 Hi friends, I am Dr. Karthik Nagesh, chairman of Neonatology and the Manipal Advanced Pediatric Children's Center at Manipal Hospital's Manglo. I do think and it's quite plausible that the third wave is likely to affect children more in the coming few months if you're not adequately prepared for it. It is basically quite likely that the new Coronavirus Mutants Chain which is the B167 is probably likely to afflict children more and we have to be mentally prepared for that and we should possibly put up into place and ramp up all facilities to be able to tackle this menace. There is now enough evidence that the current strain of B167 is afflicting children more than earlier it was seen. In fact if we see the data which is emerging now in the state of Karnataka where I work more than 40,000 children have been afflicted in this last one and a half months alone which is much more than the numbers which were afflicted throughout the whole of the last year in the first wave. Though the infectivity of the strain is seen to be more this time afflicting more children but children are not falling that sick. I would say for every 100 children who are falling ill with the Coronavirus nearly 99 of them would be easily managed at home with just some teleconcertations with doctors and adequate care at home with the parents looking after them and monitoring them for any increase in symptoms or signs. But then amongst the one percent also who have required hospitalization they have also not been very unwell. They have needed some basic care in the hospital and monitoring with less than one third of them requiring ICU care. But nevertheless we should not become complacent on this and probably not look into trying to prevent holocaust of an epidemic proportion of cases from falling at our doors and not being prepared for it. Now what are the measures we should probably take as parents and as healthcare authorities and as doctors to prevent such a catastrophe occurring in children. It's well known and we ought to be aware that children are not really adults or small. They have their own physiology and the disease pathology may afflict them in a different wave than much what we can fathom. So we have to be prepared for any eventuality. Children are also unique in the sense they cannot be really deprived from the care of their parents or other caregivers and therefore when a child falls ill with corona it's likely that even parents can get afflicted and parents need to be the primary caregivers of the child needs care and hospitalization. In this in mind health authorities have to prepare a very very robust pediatric covid task force in the state or in the smaller towns and cities of the state and be prepared for this menace in the next coming months. This would mean in addition to ramping up infrastructure facilities in the existing hospitals we would have to probably create corona care units for children and mother dear we have to possibly take into consideration that the mother and the child cannot be separated and the mother would have to be the primary caregiver or one of the parents would have to be the primary caregiver of the child falls ill. So ramping up basic infrastructure facilities in terms of beds in terms of other equipment in terms of monitoring equipment personal both medical nursing other health care workers and frontline workers is important at this stage. We have to start looking out for volunteers who are able to be able to give care to these children irrespective of them having covid there are many many people especially social workers psychologists who are required to be looking after these children also basic care health workers need to be available to look after these children. A smart set of task force members have to be gathered together now to think of all the basic possibilities this would include apart from government officials who are in the front line of working with corona cases and have to also involve senior pediatricians in the city both in the government sector and in the private sector to be able to look into these matters and can be an advisory for this. The other thing which needs to be ramped up soon as possible is to improve vaccination services for the adults in the family. I am sure the government is trying its best to get as much vaccination as possible done particularly it is being recognized in the second wave now that children are getting afflicted because of infections coming through adults children are not going to school they're sitting at home they have not been exposed to any other children as well and in the earlier way we had suspected that children may be the carriers of this infection to adults so hence schools had been stopped but if you see now in this last two months or so most of the children who have got afflicted have got it from the adult caregivers at home so if the adults especially parents of children were to be vaccinated soon as possible this drive if it happens very fast they heard immunity improves adults will probably not spread the infection to children and therefore children can be protected to a large extent the evidence is now showing that if the caregivers are protected well by vaccination and if the caregivers have a covid appropriate behavior which means in a certain unit inside a house there's a family bubble and the parents and grandparents are aware they are the ones who really are likely to go outside the house either for shopping or for work they would have to have a very very staunch covid appropriate behavior which means masking themselves maintaining social distancing and doing a lot of hand washing procedures when they're outside and when they come into the home before they mingle with the children they have to be very sure they have disinfected themselves trying to take a bath and trying to sanitize themselves before they are in close contact with the children and if they feel especially they've been exposed when they have been outside they have to take all these precautions adults by chance they get afflicted with the coronavirus infection they have to keep themselves away from the children especially for the first 14 days of isolation period masking themselves well and maintaining all covid appropriate behavior so that the child doesn't befall the illness this I think would be very necessary and this should be sensitized to all parents and probably in the next coming months more and more the media should responsibly try to convey this to parents especially in parents who are not likely to be very educated and likely to be in the urban slum areas or likely to be in the rural sector because that is where we think the message has to reach out and that is where we think it's likely that the next major epidemic proportions of corona is going to hit and very very susceptible children are likely to get afflicted of course we know that children immediately may be having a good immunity and that is why in the second wave we have seen that children who afflicted with this highly infectious virus which you can't really escape from are not falling very sick but then there are some other side effects of the sequelae of this disease which we are beginning to recognize more and more so in the world some of these syndromes are called the multi-system inflammatory syndrome as seen in children which is very devastating complications of the virus so children who have got afflicted with this virus they can develop these symptoms later on in the course of the disease and they can become very sick and needing intensive care so sensitization of parents about this aspect also has to be done so that