The health ministry on Wednesday issued detailed guidelines for management of the coronavirus disease in children amid concerns that a possible third wave of the pandemic could affect those below 18 years.
The guidelines, issued by the Directorate General of Health Services, said antiviral drug remdesivir is not recommended for children. “There is lack of sufficient safety and efficacy data with respect to remdesivir in children below 18 years of age,” it said.
The ministry advised that steroids should be used to treat only moderately severe and critically ill patients who are hospitalised. “Steroids should be used at the right time, in the right dose and for the right duration,” it said. “Self-medication of steroids must be avoided.”
The government also recommended a six-minute walk test for children above 12 years to assess “cardiopulmonary exercise tolerance”. However, it is not meant for patients with uncontrolled asthma.
The guidelines suggested that doctors treating children who have contracted the virus must be highly selective in prescribing high-resolution CT scan. “The scan of chest provides better visualisation of the extent and nature of lung involvement in patients with Covid-19, but any additional information gained from HRCT scan of chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment,” the document said.
For asymptomatic infection among children, the guidelines recommended no specific medication. “Promote Covid appropriate behaviour (mask, strict hand hygiene, physical distancing),” it said.
In case of moderate infection, the guidelines suggested initiating immediate oxygen therapy.
For severe infection, the health ministry said that fluid and electrolyte balance should be maintained, and the corticosteroids therapy should be started. Corticosteroids are lab-made medicines, which work in the body like the hormone cortisol in fighting and controlling swelling. Inhaled versions are usually used to treat lung problems such as asthma and chronic obstructive pulmonary disease.
Covid in children
On May 13, India’s drug regulator granted permission for conducting the clinical trial of Bharat Biotech’s Covaxin in the age group 2 to 18 years. The All India Institute of Medical Sciences is screening children between the age of 2 and 18 for the trials.
However, All India Institute of Medical Sciences chief Randeep Guleria on Tuesday said that there was no data, either from India or internationally, to show that children will be seriously infected during the subsequent waves of the pandemic.
NITI Aayog (health) member VK Paul had also dismissed concerns. “It is uncertain that a wave would affect children specifically,” he told India Today. “ Till now, children have displayed similar seroprevalence as adults, which means, they are as much affected as adults.”