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Health & Wellness

Bone of no contention

With the drop in temperature, some people experience ache
or discomfort in their joints and bones. Doctors suggest ways
to relieve it and prevent its occurrence to some extent.

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Staying warm is important as temperature is dripping with every passing day, so is taking care of your health to ward off common diseases during this season: Flu, common cold, fever, tonsil, eczema, joint pain and cold sores among others. Various studies show that viruses tend to multiply faster in wintertime which can make people fall ill. Thus, it’s wise to stay extra vigilant about your well-being.

 Most often, the elderly experience acute pain in bones and joints during winters though young people complain of lower back pain at times. Dr Nitiraj Oberoi, director Orthopedics / Bone and Joint Surgery at Fortis Escorts Bone and Joint Institute, Delhi agrees, “Some of us are likely to suffer from common aches and pains, especially pain in lower back and joints as winter sets in. The elderly are more prone to have stiffness in the large joints of the lower limb and sometimes the fingers. Young active people can experience early morning lower back pain.” Adding to it, Dr Chandrashekhar Dixit, consultant- Orthopedic and Joint Replacement at Jupiter Hospital, Pune says, “Knee and hip pain are the most common complaints, joint pain can affect any part of your body be it from your ankles to your shoulders or hands. It can range from mildly irritating to excruciating pain and can last for a few weeks.”

 If you experience any unusual or new symptoms including persistent swelling and redness consult your orthopedic specialist, advises Dr Dixit. “The onset of winters sees flaring up of the bone pain and joint discomfort in people with preexisting arthritis and osteoporosis. Staying indoors decreases the activity levels and inadequate amount of sunlight exposure adds to it, culminating in joint stiffness and decreased amounts of Vitamin D production,” says Dr Ramneek Mahajan, senior director, Orthopedics & Joint Replacement at Max Super Speciality Hospital, Saket, Delhi. But what causes pain in bones and joints or makes the existing condition sever. “Though it may not be the temperature directly, several factors make winters more difficult for people with joint pain. 

The threshold of pain resistance lowers in winters as with the drop in air pressure, nerve endings in our body become more sensitive and tissues swell. Even a minor injury or minor stiffening of muscles can cause intense pain even in people who did not have any joint issues previously. Colder temperature also affects the blood circulation patterns that can aggravate joint pain and stiffness,” emphasises Dr Ashutosh Jha, consultant, Orthopaedics at Columbia Asia Hospital, Ghaziabad. Ample physical activities, exercise and a proper diet can lead to strong bones and joints.

 Dr Mahajan says, “Exercise, even if indoors, to keep those joints supple and muscles well perfused. Increase the intake of milk products, green leafy vegetables, eggs and cod liver oil. Always consult a doctor before starting supplementation.” 

Dr Jha adds, “Limit outdoor exposure and wear warm clothes, ensure sound sleep and right posture—sleeping on your stomach may stress the low back and spine, so sleep on either of your sides, take a hot shower to promote blood circulation and release muscle spasms, drink at least two to three litres of water daily to stay hydrated and flush the toxins from your system.” 

To maintain bone and joint health, Dr Kiran Reddy Mekala, senior consultant – Orthopaedic at Apollo TeleHealth suggests: a) Physical exercise for at least 20 minutes regularly. It can be walking, cycling, treadmill or jogging. b) Hot water bath and hot fomentation is advised. c) Yoga practice helps maintain the flexibility of joints. d) Exposure to sunlight between 8 a.m. to 11 a.m. She adds that the middle-aged and old aged people should avoid cross-legged sitting, brisk walking, running, stair climbing and walking down or top the hill.

 Ways to keep bones and joints stronger naturally Healthy

 bones are the pillars of overall good health. Therefore it is essential to take good care of your bones from the right age since you achieve maximum bone mass in your 30s. If your bone mass is low by the time you reach your 30s, chances are you’ll face bone loss later in life, says Dr G. Prakash, Deputy Chief Medical Officer at Jindal Naturecure Institute, Bengaluru. Bones can be strengthened naturally in different ways.

 Dr Prakash asserts that one of the most critical factors that determine good bone health is how much vegetables you include in your diet. Rich in Vitamin C, vegetables promote the production of bone-forming cells. Also, the antioxidant properties of Vitamin C restrict any damage to the bone cells. The absorption and processing of Vitamin C in the body occur with the help of Vitamin D which is why you need to get plenty of sunlight and consume foods rich in Vitamin D. Other than that, he suggests improving the protein intake since protein improves the strength of your bones. 

