In the recent guidelines issued by the Directorate General of Health Services (DGHS) under the Union Ministry of Health and Family Welfare, parents and guardians have been recommended against making children under 5 years of age wear masks. A number of other directives such as more discriminate use of HRCT imaging (High-Resolution CT test) for diagnosis among children and discontinuation of remdesivir in children below 18 years of age were issued.
Despite the wearing of masks has been one of the indispensable protocols to combat Covid-19 so far, it is now being restricted only to adults and older children. Children under the age of 5 will not be required to wear masks. Children aged between 6 to 12 years may wear it, but only under the supervision of parents or guardians and the consulting doctor.
This is in line with the guidelines published by the World Health Organization (WHO) in the context of Covid protocol for children below the age of 18. WHO advocates restriction on children aged under 5 on wearing masks, and for those above 6 years, it dictates that masks may be worn based on the degree of transmission in their localities, and provided they are capable of “safely and appropriately” using them.
Therefore, the government guidelines seem to be well in line with the international standards. This is perhaps with a view to protect young children from the possibility of hazards from masks such as asphyxiation, infection due to improper hygiene practices, or while interacting with high-risk patients.
The circular also recommended against the prescription of Remedesivir for children in asymptomatic, mild, or moderate cases. “There is a lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” the guidelines said.
It also called for more conservative administration of steroids in patients. For the steroid to work well they have to be given at the right time. The report stated that treating asymptomatic and mild cases of infection with steroids can in fact be harmful.
The DGHS recommended steroids only in hospitalized moderately severe and critically ill COVID-19 cases under strict supervision. “Steroids should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided,” it said.
These instructions are particularly significant as the peak of the second wave witnessed mass hoarding of vital drugs, and self-administration by patients leading to fatal consequences.
The report also emphasized healthcare professionals to exercise scrutiny in prescribing HRCT scans for patients under the age of 18. This test helps detect the extent and nature of lung involvement in patients with Covid-19 but does not factor in as much in deciding their course of treatment. “Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in COVID-19 patients,” the guidelines said.
This may have been to ensure minimum movement of people, particularly when infected. Moreover, hospital admission increases the risk of healthcare-associated infections with multidrug-resistant organisms. For asymptomatic infection among children, the guidelines recommended no specific medication and promoted COVID-appropriate behavior (mask, strict hand hygiene, physical distancing), and suggested giving a nutritious diet.
The guidelines said that for a mild infection, paracetamol 10-15mg/kg/dose may be given every 4-6 hours for fever. Throat soothing agents and warm saline gargles in older children and adolescents have been recommended for cough. The circular also suggested initiating oxygen therapy immediately, in case of moderate infection.
In addition to this, the notification issued by the Union also recommended a six-minute walk test for children above 12 years under the supervision of parents/guardians. “It is a simple clinical test to assess cardiopulmonary exercise tolerance and is used to unmask hypoxia. Attach a pulse oximeter to his/her finger and ask the child to walk in the confines of their room for six minutes continuously,” the report said.
More recently, many states had announced the creation of task forces to aid in preparation for a potential third-wave between July and September. The third wave is also expected to target more numbers in the youngest demographic group, that is children. It is possible that the circular, which is focused solely on Covid-19 protocols for children, has been released in anticipation of the same.