Children can develop a rash or even get heart or kidney failure. Many are being rushed to hospital after losing consciousness and suffering from convulsions,” he added.

Silver lining

Amid the all-pervasive doom and gloom, there is a silver lining in the contagion cloud.

Dr Udani said that the recovery rate of the Covid-positive children is 100 per cent, despite the MIS.

He urged parents to keep an eye out for MIS while they undergo treatment at home and adhering to all precautionary measures such as self-isolation.

“At least 50 per cent of the paediatric patients were admitted to the hospital in the past 21 days. They’re found to be suffering from fever, severe gastroenteritis-like symptoms and dehydration. Some children had suffered from respiratory distress such as pneumonia and some had fever for five days, even though nobody from their family had tested Covid-19 positive,” said Dr Parekh. “Later, it was found that they could have contracted the infection while playing in compounds, visiting gardens, open spaces and shopping malls,” he added.

Safeguarding children’s health

Fear is prevalent among residents amid the Covid-19 threat to children in Mumbai.

Many housing societies have put up notice boards, barring children from playing in residential complexes and have also locked up terraces.

Harsha Kumara Udupi, a resident of Uranus Co-operative Housing Society at Thakur Village, Kandivali, Mumbai, said that 40 out of 150 housing societies in her neighbourhood have been sealed.

“Children are not supposed to play or even go for walks. Cycling is also prohibited. We have an in-house apartment software where an announcement has been made to safeguard children’s health. Many residents are isolated at home and we don’t want children to loiter and get infected,” said Udupi.

Recommended steps of precaution

> If anybody in a family tests Covid-19 positive and the child is mildly symptomatic, the kid should also undergo test.

> If the child is asymptomatic and grandparents are present, isolate the grandparents to another location.

> If there is a fever for more than three days, no antibiotics should be administered.

> Children suffering from severe gastroenteritis, sore throat or breathlessness should be referred to a paediatrician immediately.

> If children develop a rash, conjunctivitis or coloured toes, refer them to your doctor at the earliest.

> Watch out for other symptoms such as inactivity, listlessness, irritability and loss of appetite.