New Delhi: Experts are divided over decisions in Indore and Delhi to include children in the serological surveys for better understanding of the Covid-19 spread.
Indore started its sero survey sample collection on 11 August, and according to the guidelines mentioned by the authorities in Madhya Pradesh, a sample size of 33 per cent will be that of children aged between 1-18.
In Delhi, directions for the second sero survey that was conducted between 1 and 7 August had called for 25 per cent of the samples to be from those of the 1-18 age group.
Authorities in Indore insist that their survey is in line with the Indian Council for Medical Research (ICMR) guidelines.
“Including children in the survey is a part of the guidelines issued by the ICMR. Additionally, we do desire a truly randomised data set,” Jyoti Bindal, the dean of the Mahatma Gandhi Medical College in Indore, who is heading the survey, told thePrint.
ICMR’s only nationwide serological survey, however, only covered adults.
But experts ThePrint spoke to raised questions on whether children, the demographic least vulnerable to the virus, should be a part of this survey at all. Experts also said that even if they do happen to contract the coronavirus, they may be asymptomatic or mildly symptomatic.
While some public health experts debated the ethical dilemma of drawing blood samples from minors, others said the sero surveys including children will not only help understand the spread of the disease but will also help determine whether schools can be reopened.
Giridhar R. Babu, professor and head, lifecourse epidemiology, at the Public Health Foundation of India, a government-private collaboration said it is important to conduct sero surveillance in all age groups, especially in children.
“We need to understand what is the level of their immunity and whether it is safe to open schools as of yet. Only when you do a survey across age groups will you be in a better position to make a decision,” he added.
“I don’t think it is safe to open schools yet because we still don’t know how children are going to get affected,” he said. “It is not just a matter of children becoming super-spreaders; the other problem that plagues the children of our country is that one in three children in our country is malnourished and so their immunity levels are not robust enough to handle the virus.”
He, however, flagged the ethical concerns.
“The only problem that arises here is drawing blood from children,” he said. “It is an ethically difficult thing to do, before drawing the blood of a minor you need their permission and the parents’ permission. But scientifically it can provide important information.”
K. Srinath Reddy, president of the Public Health Foundation of India (PHFI), elaborating on the ethical dilemma of the practice, said, “There are theoretical conservations on why it should be done and practical conservations on why it should not be done. The theoretical implications are that you want to do a truly randomised sample, this can be defended by saying that although schools have been shut children have been mixing with other people and may have been likely been exposed to the virus. They may have also been infected and spread the disease.”
He explained this point by saying that so far it has been found that adults are more vulnerable to this disease and even when children contract the coronavirus they are likely to be asymptomatic.
He also explained the nature of the survey.
“This is only a surveillance study meant for research purposes. If it indicates an infection level of 10-15 per cent it may not mean that a herd immunity has been developed, it could be a simple case of T cells being activated in the population,” he said.
“So the question is what are we doing it for and the other thing is there is a possibility of there being a large number of false positives due to the other coronaviruses and they get amplified in asymptomatic cases.”
He added that such surveys help get a population profile and not individual profiles so cannot be used as an immunity passport.
Dr Rajib Dasgupta, chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, said it is too early to comment on such surveys until the time the final reports are published.
Although, he added, there are some key issues that need to be kept in mind when these surveys are being conducted: “What is the assumed prevalence rate based on which the sample size has been decided, the other is the issue of ‘where’. As we have seen so far older parts of cities, which are more congested have seen a faster spread than the more planned parts of the city.”