Your diet should include rich sources of protein like lentils, legumes, dairy products, eggs, nuts, and seeds. “Maintain the required amount of magnesium and zinc in the body as magnesium activates Vitamin D to absorb calcium. Zinc plays a crucial role in mineralisation and bone metabolism. Besides focusing on your diet, you should focus on maintaining a good lifestyle and indulge in a proper exercise routine,” concludes Dr Prakash.

Tips to maintain healthy bones and joint

1. Exercise works best to maintain good bone health as it maintains bone density and is preventive against osteoporosis. The advantage of exercise during peak winters is that the soreness or stiffness of the joints is kept in check due to adequate blood supply which counters the effects of vasoconstriction. Exercise works even better for the elderly as their joints get better coordinated and this prevents falls.

 2. Eating citrus fruits like oranges, amla, etc, in any form helps the body to build adequate stores for good bone, joint and skin health. A balanced diet is a key to overall healthy living.

 3. People who are overweight have higher chances of getting arthritis. Maintain your weight to keep the knees healthy. As knees handle the weight of full-body they need to be strong and flexible. 

4. Warm water shower relieves the stiffness in joints and also gives relief from arthritis pain. Warm water bath also makes you feel better by reducing stress.

 5. Bone mineral density may reduce if you take excessive amount of tobacco and alcohol, therefore consumption of tobacco and alcohol should be minimised.

 P.S: People who are above 50 years should get a regular test done for bone mineral density. This will help in determining the number of minerals one has in their bones.

Common mistakes one must avoid

1. High heels put extra stress on your knees so avoid anything that’s bigger than one and a half inches. 

2. You should use your strongest, largest joints and muscles; when you lift or carry items, use your palms or arms instead of fingers. Also, hold the weight close to your body to cut down stress. 

3. Improper stretching techniques, always do dynamic stretches.

 4. During winters, people stop exercising, hence, cutting down on this activity only leads to decreased range of motion and more joint pain. 

5. Wearing ill-fitting shoes and clothes while exercising may hamper the joints. Therefore, wear proper shoes to ensure it provides shock absorption and stability. Also, good hydration helps reduce injury.

 Dr Nitiraj Oberoi, director Orthopedics/Bone and Joint Surgery at Fortis Escorts Bone and Joint Institute, Delhi

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Health & Wellness

SKINCARE ROUTINE: WHEN LESS IS MORE

Dr Aparna Santhanam

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Are you the type who wakes up every morning, worried and wanting to do so much for your skin? Do you have guilt pangs gnawing away at you every time you look in the mirror? For most of us, life begins and ends with planning our skincare routine, adding and eliminating products in our cart till the sun stops shining.

Fret not, your skincare regime doesn’t have to be an impassable labyrinth, it can be simplified to make it more manageable and consistent. Here’s a step by step guide to making your life easy.

• Get Organised – To begin with, make a list of skincare problems you actually have, for example, you have acne or pigmentation or dark spots or just plain dry skin. It’s important to understand your skin and how it behaves. Look for products with Vitamin C in them, which is a super ingredient to remove your spots, dullness and any uneven skin tone.

• Know your skin type – It is very important to understand your skin type to invest in the right product. How do you determine that? Very simple, just notice how your skin feels right when you wake up. If you have oily skin, it is recommended to stick to light hydrating products which are non-sticky like Serums. People with acne-prone skin, are recommended to use products with Salicylic Acid. For dry skin concerns, Hyaluronic Acid will save the day!

• Choose Hero Products – Eliminate products that serve only one purpose, instead invest in all-rounders, for example, replace moisturiser with serum. A serum is an all-rounder that can easily cater to your skin’s need for hydration while priming it and leaving it with a soft dewy finish. The product formulation of serum has smaller molecules that work together to penetrate the skin to a degree that facial creams or moisturisers don’t. Choose products with potent ingredients such as Vitamin C, Hyaluronic Acid and Salicylic Acid.

• Budget – It’s important to plan and create financial demarcations so you don’t let your skincare budget eat into other important components of your living and lifestyle. Apart from choosing products that multi-task, look for maximum value at minimum price.

• Stay Positive & Hydrate – Whoever said beauty is only skin deep was referring to staying connected with our intrinsic goodness and richness of character. While it’s important to take care of what we put on our skin, it’s equally important to feed our mind with the right ingredients.

