Covid-19: What you need to know today
Ever since one of the country’s top doctors spoke about how there would be a third wave of Covid-19, one that would disproportionately target children, the subject has dominated the headlines. He was wrong, of course. What’s become clear over the past year-and-a-half is that many top doctors and medical policymakers know very little about current science (the Sars-CoV-2 virus and Covid-19 were both unknown to science till early last year, and the only way to know more about both is to keep abreast of current research, of which there has been a surfeit), and that media (especially TV channels) is more interested in the brand equity of doctors and experts than in their knowledge. The logic behind the argument that children are more at risk arises simply from the fact that they are not yet eligible for vaccines in India. Canada and the US have begun vaccinating children; the UK soon will; and a chorus demanding the same has begun in India (there was even a suit filed in court by a 12-year-old).
I believe everyone, including children, should be vaccinated, but I also believe it is important to prioritise jabs.
Regular readers of this column will know that I have been a strong votary for maximising reach by focusing on the delivery of the first dose of the vaccine by extending the gap between doses. That’s because the data suggested that even one dose could provide adequate protection against severe illness and hospitalisation. But that was before the emergence of variants. What we have now come to know is that two doses are needed to combat the Delta variant of the Sars-CoV-2 virus, B.1.617.2, first sequenced in India. That will likely require India to refine its vaccine policy again – there’s no shame in this; we should change our minds and approaches as new data becomes available – and perhaps shorten the gap between two doses of Covishield, the Indian version of the AstraZeneca/Oxford vaccine, made locally by Serum Institute. This is the vaccine being administered to most Indians, and research by Public Health England shows that while the efficacy of the AstraZeneca/ Oxford vaccine, in dealing with the delta variant, is 33% after the first dose, this increases to 60% after the second. That marks a 7 percentage point drop from the vaccine’s efficacy otherwise. There is a similar drop for the Pfizer/BioNTech vaccine. It is also believed that Covaxin, the other vaccine that is currently part of India’s vaccination programme, is also very effective against the variant, but data on this isn’t available (indeed, even final data on the Phase 3 trials is not, but that’s another story).
Since it is a reasonable assumption that most of the cases in India are being caused by the new variant – we aren’t sequencing enough viral genomes to know for sure, but research by the Institute of Genomics and Integrative Biology recently showed that the variant was responsible for Delhi’s second wave – the logical response would be to try and fully vaccinate (two doses) as many people as possible. One dose may not be as much of a protection against severe illness as we once thought. Given that vaccines will continue to be in short supply for at least a few months – the 2.16 billion number mentioned by the man in charge of India’s vaccine policy, Dr VK Paul, in a briefing, as the number of vaccine doses India will acquire between August and December, is almost definitely an overestimation – it makes sense to focus on fully vaccinating as many people as possible over the age of 18 (there are 940 million) before moving to those under 18 years of age.
According to a March note by the US Centers for Disease Control and Protection, less than 10% of the total cases seen in that country till mid-March were in those under the age of 17. CDC also cited research that showed that most children who do get infected by the Sars-CoV-2 virus, tend to either be asymptomatic or have very mild symptoms. From the start of the pandemic, till January 27, 2021, the US, according to that note, recorded 203 deaths of those under the age of 18. In the same period, according to world o meters. info, the country as a whole saw 450,706 deaths. That means only 0.045% of those who died in the US till January 27 were young people under the age of 18. More recently, research from Sao Paulo’s Butantan Institute cited in Nature, showed that when 62% of the adults in Brazil’s Serrana were vaccinated, the result was an 80% fall in symptomatic cases, and 95% drop in deaths, even among children.
This isn’t surprising. If children are less likely to be infected, and there is an overall fall in infections in a population on account of many of the adults being vaccinated, it is only logical that there are even fewer chances of the children coming in contact with an infected person. Sure, we still need to understand whether the Delta variant affects children differently (Are they more vulnerable to being infected by it? If so, does it also increase the possibility of symptomatic infections?), but on current evidence, there’s no reason to panic about children being targeted in the third wave, and enough justification to prioritise vaccinations for those over the age of 18.
PS: India has issued perfect light-touch guidelines for the clinical management of Covid-19 in children, should they get infected (see page 8).