they don't become complacent if a child has a milder variant of the disease and then becomes better but the close monitoring of the child and the symptoms has to be done for the next about a month or so after the child has recovered from the corona illness now in terms of the covid task force which I had earlier talked about we need to involve pediatric associations like for example the Indian academy of pediatrics as also the neonatology forum of India to try to be advisory body for these task force so that the latest guidelines in the care of these children and the latest developments in the treatment of these children can be passed on to senior government officials who can probably take upon the preventive aspects on a war footing that I think is very essential because there should be a good partnership between adokese bodies professional bodies and also of course the private sector as well the good private and public partnership has worked well in this last one and a half years of battling the coronavirus in adults and so also we should look forward to strengthening this partnership trying to prevent the disease from afflicting children and preventing a major catastrophe vaccination is definitely known to protect and we are really looking forward to the vaccine being available not only to adults but even children at least in the age groups of 12 to 18 years where children seem to be afflicted more seriously with the coronavirus so legislation has to be brought in the vaccine should be probably made available after whatever initial safety and efficacy trials if they are ramped up faster if it can be brought about for children to be given soon as possible I think that will be a big step away there is no doubt vaccination does prevent disease because we have seen in the history more so as pediatricians we all believe in vaccination we know that for the last about 50 years we have been vaccinating children effectively diseases which have been major disasters in the past like diphtheria tetanus polio whooping cough hepatitis being chicken pox practically they have been made extinct because of the scrupulous vaccination programs which have been adopted universally across all countries as national immunization programs so vaccination with good robust vaccines does help and we should probably aim towards this soon as possible at least to the caregivers of these children as much as possible so that the children are thereby protected there has to be a lot of resource utilization and the covid task force which has created should be able to increase the number of beds in the periphery apart from good telemedicine which can look after children both in the rural sector and in the urban sector by group of volunteer doctors and healthcare workers to monitor children at home to sensitize parents about what to look for in their children and to be able to make sure these children stay healthy and recover from the illness at home which we are very sure more than 95 percent of them will do so but in the remaining children who need a little closer monitoring we need to have simple corona care units which are available where the mother and child or the father and child or any other caregiver at the child can be kept together for a few days monitored there could be a team of doctors available to look after them or any basic healthcare workers just to look after them under the guidance of a team of doctors at the district level increasing importance should be given to referral services and transport services so that these children if they become unwell if they recognize early and picked up they can be transported effectively by some good ambulance services transport services to a higher center which can look after these child both for secondary and tertiary care now typically in cities big towns metros there are lots of children's hospitals mother and child standalone hospitals which are available and small nursing homes which are available who can easily monitor most of the problems with these children multi-speciality tertiary care hospitals are already burdened with a lot of children and adults who are getting afflicted with sick corona symptoms and their ICUs are full and also number of ICU beds for children in multi-speciality hospitals are limited but no doubt if they get filled up we can probably try to improve the number of beds which are existing in smaller hospitals which are basically functioning for the mother and child for example the maternity hospitals or the children's hospitals where these services can be ramped up a bit more and children can be looked after there most of the children who have been afflicted in the second wave and in the first wave we have seen have been requiring only that much of care not really advanced tertiary care or quaternary care so we can probably try to resource utilize all these facilities available so small committees of resource people the so-called small COVID task forces can be made in the smaller towns and cities with the local senior pediatricians involved and nursing home owners or private hospital owners involved as well as the government doctors and the government officials so that resource utilization can be made and beds can be allocated at various level at the peripheral level, secondary level and at the tertiary level for six children to be looked after till they get better we do think yes in this current way we do think children have been afflicted more than what it was in the last wave as I mentioned earlier as far as the last wave was concerned over the period of one year whatever number of cases of children afflicted with COVID we have seen we have seen almost double that number only in this last two months and we are really praying that it should not happen that these numbers increase dramatically and there is a third wave in children which will be unfortunately a disaster if that was to occur so we should try to use as much as possible preventive methods to prevent that from happening more social consciousness if that happens schools if they are not yet reopened public gatherings if they are limited children will be less exposed adults if they maintain good COVID appropriate behavior both outside and inside the home and the bio bubble inside the home is not broken chinnara are then likely to remain safe and we should look forward to them easily tidying over this crisis for the next six months if we are really careful we should be able to do that meanwhile we are hoping a good vaccine should come to be effective for children as well as has been now licensed in the western countries probably children about 12 years of age should be vaccinated soon as possible if it is likely that the vaccine could be made available to them that will be definitely a useful thing to happen to prevent the disease in children trials are now happening and even in this country the government and the ICMR has given a go-ahead for a trials to be started in children above the age of two years for the COVID vaccines developed in this country and we are really hoping to look forward to them being proven to be safe that's very important and effective the COVID disease is probably in our minds as we think as pediatricians likely to be there for years to come and no doubt the new mutant strains will keep coming up and popping up as often but if a COVID-appropriate behavior is adopted and if a reasonably effective vaccine is developed I think we should be able to tide over this present crisis and should be able to look after children and adults preventively and therapeutically fairly well in the next few years to come thank you very much