Skincare routine planning is often perceived to be a daunting task, that is why it’s important to have a fair assessment of one’s requirements. The first step towards getting a good skincare routine is to make an effort to understand the ingredients, decide your budget, and most importantly choose well-researched hero products. I recommend going for products that are all-rounders. For example, a serum is a multi-purpose product that can easily eliminate the need for a hydrator or moisturiser, is more efficacious and budget-friendly. Besides this, make sure to stay hydrated and positive, your inner radiance invariably reflects on your face.

The writer is Skin Expert, ITC Charmis.

Skincare routine planning is often perceived to be a daunting task, that is why it’s important to have a fair assessment of one’s requirements. The first step towards getting a good skincare routine is to make an effort to understand the ingredients, decide your budget, and most importantly choose well-researched hero products.

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Health & Wellness

HOW YOGA CAN HELP WITH OXYGEN SATURATION

Sarvesh Shashi

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YOGA & MEDITATION FOR THE STRESSED MIND

Good health is one of the greatest resources for creativity and peace of mind. In today’s day and age, health is not a static state; it is dynamic ever-changing. The unprecedented pandemic we are dealing with today has brought about newer challenges for health which we are continually fighting. Good health results from a perfect diet, suitable physical activity and a mind, which is calm. One of the biggest challenges today is the dropping oxygen levels for those who suffer from Covid. As a Covid survivor, I can say that my oxygen levels did not drop below 99 and I owe that to Yoga along with daily breathing exercises.

Oxygen is very essential for life. Due to a cardiac or a respiratory disorder, some of us are not able to get sufficient oxygen for our body cells. By proper yogic practices, this could be brought under control.

Yoga is unlike any other exercise. It is a detailed science and to understand it, it is important to know why we do what we do.

Effect Of Asanas In Improving Oxygen Saturation

Standing Asanas – The dorsal spine which supports the lungs is well aligned in standing poses. Elasticity is given to the anterior and posterior intercostal muscles and the lungs open out so that oxygenation is the better and vital capacity of the lungs does not reduce. The directions of the movement are so varied that all parts of the lungs are toned up. The cells of the lungs are kept soft and supple. The energy levels of the body are kept up. Better blood circulation is attained in the thoracic organs.

Inverted Asanas – Due to better circulation, more pulmonary veins and capillaries open up. This ensures cellular longevity. The rhythmic pressure of the lung movement exercises the entire respiratory tree and cells of the lungs. This happens without a rise in oxygen consumption. This is a peculiar feature of yogic exercises. The vital capacity of the lungs improves by regular practice. The capacity to withstand altitudes is derived from inverted poses. When practised at high altitudes, the lungs are warmed up immediately.

Back Bending Asanas – Though the decline in lung capacity is accepted as part of the normal ageing process, Yoga offers a solution. The vital capacity of the lungs can be kept up by back bending asanas that maintain the elasticity of respiratory muscles and the oxygen-carrying capacity of the lungs is unaffected.

Effect Of Pranayama In Oxygen Saturation

Pranayama is often erroneously called only deep breathing. In pranayama, the actions are so unhurried that there is adequate time for every alveoli to take in oxygen. The drawn in energy is also not allowed to forcefully exit from the system. That is the reason why exhalation is very slow. This gives time for the system to continue to absorb energy even during the exhalation phase.

The lung muscles accommodate more inflow oxygen and blood. The haemoglobin/oxygen saturation is enhanced during kumbhaka (retention of the breath) as there is enough time for saturation as the inspired breath is not let out. The inspiratory volume and expiratory volume are made healthy. The vital capacity increases.

Regular Yoga practice can have the following benefits:

• Easy breathing

• Better blood circulation and effective oxygenation.

• Better performance of the respiratory system.

• Lungs become strong

The writer is the Founder of SARVA.

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Health & Wellness

COMBATING COVID WITH SYSTEMS THINKING

Instead of blaming governments, it is time for all stakeholders to adopt systems thinking in managing the possible third wave of the coronavirus pandemic.

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The first wave of Covid-19 last year had caught India unprepared and the lockdown provided an extended period in which they could try to ramp up the health infrastructure in the country. With the deadly second wave of Covid-19 hitting the country unexpectedly, it exposed the inadequate preparedness and the absence of the systems thinking approach to combat a highly infectious disease that took a heavy toll on lives. 

The Covid-19 pandemic is a dynamic problem and there is no real or absolute solution. In this fast-changing environment, every day people come across new interpretations, multiple variants of truth, misinformation, and rumours. It is far too aggressive for any existing healthcare system, anywhere in the world, to tackle the crisis with a predetermined or existing model of treatment. Instead of blaming the governments, it is an important time for all stakeholders to adopt systems thinking in managing the second or future waves of Covid-19. 

