Let elderly, children be allowed out with necessary precautions, say experts

With the fear of the third wave of Covid19 due to the Delta variant looming large citybased paediatricians and health experts say it is high time people change their approach and allow children and the elderly to venture out with necessary Covid19 precautions This they say will help them overcome both the physical and mental strain of being confined to the four walls of the house and better equip them to face the situationDr Wiqar Shaikh professor of Medicine Grant Medical College and Sir JJ Group of Hospitals said that history has taught us that wave after wave is to be expected until the pandemic finally abates He said that the third wave of Covid19 in India is inevitable and should hit the country before the end of 2021 However it is impossible to predict whether it will be less or more disastrous than the second wave He also said that there is no evidence yet to suggest that it will affect children more than adultsDr Shaikh said the sero survey initiated by the Government of IndiaICMR has shown that approximately 23rd of the Indian population has developed antibodies to Covid19 But he claimed that in a viral infection antibodies have an extremely limited role to play and that too only at the beginning of the infection Dr Shaikh added It is the Tcells which have a major role against viral infections The two types of Tcells which are involved in killing viral infected cells inside the human body are the TNatural Killers and the TCytotoxic cells I am surprised that a study of Tcell immunity against Covid19 has not been initiated in India which would give us a much better insight into the immunity levels for the infection in the Indian populationDr Ketan Vagholkar D Y Patil Medical CollegeDr Shaikh added that several schools and colleges across the country have opened up for classes on campus and said he was shocked Maharashtra has not yet opened its schools and colleges He also expressed deep regret that children and the elderly across the nation have remained cooped up at home due to the pandemic since March 2020 In societies where people can avail of the adequate recreational facilities such as walkingjogging tracks gardens and indooroutdoor games being locked up in the apartment for some time could be acceptable However majority of the population particularly in chawls slums and rural areas remains locked up in their homesDr Shaikh said that it is now time to allow children and the elderly to move out of their homes albeit with Covid appropriate behaviour particularly the use of masks He emphasized that all over the country particularly in Maharashtra schools and colleges should allow students to attend classes He also added that kindergarten and primary school students could wait but high school students should now go to schoolldquoRecent Covid antibody surveillance studies in Mumbai and Maharashtra among children and adults have shown fairly high levels ranging between 43 per cent55 per cent This is suggestive of Covid infectioninduced antibodies But how many of these antibodies are of the neutralising type that will provide protection to these individuals on being reexposed to a fresh episode of Covid is not clear While children are less likely to experience serious symptoms of Covid19 the disease is not entirely benign in them Children tend to have a much stronger immune response than adults which is why they canrsquot be given the same dose of vaccine as adultsrdquo said Dr Subhash Hira professor for Global Health University of WashingtonSeattleA woman is vaccinated at the Sree Cinema BMC health post Mahim on Tuesday PicAshish RajeldquoWe do have cases of postCovid syndrome multisystem inflammatory syndrome which can be quite severe bringing kids to the hospitalsrsquo intensive care units Hence India and the world are waiting for vaccine trials which are under way for children aged 26 712 1318 years of age For example in India 500 children were recruited in June 2021 for the Covaxin trial in 6 hospitals including AIIMS New Delhi AIIMS Patna Nagpur etc in three age groups Each group was given Covaxin in varying quantum of injections or nasal spray in three dose variations No major side effects were reported after the first doses They are due for the second dose after 28 days ie towards end of July 2021 Their total followup will be 208 days ie 7 months The results will be out by January 2022 If results are acceptable the childrens vaccine programme can be launched soon thereafterrdquo said Dr HiraDr Hira added But a global disaster of the magnitude of Covid19 is caused by a respiratory infection that comes in waves that are months and years apart just like the Ebola epidemics of Congo before and after 2014 I think that Mumbai will reach a point in SeptemberOctober 2021 when 7037 of its adult population above the age of 18 years will be vaccinated So Mumbai will cross an important mile stone of this pandemic The community should honestly pledge to three main barrier methods ie use of proper masks