COVID-19

Urgent need to better protect children below 12 years against Covid

In this column, the author discusses the issues of the possible emergence of new COVID variants, symptoms in children, new COVID drugs and booster shots

ByDebananda S Ningthoujam

Updated 13 Feb 2022, 3:26 pm

Representational Image (Photo: Unsplash)
Representational Image (Photo: Unsplash)

 

The WHO has warned that the pandemic has not ended and more SARS-CoV-2 variants are expected to arise in the near future (Reuters, Feb. 11, 2022). Dr Soumya Swaminathan, Chief Scientist, WHO said, "We have seen the virus evolve, mutate...so we know there will be more variants, more variants of concern...so we are not at the end of the pandemic."

Why the Covid pandemic may linger for longer

The next variant to emerge may be more infectious than Omicron and may have higher vaccine escape potential, according to Dr Maria Van Kerkhove of the WHO (TOI, Feb. 9, 2022). That means the current vaccines will be much less effective against the new variant(s). We need to reduce the spread of the coronavirus and increase the vaccination rate across the globe to lower the risk for the rise of new variants.

Wherever the virus surges in any corner of the world, where there is a large population of unvaccinated people, the chances of emergence of new COVID variants remain high. There is even now a scary 'vaccine divide' in the world. There are countries where the vaccination rate is very high and others where the rate still remains very low. Unless the rich countries of the world act in synergy and unless the healthcare authorities in under-vaccinated nations initiate a proactive drive to quickly increase the ratio of vaccinated people, the pandemic may not end rapidly and may linger for a long time to come!

COVID in Children below age 12

According to a report published by Channel News Asia (CNA, Jan. 21, 2022) children below age 12 are starting to form the majority of cases admitted to hospitals. Omicron largely affects the upper airways and children are very sensitive to inflammation in the upper airways. Therefore, more children with Omicron infections are admitted for treatment, according to Kenneth Mak, director of medical services.

This situation is further compounded by rise in numbers of children with non-Covid-related respiratory infections who may also require hospital care. Luckily, these children don't need long stay or ICU care.

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But about 100 children out of 100,000 cases may suffer from MIS-C. Half (50%) of these children with MIS-C needed ICU care. The number of children with severe COVID or having severe complications after COVID-19 infection is not trivial. While infections in children are usually less severe than in adults, the infections cannot be considered mild.

Therefore, there is the urgent need to better protect our children against Covid-19 and the risk of Long COVID post recovery.

New COVID Drug Bebtelovimab

The US FDA has recently approved Eli Lilly's antibody drug for people aged 12 and above who are at risk of serious illness (Reuters, Feb. 11, 2022). The drug is called bebtelovimab and is authorized for emergency use in mild-to-moderate patients who are at risk of progression to severe disease, hospitalization or death. It is effective against Omicron as well as BA.2 subvariant.

A drug combo, remdesivir or molnupiravir with the experimental drug brequinar, has been shown to block the replication of SARS-CoV-2 virus. This finding has been published in the premier journal Nature. These drugs were found more potent when used in combination than individually.

Protective effects of a booster dose wanes

The Center for Disease Control (CDC), USA has recently reported that the protective effects of a booster dose wanes after about 4 months (Deseret New, Feb. 11, 2022). The protection against hospitalization due to Omicron was raised to 91%, two months after the booster (3rd) shot, but it decreased to just 78 per cent, four months after administering the booster dose.

After two doses, vaccine effectiveness against hospitalizations declined from 71% in the first two months after second dose to 54 per cent five months after the second dose. This reinforces the need for additional booster doses (4th, 5th, 6th, 7th and so on) at intermittent intervals till the pandemic ends.

The worst-case scenario

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"The thing about the pandemics is that they don't have an official endpoint", says William Hanage, Harvard University (El Pais, Feb. 9, 2022). The only way to reach a clean end to the pandemic is when you completely eradicate the virus. According to the leading scientist, the best-case scenario is that the immunity elicited by Omicron and the rate of vaccination administered so far means that we may no longer see serious waves of infection. The worst-case scenario is that a new variant arises and it is capable of causing either severe infections or capable of triggering a severe strain in the healthcare system due to the massive number of people it infects. This healthcare load may not just be due to the number of people that the variant infects but also due to the doctors and nurses it infects, compromising the healthcare capacity needed for hospitalized patients.

Omicron most probably may not be the last variant of SARS-CoV-2 that we will see. This view has also been publicly shared by Dr. Leana Wen, George Washington University, USA (Deseret News, Feb. 4, 2022). She further adds that the BA.2 subvariant of Omicron will not the last COVID-19 variant.

Mutating, and evolving new variants is the nature (dharma/karma) of a virus. Whether a new variant is concerning depends on if it's more contagious, more virulent, or if it can escape prior immunity from infections or vaccinations. That's why increasing the level of vaccination globally is of utmost importance. The more population immunity we have, the less number of viruses will spread and mutate, and less will be the chance of new variants emerging. That's how the world can rapidly emerge from the clutches of the pandemic.

According to Paul Duprex, University of Pittsburgh, USA the pandemic may end via various scenarios (Boston Herald, Jan. 16, 2022):

1. A vaccine or treatment is developed and ends the pandemic just as polio was eradicated by the polio vaccine (the mRNA vaccine seems to be working in that manner but it could not be jabbed worldwide) (pharmaceutical ending).

2. The wildfire burns itself out: (that's how the Spanish flu of 1918 ended) all those infected either die or develop immunity (medical ending).

3. People ultimately get tired of the virus and learn to live with the disease (social ending).

Dr Anthony Fauci, Director, NIAID, USA has just released a pandemic preparedness plan for America. The crux of the plan is what is called "Prototype Pathogen Approach." The plan is to take about 20 families of potential pathogens (5 of them are of highest priority) and establish certain commonalities within each family and work out diagnostic tests, vaccine platforms, multiplex diagnostics and therapies. You need not immediately develop vaccines against all 7 families, but you make take a few initial steps such as developing a prototype vaccine, and putting it through phase 1 clinical trials. When you get an outbreak within that particular family, you don't have to start from scratch. The potential pathogen families that can trigger global outbreaks include rhinovirus, flavivirus, alpha virus, and coronavirus etc.

The other arm of the plan includes development of small molecule antiviral drugs that can be used across all lines of certain viruses such as flavivirus, arenavirus or alpha virus etc.

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covid vaccinecovid-19 updatenew variantscovid drugschildren

Debananda S Ningthoujam

Debananda S Ningthoujam

The author teaches and studies microbial biochemistry and biotechnology at Manipur University

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