Covid-19: How to prepare India’s health infrastructure to protect children from the third wave of Covid

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In 2020, hospitals and the entire health system struggled to pivot and cope with the catastrophic Covid-19 epidemic. We have lost millions of lives. Lucky for us, our children, nearly 40 percent of India’s population, were somehow protected from the worst of the disease.

The serosurveillance reports indicate that healthy children are largely asymptomatic or mildly symptomatic, but children with co-morbid conditions have more severe manifestations and poorer outcomes. And although children currently account for around three to four percent of hospital admissions in India due to Covid-19, looking at the In the United States, the number of children hospitalized is increasingIndia cannot be nonchalant about the protection of its children.

India must meet the challenges of health infrastructure with the right medical expertise, equipment and approach to protect its children from a possible third wave of Covid-19.

Strengthen pediatric care
Even before the pandemic, for millions of Indian children, “normal” was never good enough to begin with. Primary health centers (PHCs) and community health centers (CHCs) meet the majority of health care needs in rural and marginalized India, but face a severe shortage of pediatricians—82% and 63% of positions were vacant in these rural and marginalized areas, respectively. Therefore, we must launch a nationwide appeal for the recruitment of pediatricians into the government health system.

Pediatric intensive care is needed because severe Covid-19 in children can take somewhat different forms than in adults. Unlike adults, children’s medical devices and equipment should be available in different sizes and monitoring systems. Our observations on the ground show the urgent need for pediatric equipment in PHCs, CHCs and district hospitals.

Children in hospital need a supportive environment because they are far from their parents and in a foreign environment. We need to introduce detailed protocols for protecting children from Covid-19 Appropriate Behavior (CAB) for caretakers, doctors and healthcare professionals, such as training them in communication skills, understanding non-verbal cues while taking care of children in hospitals. Overall, hospitals also need to have cheerful spaces with colorful walls, toys, and activities to help kids stay cheerful. To help children and parents cope with uncertainty and anxiety, public health advisers and PHC and CHCS counselors should also be used.

To recover children, healthcare workers must train frontline workers like ASHA and parents to identify post-recovery symptoms such as psychological stress, anxiety or multisystem inflammatory syndrome, a serious illness in where parts of the body, such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin or eyes become severely inflamed. This will help them report to healthcare professionals in time to seek appropriate medical help.

Finally, governments should set up pediatric working groups to standardize guidelines for the clinical management of children, train pediatricians and analyze the existing infrastructure for the treatment of children. This working group can also develop the integration of Covid-19 care into regular health programs to ensure that patients with serious illnesses do not suffer.

Need more
We need to prioritize vaccinations for vulnerable populations – pregnant and breastfeeding women, parents of infants and young children, while vaccination trials continue for children. Access to healthcare is a challenge for women and children due to lack of mobility. Therefore, initiatives such as Doctor on Wheels should be explored. Vehicles, equipped with essential medical equipment, vaccines and drugs, can travel to remote and marginalized places to immunize and provide medical assistance. Free medical teleconsultations can facilitate home care, testing and referral of critical patients to nearby hospitals, as well as the crucial element of psychosocial counseling.

More than a third of children in India suffer from malnutrition, putting them at risk of severe Covid-19 and even death. Therefore, we need to scale up programs to protect, promote and support optimal breastfeeding, age-appropriate complementary foods, and strengthen nutrition programs such as midday meals with supplemental nutrition.

Family and community mobilization
Community awareness programs are effective. We must mobilize the existing structures of PRI, common service centers (CSC), anganwadis and women community leaders to reach out to the community and prepare them to face the effects of Covid-19 on children, raise awareness on CAB, immunization and childhood – appropriate protocols through community outreach, community radios, television and social media. Bhutan’s Covid-19 campaign has even included religious leaders for successful community engagement.

Psychosocial support begins with preventive care. Since the pandemic, children have been exposed to uncertainty and anxiety since there has been no filtration of information related to Covid-19. Outreach programs should enable families to filter frightening and upsetting information, correct any misinformation or rumors they hear, and convey information to children in a way they understand. In addition, children need mental health care outside the formal system, i.e. villages and communities.

Finally, government and civil societies must collect data and work with scientific groups to understand the global impact of the Covid-19 pandemic and associated lockdown on children across India.

We need to collectively rally behind a practical, concrete plan to protect our children: investing in health and education, building more resilient systems and services that can reach all children, and ensuring that investments continue to be made for their health and their future.

The author is the national director of ChildFund in India.