Dengue

After all the festivities end, it’s about time children go back to school as several states finally open doors from November 1. While the reopening of schools started in graded manner, parents’ worries for their wards’ health spark a debate as pollution, Dengue and Covid pose a threat.

To discuss about the same, Medically Speaking spoke to a panel of experts that included: Dr Neeraj Nischal, Internal Medicine, AIIMS; Dr Krishan Chugh, Pediatric Department, Fortis Hospital; Dr Anil Gulati, Pediatric Department, Max Hospital.

Here are a few snippets:

What would you like to tell the parents who are still holding of sending their children to schools because end of the day this fear of Covid still lurks in the back of our mind even though the cases are at an all-time low.

Dr Neeraj Nischal: We have been dealing with Covid since the last two and now we need to find a way to co-exist with it. The only thing which has not started yet is the schools of the children. Everybody is worried about the safety of the children but what we have realized is that the cases have come down and children are going everywhere whether its mall, picnic, trips, etc. but schools. Risk of Covid in school is almost the same as going outside. Definitely, schools have a better control over the virus as compare to any other place. As far as the Sero-Survey and other things are concerned, even prior to the second wave, we thought we have already controlled this disease, but we were wrong. I feel this is the right time to open the schools with all precautions in place.

Parents’ concern here is that when going out to malls and trips, they can enforce their children to wear masks but cannot keep an eye on them in the school. Children also like to mingle with each other. Do you agree with this line of thought?

Dr Krishan Chugh: When it comes to going to school, they are compared to malls and other places. Children stay with each other for several hours, depending on the various factors and in a comparatively closed space as the classrooms, as they are not huge these days. So spread of covid from one to another is possible probably slightly more than what it would be in other places, where the contact with each other is not close enough. But the fact is most children have not suffered very serious disease in the past, so we can expect that even if they contract the disease, they will not catch any severe disease. But they can become carriers and spread them to elderly back at home who are in comorbid condition.

Did you see children catching Covid in second wave build a strong immunity against the virus and can we still rely on that, keeping in mind that children do not develop severe Covid complication?

Dr Anil Gulati: We didn’t have to face a deluge of pediatricians when the waves were going on and henceforth, we didn’t get them tested when the whole family was suffering. When they come to us for some other reason and they have fever, we get their antibodies done and they’re positive. It is like D-Factor vaccination. I think the bigger worry is that children should not be the victims now, they have been reasonably exposed in the past and they had faced it better than the adults. We were very lucky that not many children were sick enough.

Do you think there is a need to vaccinate children on an urgent basis and can it go simultaneously with vaccination of the population?

 Dr Neeraj Nischal: Definitely, vaccination is going to be an important part, but most of the children carry antibodies. What we realized during even second wave, which was deadlier than the first wave, is that the chances of re-infection even in those who have contacted earlier was less. The same thing applies to the children, luckily they have been spared relatively by the particular virus so far. Whatever patients we saw, we saw children who had some comorbidities, whether its related to some childhood leukemia, or some liver related disorder. Apart from that, few more pediatric patients landed up in ICU and because of Covid-19, in 18 months we hardly saw any patient. So, from my point of view definitely they are safe and we should try to start vaccination as soon as possible but we should not keep our schools closed thinking that they will start because everybody is vaccinated, because that is going to take time even if we try at first place.

Speaking of Comorbid children, what should be the precautions they should take at this point of time considering schools have reopened?

Dr Krishan Chugh: Yes, it is the reality that we should be sending our children to school but the question is, is it today or could it be postponed a little more? My belief is that we could have waited for the two to three weeks more, reason being that it’s a festive season which are celebrated with a bash, people come close for longer times. To see an impact of that, probably we need to wait for two weeks after Diwali festival. Around 20-25^th or November would have been a better date to reopen schools. By then we would have seen the effect or by chance another kind of wave or more number of cases is coming, then we would probably take more precautions either open the schools only very partly or may be differ again.

Dr Gulati, would you agree?

Dr Anil Gulati: I agree with him because last year also, when Diwali rush was there in all the markets, we had a lot of cases. Its like being extra cautious. If they have been in the house for two years, another few weeks, two weeks, three weeks probably would not matter. But what I see is that they are opening in phases. They have warned the parents also. There is an abundance of caution. The schools are giving parents an option, if you agree, you can go online classes or offline. I think the message is clear to the parents, we have to live our lives. Live with caution, we cannot stay indoors and children have stayed under house arrest for two years and I have a sympathy with their overall development.

Considering the status of rural areas and how much children absorb sitting online, what do you think reopening of schools at this time good idea or perhaps it should be delayed a little more?

