By:
Dominicus Husada
Member of the Airlangga University Covid-19 Vaccine Team, Consultant for Child Infection of FK Unair/Dr. Soetomo Hospital
ENHANCEMENT Covid-19 cases throughout June 2021 cannot be separated from the spread of the Delta variant in the country. Genetic sequence evidence from UGM and ITD Unair confirms this. Most of the viruses obtained from patients from Madura Island, for example, are clearly the Delta variant.
This variant was first identified in India during a massive increase in cases recently. Compared to its predecessor, the Delta variant is able to spread faster. The rise in cases in India, Indonesia and most other countries around the world, including the United States and Western Europe, is very evident.
When the Delta variant was rampant, there was also a significant increase in the number of children under 18 years of age. Similar reports came from various big cities in Java which became the epicenter of the wave in June 2021. The proportion of children with children should be relatively small and tend not to be heavy.
The situation became even more shocking because at the same time UI published in an international medical journal findings in their hospital which showed high mortality of pediatric patients. No wonder then came the statement that the child sufferers in Indonesia is the highest in the world.
Of course, the deaths of children with children in Indonesia are also claimed to be the highest in the world. The number of child sufferers officially announced in the country is actually around 12 percent. There are some countries that have similar proportions, but in general the proportion is usually below 5 percent.
In fact, the evidence so far has only confirmed that the Delta variant was able to spread more quickly. This virus makes binding with cells more efficient. A search through CCTV footage in Sydney showed that transmission of the virus could have occurred only from contact for a few seconds at a distance of about half a meter. Transmission became so easy and it was proven that the genetic sequence of the virus in different people was identical.
Experts have not been able to confirm whether this virus is more deadly. What is happening in our country and India is a sharp increase in cases which makes health services very difficult. Some patients cannot be treated properly and may end up in death. When the patient is very high, doctors and other health workers must prioritize which patients will be saved. By itself the number of deaths will be higher as well.
Experts also do not dare to confirm whether the Delta variant prefers attacking children. What is happening all over the world is an increase in the number of cases, including in the younger age group. In absolute terms, the number of sick children is very large. Because in developed countries, in general, many older age groups have received vaccines, it is natural that the groups most affected are those who are younger than those who are not currently the target of vaccination.
Another reason is that most developed countries have also started school activities. The gathering of large numbers of people, including in educational facilities, has the potential to rapidly increase the number of cases. In the UK, after the situation has been relatively calm since March, when schools reopened, this week they saw a significant increase in the number of cases among school age, especially at the junior and senior high school levels.
Meanwhile, the high level of child mortality in Indonesia can be explained from the level of child health which before and during the pandemic was relatively below the level of child health in developed countries. Many children in Indonesia have diseases, either in the form of infections, congenital abnormalities, or other diseases. Almost all the children who contracted Covid-19 and died were from this group.
Healthy children who are only infected with the SARS-CoV-2 virus, the same as in other countries, more can be saved. For children with TB disease or poor nutrition, the additional infection with Covid-19 can be deadly.
Even though the Delta variant does not directly select pediatric patients, the idea to open a school which should be carried out in the country in July 2021 deserves to be postponed. WHO has provided several criteria before schools can restart, including the general incidence of illness, the level of transmission, the number of tests carried out, and the ability to trace contacts. This is to minimize the risk of the child being infected. The official statement of the Indonesian Pediatrician Association refers to the WHO announcement.
Another thing that is also important is the immunization status of all adults in the school concerned. Experts assess the ability of children to transmit Covid-19 disease is not as big as the role of older people. It is very natural that these would-be carriers are vaccinated. Of course, until the end of June 2021, in Indonesia there is no vaccine that can be used for children and is accepted internationally.
This July, we will commemorate National Children’s Day. It is appropriate that we provide extra protection for children during the pandemic. We must protect them from all dangers that are ready to pounce. They are the successors and future of the nation.
As with the previous wave, in one location, the increase in cases will only occur 1–3 months and then decrease again. If the atmosphere is relatively calm, especially if it is accompanied by the mass immunization movement which targets 1-2 million people per day like in the United States, the discourse of starting offline school activities deserves to be revived. Changes to plans in the midst of a pandemic situation are clearly unavoidable and will often be faced. That’s where the real test for us is.
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