Time for a partnership

Caring for OUR Children during the COVID 19 Pandemic

Dr.Kezevino Aram, President, Shanti Ashram

“We must follow the evidence. There are no short cuts!” – Director General, WHO, 27th March, 2020

The morning newspaper brought us the news that a 10 month old baby was among the 8 new COVID 19 cases in Tamil Nadu. Parents have now started worrying even more about the health & safety of their children as more cases emerge in different parts of the country. As a trend these numbers will only go up.
Some concerns amongst parents are: Can my child be infected? Where should I go to seek care? When should we be testing? As a family, what can we do to stay healthy – physically and mentally – during this unprecedented lock down?
Child Health practitioners and Public Health experts have also been raising the same questions and drawing up protocols to provide medical care and community centered interventions. So here is an attempt to initiate a dialogue with parents so that OUR CHILDREN benefit from our care and our collective thinking.

Quick recap of the evidence and data:
 As of today (30th of March), over 7,20,000 people across 203 countries have tested positive reads the Corona virus dashboard at Johns Hopkins
 Over 31,000 people have lost their lives to and from the complications triggered by the COVID 19 pandemic
 Rapid diagnostic tests are being explored by individual countries and WHO for widening testing
 There is NO cure yet!
 The only confirmed piece information is that this rather new type of CORONA virus spreads through droplets from symptomatic and asymptomatic carriers!

Policy and its implication on the lives of OUR children: India started a nation-wide lockdown at the stroke of midnight on 25th March, 2020. Schools and Colleges across the country were amongst the first to initiate precautionary closures, with Tamil Nadu closing a fortnight ago on March 15th. Millions of children have a new situation where they are not only at home but mostly confined indoors; their daily association with fellow children disrupted while adults watch on them with heightened anxiety.

We know that poverty, powerlessness and disease combine into a vicious cycle, more so in situation like the one we find ourselves in now. In particular, the lives of vulnerable children have the compounded burden of deprivation and disease. The Nobel Laureate Abhijit Banerjee rightly highlighted their plight in an interview yesterday, “the poor are not just losing their livelihood; they are also at a potentially higher risk of losing their lives”.

While the situation is still dynamic, India has introduced many evidence driven policy interventions to achieve the twin goals of 1) disrupting the transmission of the virus (lockdown to increase social isolation) and 2) minimizing burden on the frail healthcare infrastructure. By and large, people’s support for the measures has been positive. This ‘never before’ taken policy has direct implications on the lives of 1.3 billion people and millions of children, particularly the most vulnerable amongst us. As a community, let us look out for our children and support their care in their homes, in the warmth of their families.

Meanwhile, how can we prevent the COVID infection in children? Epidemiologists in India and across the world say these containment measures are absolutely vital and a country of our size has done well in deploying it early in the course of the pandemic. But these measures alone are not enough. Testing, treatment and aggressive contact isolation must be scaled to ultimately and decisively reverse the pandemic.

Keep believing in, practicing and sustaining:
 Physical Distancing, erroneously and popularly called Social Distancing.
 Personal hygiene matters more than any time before: Wash your hands often with soap and keep your living quarters clean as a family.
 Mental well-being will be as important as physical care: Interact with your children – ask them how they feel, what they would like to do and find new things to do together. Senior Psychiatrist Dr. Srinivasan observed, “Don’t stress, stay calm and seize this rare gift of time to deepen your relationships with your family, especially your children! See this as an opportunity to hit the refresh button”. Separately lots of validated resources are available online and offline but time-tested common sense approach will work well too.
 Keep a check on the health of your loved ones: If your child experiences fever, cough/cold and/or breathing difficulty, reach out to your Paediatrician, Family Physician or the health care institution in your vicinity.

Information on Healthcare & Testing:
 There is a strengthened partnership in place for our children: Government and Private health care institutions are increasingly working together to care for greater numbers of children. Dr. S. Ramalingam, the Dean of the P.S.G. Institute of Medical Sciences and Research, my alma mater, just released to the nation its COVID 19 preparedness plan. This includes a comprehensive strategy team with health care providers and public health care experts to service a 200 bed dedicated health care facility. Creative collaborations such as this are on the rise across the country; so do keep track of this while you follow the pandemic.
 Health care institutions, Pharmacies and essential services are finding practical ways to provide care for our children round the clock. Be aware of the new protocols that many city and community health clinics have introduced like tele-consulting, referrals, hospital visiting guidelines and providing financial waivers.
 ICMR guidelines for testing in India (as of 20th March) : 1) Symptomatic individuals who have foreign travel history, 2) Symptomatic individuals with contacts to people with foreign travel history, 3) Health care workers in contact with such patients, 4) All hospitalized patients with respiratory illnesses (fever, cough and/ or shortness of breath), and 5) Asymptomatic direct and high risk contacts are all currently eligible for COVID-19 testing. Our hope is testing will be expanded to the wider population as soon as possible.

Remember, care givers are only a phone call, text or an email away – Reach out!

Capacities are being built at an unprecedented and newly imagined ways. More than 1 million health workers have been trained through the courses on OpenWHO.org. “We will continue to train more”, says the WHO communiqué. In these testing times, the compassion of my fellow health care providers has struck me greatly. My mentor and one of the leading Paediatricians of India, Dr. M. Ramawamy has called me several times in this past week to think aloud on how millions of children can be protected and treated during the COVID 19 pandemic. He observed, “Children need great attention during the pandemic. They have to feature high in our national response. Scientific evidence suggests that we need to expand testing as a next step immediately. Every Physician must be able to do so, so that in local communities and neighbourhoods we can test, treat and isolate people for care. Here is where we can start the first informed and directed response to reverse the course of the pandemic”.

Let us as a nation be patient and collectively look out for one another, even as the scientific teams add more nuance, depth and scale to the public health response!

As health care providers and people of faith, we want to remind you the inspiring words of Mother Teresa, a devoted citizen of India and an example to the world in caring for the vulnerable.

Never be so busy as not to think of others!

Grateful to Bhaskar.J.Endow for helping me write this collaborative piece for our Children. His editorial inputs and technical support are vital in these times of ‘working from home’. Over the past years you have often been my first reader. Thank you P!
I have benefitted immensely from the contributions of the leading minds from across the world in these unprecedented times to make sense and discern. Action is the ethical call from every single luminary. To each of them my heartfelt thanks. It is the time for action and we must each ask this vital question ‘what is it that I can do in this situation?’
The data, evidence, reflections and contributions of the scientific community worldwide has informed my understanding of the issue and helped me deliberate on potential solutions. WHO, ICMR and Harvard T.H.Chan School of Public Health, my alma-mater, portals were frequented for updates. Knowledge transcends divides as does compassionate service!
As an Indian, it has given me immense hope seeing the nation come together with courage and humility; with preparedness and openness; with absorbing the global knowledge and using our jugaad to create practical solutions to contain the pandemic whilst simultaneously advancing the discourse in health. A billion people are living the spirit of Sarvodaya – one that Mahatma Gandhi visualized for his motherland and the world!
To every child out there, nearly two billion of them worldwide – a reminder that ‘you are our priority in difficult and in happy times! You give me purpose – you inspire me to think and work together and to advance the common good’.
Aradhya Aram – Bua loves you very much, I remember your wise words often, ‘It’s important to be kind- Bua’. I am using the beautiful drawing you sent after England went into a lockdown for this article.
To my community at Shanti Ashram and the International Center for Child and Public Health (ICPH) – I write because I am moved by what we do collectively, each day for OUR CHILDREN