Monday, September 27, 2021

COVID-19 and Children

By Dr. Sabrina Kitaka 

I have had the opportunity to interact with hundreds of parents throughout the COVID-19 pandemic. One of their most common questions has been, “Doctor, do you think my baby could have COVID-19?”

During the most recent wave, children are affected by COVID-19 in roughly equal numbers as adults. However, infected children typically don’t become as sick as adults, and some do not show any symptoms at all.

While children are less likely to become seriously ill, there are risks that we should all be aware of and some steps you can take to keep you and your family safe.

Which children are most at risk from COVID-19?

The children most at risk from COVID-19 have pre-existing comorbidities like cancer, congenital heart disease, sickle cell disease, and chronic renal failure. Children with underlying conditions like obesity, diabetes, and asthma are also at higher risk of serious illness from COVID-19.

Children with any of these conditions need to be protected from exposure to COVID-19 as much as possible. If your child does not have any of these conditions, their risk of serious illness is relatively low.

However, children can be a potential driver of infection rates because they are more likely to have mild symptoms and be asymptomatic virus carriers. The possibility of children spreading the virus is the primary justification for keeping them away from crowded places like schools to slow the infection rate (flattening the curve).

During lockdowns and school closures, it is vital that we all, as parents, care for our children’s physical, mental, and emotional health. We can do this by encouraging them to continue school activities, engage in physical exercise, and practice maximum levels of hygiene like handwashing.

Why do children react differently to COVID-19?

The answer is not yet clear. Some experts think that children might not be as severely affected by COVID-19 because they often get common colds caused by other coronaviruses. Their immune systems might therefore be primed to fight off COVID-19 infection. It is also possible that children’s immune systems interact differently with the virus than adult immune systems, but research on this question is still ongoing.

In Africa, our children are more regularly exposed to various microbiomes. Presumably, they have an expanded load of gut microbiota as a result. African children may thus have an even more robust immune system to combat COVID-19 infection. However, research on this topic is still limited.

What can I do to protect myself and my children from COVID-19?

The Pfizer/BioNTech COVID-19 vaccine is available and approved for children aged 12 and older. Several other companies have started enrolling children as young as 12 in vaccine clinical trials. Studies with even younger children will also begin soon. The list of vaccines approved for children will likely grow in the months ahead.

Besides vaccination, the best thing you can do to protect your children is to follow existing public health guidelines. These guidelines include washing your hands often, practicing social distancing, cleaning and disinfecting your home, and wearing a cloth face mask in public.

It’s also essential to stay on top of your child’s immunization schedule. Don’t allow fear of the virus to prevent your child from getting their vaccines to prevent other serious illnesses, which in turn would increase their risk from COVID-19.

By Sabrina Bakeera-Kitaka

Department of Paediatrics, Makerere University College of Health Sciences, Fellow of the Uganda National Academy of Sciences (UNAS).

Wednesday, September 8, 2021

COVID-19 has given African scientists a new momentum for sharing science advice with governments

By Esther Nakkazi 

For the last 18 months of COVID-19, governments have made science the centre of decision making and science advice and policy recommendations by scientists have presented an opportunity to deal with the pandemic. 

Delegates attending the virtual International Conference on Science Advice to Governments  in Montreal, Canada, from August 30 to September 2, heard that as policymaking will likely change, as governments learn new lessons from the pandemic in terms of science advice and science diplomacy. 

The conference was seeking to come up with some kind of blueprint for science advice at a global level because science is at the center of advising government and governments.

Salim Abdool Karim, the Director of the Center for the AIDS program of research in South Africa said he and other scientists have been quite struck at the profile of science during this pandemic. 

“I've been involved in giving scientific advice over many years, and I'm used to it being a backroom activity with those receiving it taking off what they wish. During COVID, science advice became very much front and center, because people were being directly affected and in the midst of so much uncertainty, they would much rather that the scientists were providing the guidance rather than ideology or different vested interests,” said Karim.

