Covid and Children

We are in the midst of a pandemic caused by novel coronavirus SARS-CoV-2. Fortunately, children have been less affected in terms of both complications and death. Although signs and symptoms are similar to adults, a smaller number of children tend to be asymptomatic.

I will highlight some salient features concerning Covid and children.

The prevalence of paediatric cases is 2% in US and 2.2% in China. Most of the children had exposure to household members with confirmed Covid-19.

Signs and Symptoms
Among children with available information, 73% only had symptoms of fever, cough or shortness of breath, compared with 93% of adults aged 18-64 years. Body pain, sore throat, headache and diarrhoea where common symptoms in adults. These were less commonly reported in paediatric patients. Information on hospitalization, status was available for 29% cases in children aged <18 years and 31% cases in adults.

It is observed that children do not always have fever of cough as reported signs and symptoms. They are likely playing a role in transmission and spread of Covid-19 in the community, thus emphasising the need for strategies like social distancing and everyday preventive behaviours to curtail spread of virus.

Preparedness for reopening and conduct of schools during Covid and post Covid period
It is absolutely important to give correct information to children regarding the pandemic, which is essential to prevent anxiety and fear among children, and decreasing stigmatisation of teachers and children infected. WHO and UNICEF have released a joined document addressing the issues related to prevention of spread of Covid-19 in schools.

Impact of COVID-19 on schools
The resultant impact on the students are:
1.    Interrupted learning
2.    Poor nutrition - mid day noon meal scheme providing significant proteins and calories is unavailable
3.    Confusion and stress for parents and teachers
4.    Challenges of e-learning and home schooling
5.    Gaps in child care and high economic burden for parents
6.    Rising exposure to child pornography, sexual exploitation and domestic violence
7.    Social isolation

Measures to be adopted by the school administration

When schools are fully or partially open, COVID-19 prevention and control strategies should be maintained. The recommended actions and requirements outlined in the following section are simple and can be adopted in all schools irrespective of the economic discrepancies.
1.    Hygiene and environmental cleaning to limit exposure
2.    Physical distancing at school
3.    Regular screening and management of symptomatic students, teachers and other school staff
4.    Communication with parents and students
5.    Additional school-related measures
6.    Regulations to be followed in Residential schools

Physical distancing at school – some tips

Measures given here also addresses the issues of spacing in schools especially staggering the opening hours and modification of timetable.
a.    Maintain a distance of at least 1 metre between everyone present at school.
b.    Increase desk spacing (at least 1 metre between desks), putting dividers in between desks, altering the arrangements like a circular class room, staggering recesses/breaks and lunch breaks (if difficult, an alternative is to have lunch at the desk).
c.    Modify the timetable, with some students and teachers attending in the morning session and others in the afternoon session. Another alternative is to have half the students attending on 3 days of a week and the other half on the other 3 days {odd-even plan}.
d.    Consider increasing the number of teachers, if possible, to allow for fewer students per classroom (if space is available).
e.    Advise against crowding during school pick-up or day care and if possible, avoid pick up by older family or community members (e.g. grandparents) and stagger arrival and/or dismissal times.
f.    Move lessons outdoors or ventilate rooms as much as possible (and try to avoid use of air conditioners, especially central type).
g.    Create awareness to ensure the students do not gather and socialize when leaving the school and in their free time.
h.    Cancel field trips, assemblies and other large gatherings.
i.    Limit nonessential visitors and reduce congestion in the office.
j.    Limit bringing in students from other schools for special programs (e.g., music, robotics, academic clubs)
k.    Parent teacher meetings can be restructured via phone rather than face-to-face, enabling easier communication both ways.
l.    Discourage staff, students and their families from gathering or socializing anywhere at places like a friend’s house, a favourite restaurant, a birthday party or the local shopping mall.

New systems of learning
We need content and delivery systems that harness and utilize technology to its fullest. Looking at these challenges of colleges and schools, various initiatives have come up from the Ministry of Human Resources, Department of Technical Education, National council of educational research and training (NCERT) and NGOs.

Some of the new initiatives are Swayam - online courses for teachers, UG/PG teachers for non-technology courses, e-modules on various subjects. National digital library, google classroom and e-Yantra are other resources. Swayam portal integrates NCERT textbooks, engineering and non-engineering courses and e-books for students. It is a viable alternative and easy learning to grasp the course. The portal was set up by Government of India nearly two and a half years ago and it definitely endorses the fact that e-learning may not be a distant dream.

Government has created National Knowledge Network, National Project on Technology Enhanced Learning (NPTEL), National Mission on Education Through Information and Communication Technology (NMEICT). These connect easily with institutions and provide the high-speed band network for education institutes.

Efforts need to be made by all of us to make sure PC/ Desktop/ Mobile for end delivery are available to every student irrespective of the strata of society. Giving away laptops to all students studying in 11th standard and above in Tamil Nadu is an example which shows us that this is feasible. Future of education is going to be global teachers, global university, degrees obtainable from reputed universities offering interesting distant learning content and a global outlook. Faculty will also need to stand up to this challenge of integrating technology in their teaching. Accreditation criteria need reconsideration.

Routine vaccination in COVID-19 pandemic
Immunisation has been recognised as a core essential healthcare service, and needs to be continued in a safe manner even during the pandemic. A healthy child undergoing immunisation does not have any additional risk due to the pandemic. On the other hand, immunisation is going to protect the child against vaccine preventable communicable diseases. Immunisation should be done in separate or segregated OPDs at all levels, be it a private clinic, nursing home or a multi-speciality hospital. The birth dose of vaccines needs to be given before discharge from the hospital. All the vaccines in the first year of life are a priority and should not be postponed. Influenza and varicella vaccines also need to be given. Other vaccines and boosters may be postponed only if logistics do not permit. All mass immunisation activities should be postponed to maintain social distancing measures.

Effects of the pandemic on child and adolescent psyche
Children are being exposed to an information overload and often horrifying news of the effects of the pandemic. They are witnessing high levels of stress and anxiety among the adults around them. Experiences of the new routine of staying cooped up at home; unable to frequent places they have enjoyed, meet friends, play and engage in activities that they enjoyed, have created a sense of insecurity in children even as young as 2 years of age. Therefore, listening to what children believe about COVID-19 is essential; providing children with an accurate explanation that is meaningful to them will ensure that they do not feel unnecessarily frightened, overanxious or guilty.

Dr. Abraham K Paul,
Senior Consultant Paediatrician,
Indira Gandhi Co-operative hospital, Kadavantara
Ph: 9846023388

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