With regards to Covid-19, what is currently happening in India is not only the country’s problem alone. The United Kingdom, United States, Europe, and Brazil also faced tough times in 2020, but their problems and pains were realised by the entire world. It’s now India’s turn to fight the pandemic head-on. 

If what affected the world in 2020 can be termed as CoV-1 then India is undergoing a deadly CoV-2 crisis. It appears that the country would be fully occupied with its implications and impact in 2021 because this variant is evasive and more infectious, thus causing the disease to transmit faster. Moreover, this variant is infecting both young and children resulting in more loss of life. And, it doesn’t respect “herd immunity” either. Back in January 2021, Delhi had declared that they were close to reaching herd immunity, with over 50% of its population having CoV-1 antibodies (Welle, 2021). But now, it is one of the most affected cities in India. 

India is learning its lessons fast through the experiences documented in other countries. Some systemic problems do need to be addressed with systems thinking which will require a major shift in mindset, away from linear to circular. Ultimately, the core principle of this shift is that everything is interconnected.

For the response and management of a complex and severe pandemic, like Covid-19, decision-makers need to navigate with an approach to problem-solving that considers each issue as part of a wider and dynamic system. Therefore, India needs to involve much more than a reaction to present outcomes. They need to look into a deeper understanding of the linkages, relationships, interactions, and behaviours among the elements that characterise this dynamic situation and system. 

As more and more people become infected, the number of frontline healthcare workers will most likely drop due to the overwhelming exposure to Covid-19. This drop would be a result of workers needing to be quarantined or isolated for a certain period. “Reports from affected countries have revealed in the past that 22% of health care workers were affected in hospitals across Hong Kong, with the initial wave managing to infect 80% of the staff working in the medical wards of Prince Wales Hospital. This is just one example of the magnitude with which this virus has taken a toll on the health workforce” (Nagesh, S., & Chakraborty, S., 2020). 

Furthermore, this thinking is not just a healthcare problem. It is a bigger psychological and fear-psychosis problem whereas the moment one is tested positive, he or she panics and feels like they need to be admitted directly to the hospital. It is empirically evident now that with the support of the Covid Care Program run by health-tech service providers such as DayToDay Health India (DTDHI), the majority of patients with mild and moderate severity can be efficiently managed while recovering at home. Over 60% of the hospital beds are currently occupied by Covid patients in India, who are both suspect and positive, as per The New Indian Express, 2020 news report. Moreover, these types of services also address their families’ stress and anxiety by creating a means of holistic management of the patient’s entire care journey while they are sick. 

Dealing with a dynamic Covid crisis requires systems thinking, not knee-jerk point solutions. Systems that get implemented during a crisis, are not supposed to be designed in a non-fluid way because of how quickly things change. And, blaming governments is of no use because we are all in this together. The government is in a position where they need to maintain a balance between an economic shutdown and tackling the virus spread as a whole. Even if the decision-makers adopt systems thinking approach, responsible citizens should join the fight against the Covid in the right spirit. We all need to combat the crisis as an individual, family, society, or nation and simply do our part in preventing the spread. 

If India adopts systems thinking in its healthcare delivery, it would certainly transform the way Covid is being managed currently. At DTDHI, we believe that tech-enabled human-driven solutions would not only strengthen the country’s fight against the pandemic but also result in proactive and efficient population health management. 

The writer is Founder & CEO, DayToDay Health India (DTDHI). 

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Health & Wellness

MUSIC AND MEDITATION: THE MANTRA FOR MODERATION

Shivali Bhammer

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She sat in a room by herself, the door had been locked for days, months perhaps but she was unaware. Her Ektaar sat in her lap, her eyes half-closed with a soft smile laced upon her face. Her name was MeeraBai — the Princess who found enlightenment through music.

Music has always been a way to communicate with the higher power and evokes feelings of emotion and healing with one another. The reason why I decided to be a bhajan singer is that music has the power to influence your mood and unleash your emotions. Devotional music of any kind, in any faith, allows you to silently surrender through sound. It also provides you with a vessel to carry the emotions that are burdensome on your shoulder, and through the musical notes and various intonations, you find yourself emptying that vessel of your mind into the ocean. That grace and surrender music naturally gives you without the need for conscious prayer is what can alleviate the pain and stress we feel. Anyone can think of a time of difficulty they have gone through and recall the album that gave them some solace.