hand and other sanitizations and physical distance of 6 feet for the future In such a case Mumbai will have won the lsquopandemic lockout preparedness statusrsquo and can get a goahead for a proactive lockout with fewer restrictions Soon after January 2022 when vaccine study results of children are out and if they are effective school reopening can be tried out cautiouslyrdquoldquoCurrently no one can predict the course of the third wave Through the research until now one thing we can say surely that vaccination and presence of antibodies in our bodies protects us from serious Covid illness Some get a serious infection but they are very few Also children generally have good immunity and from our past experiences we can say that children wonrsquot get serious symptoms commonlyrdquo said Dr Santosh Bansode Head of the Department Emergency Medicine Wockhardt Hospitals Mumbai CentralDr Wiqar Shaikh Grant Medical CollegeldquoNow more and more people are getting vaccinated and the number of sero surveys show that many people already have antibodies From these numbers we can say that even if the third wave arrives there is a high chance that the number of serious patients will be less and there will be more stable patients with less severe symptoms For almost one and half year the elderly people and children are trapped in homes for precautions The elderly have started getting other illnesses due to little physical activity and psychological problems as they are not allowed to go out We must think about this and now those who received two doses of vaccine and those who have antibodies should be allowed to go out with due precautions for physical activities as they were doing in the preCovid erardquo Dr Bansode addedldquoWe must think about childrens mental condition also Physical activity in open spaces and grounds is important for the mental health of children So with consent of parents and by taking full precautions we must start reopening schools We can begin with higher secondary first and then slowly primary if everything goes well Once we start vaccinating children we can take bold steps to normalize their lives We must reassess situation periodically and take decisions and change directions accordinglyrdquo Dr Bansode saidDr Ketan Vagholkar professor of Surgery at D Y Patil Medical College said ldquoChildren and senior citizens continue to be vulnerable to the delta variant though children were relatively unaffected during the first and second waves Good immunity is the best protection for children This comes with good exercise which is only possible with outdoor activities at school accompanied by good nutrition Closure of schools has led to physical inactivity and increased consumption of unhealthy fast food This has led to decreased immunity which predisposes children to increased infection Graded reopening of schools is essential to regain childrenrsquos health and wellbeingrdquoldquoSenior citizens too are badly affected both physically and psychologically Lockdowns have led to lack of physical activity thereby compromising immunity Commencement of outdoor physical activity in vaccinated individuals is necessary However Covid appropriate behaviour is a must at all timesrdquo added Dr VagholkarDr Fazal Nabi director Paediatrics Jaslok hospital said ldquoIt is difficult to predict the exact course of the third wave of the Covid 19 infection but whatever cases we are seeing in the past few weeks are selflimiting with mild symptoms These minor infections require only symptomatic treatment and mostly without antibiotics Complicated cases are rarerdquoDr Nabi added ldquoIt has been seen that to fight this infection which is not troubling children much parents are going through a lot of physical and mental stress Family members with grandparents who might have chronic issues like diabetes high blood pressure and heart disease are getting destabilized due to this stress The whole family is suffering due to this infection wave Its like burning the whole jungle to kill an antrdquoldquoIt is time for us to change our approach now so children and other family members can have a better and healthier life The physical development of children is good but they are lagging in social and behaviour development for their age Cases of autism ADHD and other behavioural issues may increase We should encourage outside exposure for the child and take all Covid precautionsrdquo said Dr NabildquoAt the same time we must encourage parents and grandparents to get vaccinated and continue their normal and healthy routine Even reinfection in an already vaccinated individual is seen to be mild and selflimiting and does not require a very strict and modified lifestyle Just as to prevent road traffic accidents we dont restrict ourselves on roads we should not bound ourselves at home to fight this infection which could affect us for years Immunisation of the whole family including all age groups and Covid19 safety precautions will prevent severe infection in them in the third wave if anyrdquo Dr Nabi concluded