BY NINA MUSLIM
MORE children are being hospitalised for Covid-19 now compared to any other time of this ongoing pandemic, according to doctors, as the highly contagious Delta strain becomes more dominant in Malaysia.
University Malaya Medical Centre (UMMC) consultant paediatric cardiologist Associate Prof Dr Norazah Zahari told Bernama more children have been coming in the last two months with Covid-19 symptoms, necessitating the expansion from one ward for Covid-19 child patients to a whole floor in the children’s building at UMMC this year.
“We did have a few cases, about two to three cases, which needed ICU admission. (The kids) suffered from complications to the heart from the Covid-19 infection,” she said, adding that out of those, one case was confirmed as multisystem inflammatory syndrome in children (MIS-C).
MIS-C is a serious complication of Covid-19 and is characterised by inflammation in multiple organs, such as the heart, lungs, blood vessels and kidneys. Although children who contract Covid-19 are less likely to develop severe symptoms, they are not immune to the disease.
Experts are not surprised to see the numbers increasing as Covid-19 has become what health officials call a “pandemic of the unvaccinated”. Until recently, children in Malaysia have been barred from getting their shot, although the Pfizer-BioNTech vaccine has been approved for children aged 12 and above since June.
“When there is a pocket of people who cannot get vaccinated, they are very vulnerable – the children, the adolescents,” said Associate Prof Dr Mas Ayu Said, an epidemiologist at Universiti Malaya.
“If you don’t have antibodies at all, it’s much easier (to get infected), like you’ve opened the gate so they’re (the virus) just coming in.”
The number of cases involving children coupled with the spread of the Delta strain prompted renewed calls from state health authorities and medical experts for the government to begin inoculating adolescents.
On Aug 15, former coordinating minister for the National Covid-19 Immunisation Programme (PICK) Khairy Jamaluddin Abu Bakar announced that vaccinations for all children in the 12- to 17-year-old age group will start from Sept 15. However, priority would be given to those with comorbidities and older schoolchildren before the younger ones are vaccinated, depending on vaccine supply.
While experts lauded the development, they say it still leaves children vulnerable in the meantime, especially as some states have begun easing restrictions for fully vaccinated individuals, including allowing interstate travel and allowing parents to dine in at restaurants with their children.
As of Aug 14, 51.7 percent of the Malaysian population, equivalent to 72.1 percent of adults, have received at least one dose of the vaccine. Out of that figure, 31.9 percent of the population, or 44.5 percent of adults, have received two doses.
Better late than never
Other countries, some of which have been inoculating their adults and youths for months, are also seeing more cases of unvaccinated children hospitalised with Covid-19 caused by the Delta variant. Possibly more infectious than measles, there is tentative data that indicates the strain may cause more severe infection.
Worse, vaccinated people can also get infected and transmit the virus although for a shorter duration and at a lower rate than unvaccinated people.
In Malaysia, it took the government two months to set a date for children to get their shot, delaying the decision due to the unlikely risk of myocarditis and pericarditis – inflammation of the heart – among adolescent recipients.
Although the risk is valid – the Pfizer and Moderna vaccines now carry a warning label for the possible adverse reaction among adolescents after the second dose – medical experts described it as extremely rare, saying the benefits outweigh the risks.
Consultant paediatrician Datuk Dr Musa Mohd Nordin told Bernama via WhatsApp that it was “better late … than never” to vaccinate adolescents.
“(It’s) heartening that JKJAV has (followed) the science and risk-benefit analysis, which is overwhelming for vaccinating the 12- to 17-year-olds,” he said, referring to the Special Committee for Ensuring Access to Covid-19 Vaccine Supply.
Quoting the US Centers for Disease Control and Prevention (CDC) data, he said the risk of heart inflammation in 12- to 17-year-old boys from Covid-19 was 13 times more than the risk of them developing it from the vaccine and 24 times for girls. However, the incidence rate is 67 out of a million second doses for boys and nine out of a million for girls. No deaths have been recorded so far.
Back-to-school shots
However, vaccinating adolescents, whose population is estimated at 2.7 million by the Department of Statistics Malaysia, will take time, and not enough will be able to get their shot before Malaysia reopens schools for face-to-face learning, currently scheduled for Oct 3.
Head of the Independent Covid-19 Vaccination Advisory Committee Prof Datuk Dr Awang Bulgiba Awang Mahmud said there was no need to reopen schools.
“I personally think there isn’t much of the school year left so perhaps it may not even be necessary to reopen schools (this year), except to (use them as vaccination sites to) vaccinate the children,” he said via WhatsApp.
He said every health district office has a school health team experienced in vaccinating children that can be mobilised for this purpose.
A Ministry of Health circular dated Aug 12 listed places schoolchildren are expected to go to for their vaccine. The places include hospitals and public clinics, as well as outreach programmes.
Dr Mas Ayu, who is also a public health medicine specialist at the Department of Social and Preventive Medicine, Universiti Malaya, said current major vaccination sites (PPV) should be included in the list.
“At the current momentum, I think within three months we can reach maybe 50 percent of the schoolchildren,” she said.
She added that the PPV should add a special lane for families to help ease the process as children under 18 required a parent or guardian’s consent for the shot, which would also provide a way to vaccinate the whole household at the same time.
Too much, too soon
Until Malaysia reaches the point where enough adolescents are protected, health experts think it is too soon to ease certain restrictions for fully vaccinated adults, especially parents and others who live or work with children.
Dr Awang Bulgiba said the easing of restrictions should be tailored and targeted at states that are showing positive impacts from the vaccination programme, such as a real reduction in the number and proportion of severe cases.
“Data, therefore, needs to be carefully analysed and factor the impact of easing restrictions into the analysis,” he said.
He also sees the need for Malaysians to temper their expectations of a “normal” life with preparations for a long drawn-out battle with Covid-19.
“The practical thing is to complete our vaccination as soon as we can to achieve some degree of population-level immunity,” he said.
He added that Malaysia should keep monitoring transmission levels within the population and maintain non-pharmaceutical interventions, such as masking and physical distancing, before slowly relaxing restrictions.
Dr Norazah said she would not recommend parents to go out with or without their children until most kids have been vaccinated or until the pandemic is under control.
“I’m not in favour of all these parents going out, and if they really, really have to go out, then please practise all the SOPs (standard operating procedures) to make sure that the ones who are unvaccinated at home are safe,” she said. – Bernama
