The Covid virus mutates to attack as many new hosts as possible. During the first wave, Covid attacked mainly the elderly and spared youngsters. The second wave is attacking a large number of young breadwinners. The third wave is likely to attack children, since most adults are already infected or immunised.
Unfortunately, children under the age of 18 cannot be vaccinated. As a result, the only host left for the virus to attack will be children, and we have 165 million of them who are less than 12 years old. Even if we assume that just 20% of them get infected and 5% of the infected need critical care, we need 1.65 lakh paediatric ICU beds. Today we are struggling with about 90,000 ICU beds for adults and less than 2,000 beds for children.
I love children, and spent most of my professional life building one of the largest paediatric cardiac surgical ICUs in the world, during which I learnt many lessons.
Children are not miniature adults. Unlike adults, we cannot have a two-month-old baby in the Covid ICU without one of the parents. How do you send a young mother or father of three children to the Covid ICU without vaccination? Unlike adult Covid ICU patients – who are left to be managed entirely by nurses and doctors – infants and small children cannot be left in the ICU without their parents.
Mothers need to breastfeed their babies, and someone should be there to ensure that the baby doesn’t throw the oxygen mask. In cardiac ICU, most kids are partially sedated, and when they are fully alert, we send them to the ward. In the Covid ICU we cannot sedate the child; they need to breathe well to maintain oxygenation.
That means we need to quickly vaccinate all the parents of young children with two doses. And this should happen now. We need to vaccinate at least 300 million young parents in the next few months. The good news is that vaccination protects. Our hospital, which always has over 500 Covid patients, has never seen a single ICU patient who had both doses of vaccine.
For affordable vaccination, the government should negotiate with Indian and foreign vaccine manufacturers for 300 million vaccines and pay them in advance to deliver in record time.
Sputnik V, I believe, has already tied up with four or five vaccine makers from India to manufacture their vaccine. Unlike in the past, we have options now. Any vaccine used on millions of patients anywhere in the world should be accepted without regulatory hurdles. What we need to do is to move quickly and get the deal done.
Once the delivery date is confirmed, the health ministry should distribute 70% of the vaccines to the private sector and 30% to public hospitals to vaccinate 300 million young parents in just one month. This can be accomplished only with the active participation of the private sector, which has the flexibility to run services 24×7.
For example, if the government delivers the vaccine for Rs 500, most big and small hospitals will agree to charge Rs 100 or 150 for the injection as a service to society. Today, most of the parents will be willing to pay Rs 500 for the vaccine, and the cost of injection of Rs 100 or 150. It can also be sponsored by corporates and philanthropists. Once the parents are immunised, the chances of the children getting infected go down significantly.
Many hospitals are acutely short of nurses and doctors. It’s not uncommon for two nurses at night to manage an ICU filled with over 20 sick Covid patients on oxygen and ventilators. That cannot happen in a paediatric Covid ICU. Parents will insist on constant attention from nurses. If the family is not happy with the medical care, and God forbid something happens to the child, there will be serious consequences for the medical staff, which results in attrition.
We need to prepare an army of young nurses and doctors on standby to move from one city to the other based on the Covid wave, to support busy hospitals. This cannot happen unless these doctors and nurses are given grace marks for various entrance and exit exams. Money will not motivate young doctors and nurses to work in a Covid ICU, risking their life.
The production of drugs and disposables used for children in the ICU, starting from Crocin syrup to oxygen masks, should be enhanced to prevent a repetition of the struggle for oxygen and remdesivir. We need to procure a large number of ventilators that can ventilate newborn babies quickly.
God has given us a window of opportunity, let’s make the best use of it and show the world what we are. I am optimistic that our government, under the able leadership of PM Modi, will address this crisis without any delay.