“The pandemic has given us the possibility to have a new momentum for science advice and to build bridges between science advices and there's an opportunity for us to position the work of science and in support to policy. So there is an opportunity for approaches, and bringing together different branches of science in support to the policy response to the pandemic,” said Stephen Quest, the Director General of the European Commission’s Joint Research Centre (JRC). 

In South Africa, as in many other countries, very early in the pandemic, governments decided to create committees of scientists to give them advice. 

“Part of our responsibility was to take the evidence that was available, little as it was and to give advice,” said Karim who was part of the 21 member scientific advisory committee. “So we saw that and a whole different way of doing things, not usually done in our governments and in that way I think that's that was impressive.”

But without the luxury of time and clear evidence, science advice for governments on the actions to be taken to control the pandemic did not go through the normal consensus and sometimes was difficult.    

“I remember the day we were trying to decide whether to institute lockdowns. When I got asked this question, I went and did a search. I went through Google looking for what is known about lockdowns, as a public health measure,” said Karim. 

He found only three documents on Google, - one was the Chinese handbook on behavior lockdown for COVID, the other in Mexico for swine flu, and a city was locked down in Sierra Leone for Ebola, that was it. “That's the sum total on evidence about lockdowns, it doesn't even feature in the two most important textbooks on public health,” he said.

With limited data to back up the advice it became apparent that countries had to collect routine information or data as part of surveillance against the pressure of time to inform the science advice and policy for their governments. 

Projects and universities have put up global panel datasets to track government policy responses to COVID-19 in almost all countries, built vaccine indicators to enable health researchers and policymakers to understand why and what is happening on the ground. 

Some researchers even had to work with mobile phone companies to track mobility patterns of citizens and map that against providing some quite useful insights in terms of the way the viruses is spreading. 

“It's all under pressure and the scientific community to find this balance between speed and quality of science. The challenge of finding comparable data remains high on the list and ensuring coordination and connection between different systems,” said Yuxi Zhang, a research fellow at the University of Oxford. 

But just as the issue of data collection is important, data protection and privacy is very important too. The pandemic has enabled collection of a lot of data for scientific work but largely this also requires a need to respect the right to privacy and to protect people's data.

In some places like within the European Union framework where strict data protection, regulatory framework is by law, the compliance is high but in other areas it is a different story.

“So for us, within the European Space it's an absolute, we have to comply with those requirements and we have to ensure that our data collection or data use or data reuse are compatible with the regulations which at times makes life complicated for the scientists, but it's a tradeoff that I think is necessary if we're going to have the trust of citizens,” said Quest.

Will science advice change after the COVID-19 pandemic: 

Scientists are optimistic that they can maintain this momentum and take some of the lessons learned but it will take resolute action on the part of the scientific community and the policy community to lock in and anchor these benefits going forward. 

“It's hard to imagine that it's going to go back to how it used to be because I think the public is very used to this idea now of scientists always talking to them, sharing science with transparency,” said Karim.

There is also a potential downside risk which is that although science is in the spotlight and people increasingly want science to give instant answers, and there's a real tradeoff between speed and quality, which requires maintaining the integrity of science, scientific excellence and being responsible. 

“I think as we have grown with this epidemic now in science advice. We've learned the art of conveying information, with its uncertainty, but in a confident way that the public can take away a clear message that doesn't leave them wondering what what's going on but they have some idea, and I think that that's, that's been happening and I've been seeing how government advisors across the world are conveying information in such a clear way now,” said Karim.

“So it is our task to combine different science based advice, and, and this one could say, balance also the different interests that are at stake. In the beginning it was purely a health related issue, but it evolved to become much broader and what we do see is that it is really difficult to have the government use science based advice on in other domains,” said Corien Prins, the Chair of the Netherlands Scientific Council for Government Policy (WRR). 

“We need to do is leverage what we've learned through the pandemic, to be better prepared for the future to have more anticipated culture. To ensure this connectivity between science and policy to ensure that we have these multi-disciplinary approaches that we really root this in to our way of doing policy in the future,” said Karim.