India starts preparation to make Covid-19 care safe for children

Treatment protocols, wards with space for parents, and specially trained staff are some measures

India has begun the dismal task of preparing its medical facilities to treat children in case the expected third wave hits them worse than earlier waves of coronavirus.  

A treatment protocol is being worked on for children who test positive. Beds and wards are being modified to create space for parents. Medical staff are being retrained. Equipment is being assessed to see if it needs re-calibration for younger bodies.   

Rahul Pandit, director, Critical Care, Fortis Hospital, Mumbai and a member of Maharashtra’s Covid Task Force, said the state was creating separate units for children within the jumbo covid centres.

“We are working out set-ups that will accommodate mother and child as the biggest challenge will be creating this extra space,” said Pandit.  

Suresh Kumar, infectious diseases specialist at Apollo Hospitals, Chennai, said that if the parents are covid negative, they may have to be kept in partitioned rooms with their child.

“For children above 10-12 years, the parent can stay in the hospital but in a different room and meet the child from time to time with precautions. So far, hospitals have not allowed attendants to stay with covid patients. For children, this has to change,” said Kumar.

As limited drugs are available to treat children, getting the treatment protocol right is now the top priority of leading paediatricians. This entails what kind of oxygen therapy should be given to children, what are the other supportive therapies, which medicines are permissible etc.

Although paediatricians say it is highly unlikely that the third wave will predominantly or exclusively affect children, they want to be ready just in case.  They are hopeful that children will not experience the cytokine storm that adults have experienced. “The immune system of children is not mature enough to create such a strong response,” said Kumar.

But, he cautioned, children have experienced what is called the Multi-System Inflammatory Syndrome or MIS-C. This is a rare but serious complication associated with covid in which different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, or eyes.

According to the Indian Academy of Paediatrics, the majority of children with MIS-C are likely to recover, if treated in time. “But we need to be prepared with more in-patient beds and intensive care beds for children,” said the Academy in a statement.  

Dr Nitin Verma, associate director general, paediatrics, at Delhi-based Rainbow hospital for children, has experienced the rise  in affected children. “I have done 40 video consults in a day compared to hardly any for kids last year. The older the child, the more the symptoms,” said Dr Verma.

For Dr Srinivas Midivelly, consultant paediatrician, Yashoda Hospitals in Hyderabad, a lot of work needs to be done.

“It is important to start clinical trials in children for covid vaccines, to give flu vaccinations to prevent severe pneumonia, and make sure there are enough beds for children to handle the caseload,” said Dr Midivelly.

At Hinduja Hospital in Mumbai, some beds are being allocated to children.  “We plan to allocate four beds in the 28-bed Covid ICU for children,” said Joy Chakraborty, COO of Hinduja Hospitals.

At Fortis Memorial Rese­arch Institute in Gurugram, Dr Krishan Chugh, director, paediatrics, is ramping up capacity for children, including repurposing existing staff.

“Our nurses in adult ICUs and those working in bone marrow transplant units and the cardiac ICU will be given special training in paediatric covid as they will be able to deal nicely with children,” said Dr Chugh.  

Other hospitals around the country also said they were beginning to train their staff to handle the needs of children.

Apart from staff, ventilators and high flow nasal cannulas also need to be re-calibrated to suit children. Pandit said that most of the new generation ventilators can be upgraded to include a paediatric mode following a software upgrade.

The National Commission for the Protection of Child Rights has recently asked all states to provide data on critical health care facilities for newborns and paediatric care, such as the number of paediatricians, nurses, support staff, and paramedical staff.