Dr Neeraj Nischal: We have lost that window when cases were much lower. That was the best time to reopen and I think we should start of course gradually, and I am saying because I have two kids one is six-years-old and the other is four-years-old. I have been seeing what behavioral change they had while at home. It’s not right to say we must wait for the ideal time because that is not going to come certainly in the next two years. Precautions must be take, that is, if we see a spurt in cases, schools must be shut down immediately. But at the same time if we say that online classes should continue through laptops, mobile and tablets, think about the 60% to 70% of the population that does not have access to these luxuries. We must take baby steps and not wait for the ideal time.

Let’s say waiting for two to three weeks can be appropriate, but then it will be mid-December and people meet and mingle again and let’s delay a little more and it is next year. What would you tell those who offer this counter to your argument?

Dr Krishan Chugh: As Dr Neeraj said there is no ideal time, but we are looking at what is obvious, which is that Diwali is a festival where we see far much more gatherings than what we see at Christmas and New Year. The two are very different from each other. Therefore, I believe the two to three weeks of delay would have been the best measure. Nothing is predictable about this virus but what we have now and what we are seeing across the world is that we are near the time when schools should open in a graded manner.

USFDA has approved Pfizer and we have Covaxin which has gotten the initial approval of the drug authority and final nod is still awaited. What will you say, at least as comorbid children are concerned, would you agreed that the vaccination should be started at the earliest?

Dr Anil Gulati : It is not me agreeing with this or not. There is a process. Whenever a new vaccine is invented or launched, there is a process we go through in a very scientific and systematic manner.

Children are very precious, I mean all the trials that place, children are excluded initially, unless the disease is children specific. We leave it to the experts who deal with vaccines, but certainly we are quite encouraged by the results of all the vaccines and they are all good.

There is a fear that owing to the festive season, children could become silent carriers. Is that a real fear?

Dr Neeraj Nischal: That will always be a fear because the biggest problem with this particular infection is that majority of them will remain asymptomatic and they may actually transfer this virus without even knowing. Therefore, right from the start, we have been talking about the social vaccination aspect, that is always follow the covid appropriate behavior. That is what we have to keep on reenforcing on our children because if they really want go to school, they have to follow this appropriate behavior. Going by my experience, my children listen better to the teacher rather than listening to me. I am certain, specially the younger children, they are going to listen to the teacher because they are bored staying at home. And of course we have to take care of them because they are the most precious thing we are working for actually.

Would you say rise in number of Dengue cases and Diwali pollution must be the bigger worry right now and not Covid?

Dr Krishan Chugh: Dengue is what is going around and many parts of the country are seeing a deluge of patients. Probably in Delhi and around is coming down little bit, but rest of the country is far worse. As far as pollution is concerned, we know that agricultural burning and fireworks are going add up and the next few weeks are going to be really bad for children’s lungs as well as the rest of the body. We know that pollution effects even the brain and not just the lungs. We are in full for a difficult period here. Let’s hope that parents as well as the government agencies will be take enough precaution to keep our children healthy.

What would be your advice to the anxious parents who are still to take a decision on whether they should send their wards to school or not, considering at least many private school are also playing quite safe and cautious?

Dr Anil Gulati: While we are very sure that the numbers have come down and its safer than what it was a few months ago, and Dr Nischal has said it is very clear there is no ideal time. I think it is the mental state of the parents which needs to be addressed. I think they need to be a counselled that finally you have to send your children to school. Each parent has a different level of fear. It is a hybrid model, either you come to school or you take online classes. It gives anxious parents some time to watch how the things go when the schools open after a week or 2 week or one month, finally everything goes on right all children will happily go to school.

Dr Nischal I am sure you agree with this because at the end of the day, one cannot stop their children from going out or playing outdoors at least for a few minutes if not an hour or a day or so.

Dr Neeraj Nischal: That’s what I have said that its really difficult to keep our children at home for their development as well and that’s why we have to take a call and hybrid mode is the best way forward for the time being. It has to be participation of both sides, parents and teachers. Schools are laying down their own norms so that the chances of the infection minimize. If we keep on following all those rules, i think we can safely open our school but at the same time we have to keep a watch, slightest sign of increase of cases and we should not hesitate shutting down schools again.

Would you advise parents to stay at home after this festive season or would you advise them to go to school and follow Covid appropriate behaviour?

 Dr Krishan Chugh: I would again say that waiting for three more weeks is not going to make a very big difference considering that they have been at home for almost two years now. When it comes to other place like cinema halls I would again advice children they should not be going to these places also for next coming weeks .