Hindu monks have always been very particular about the way mantras are chanted because of the power they contain. There are rules as to how you chant, where your tongue hits when you say a certain word, when you should take a breath and ensuring you maintain a certain rhythm and timing. Although you might find this rather onerous, it had a scientific purpose. Controlling these factors enables a certain kind of physical and mental change within you and could also be used to govern the circumstances around you. Although, we may not chant mantras in the same way anymore or with such detailed precision, just listening to them is very beneficial. The mantra is like a key that is used to unlock your chakras, break negative thought patterns, clear karma and raise not only your vibration but the vibrations of the room you dwell in. Hence why certain rooms feel so peaceful whereas others might leave you feeling tired or restless.

Music is also playful and soothing because a melody is similar to the natural flow of a stream. It doesn’t require any conscious study, thought, or energy. It simply allows you to trace and follow it and that creative movement frees you from the things that have us stuck and troubled. Music lives loftily above an ego infused world. You’ll find someone in East Asia feeling the same way about a song as someone else on the other side of the world. Or you can go to a classical concert, and regardless of an individual’s background, they find themselves identifying with the music. This brings you closer to spirituality because it is breaking boundaries and barriers that we have formed within ourselves. And if the point of spirituality is to feel oneness then music enables that. 

We associate music with love; first wedding dances, lullabies for our children, singing at the top of our lungs with friends at a concert, or even crying over a heartbreak to a song on the radio in the car. Music; to me, has always been about love, and meditation is about creating space to love and understand your real self. When you marry the two together, the emotional intensity of music allows you to dive deeper within yourself. 

There is no ‘right’ or ‘wrong’ type of music, it is a personal connection between you and sound. Sound is energy and that energy is transferred to you, therefore you decide how you wish to receive it. Whenever your mind is running in a hundred directions and you feel distracted, take a moment and listen to something that is produced specifically for you to tap into the higher (listening to a song about being jealous for example won’t be very conducive!). Breath slowly, close your eyes and allow yourself to let everything go. For all the things you don’t dare to say or release, the music will do it for you. Remember a song is temporary, so is this moment and our problems, let it seep out of you through the sound. And like MeeraBai, you will find yourself moving upwards, beyond the material and superficial ropes that have you pegged down. Your heart, as it heals, as all hearts require, will be flooded with love. Those around you will trace the sweetness of the melody by the curve of your smile and the light in your eyes. Music, coupled with your devotion and discipline, will have set you free. 

The writer is a Spiritual Urban Yogi and Indie Devotional Singer.

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Health & Wellness

PANDEMIC GRIEF: WAYS TO HELP COPE WITH THE LOSS

Samira Gupta

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There is no perfect way to cope with grief and loss but there are healthy ways to release these emotions from your mind and body.  When we experience any form of loss, grief is the first emotion that sinks into our heart. Grief can be overwhelming as it encourages other emotions such as anger, disbelief, guilt, shock, pain, or sadness to take control. 

Spiralled in these negative emotions, not only our mental health goes for a toss but also our physical health. Some may experience insomnia, increased level of anxiety, fatigue, nausea, eating disorders or over-thinking.Also, coping with the news surrounding the pandemic is challenging.

Here are fe tips on how to cope with grief:

Face the fear: While most people suggest time will heal the pain unless you face the fear and resolve it from the root, it will surface again and again. Ignoring the pain now can be harmful in the longer run. 

Release your emotions: It is vital to release the negative emotions from your body. To release these emotions, some may cry, yell, write it down in a diary or spend time alone. Expressing your emotions does not make you weak. Rather, it makes you an emotionally mature individual. 

Move on: There is a difference between moving on and forgetting about it. Every incident will remain in your memory forever and form a major part of who you will become in the future. However, when you decide to move on, you still retain those memories in your heart but do not allow them to restrict your growth. In simple words, you take charge of your life. 

Seek help: Asking for help is also a sign of strength. Never hesitate in reaching out to people to seek help. Talking to someone who truly cares about you, helps you healthily release your emotions.

Recurring emotions: The pandemic has been a tough time for all of us. Some have lost dear ones, relatives, friends or colleagues. It can be hard to deal with grief in these times. Don’t be afraid if these emotions keep recurring. Instead, reach out to coaches who can help you get rid of them.

Support your mental well-being: The best way to support yourself mentally is to take care of your physical health. From maintaining a healthy diet to maintaining a healthy routine, it will work out in your favour. A healthy body helps heal the heart.

Fill your emotional cup: Your grief is personal to you. Acknowledge and accept that it is okay to feel sad or cry. Involve yourself in activities that help you feel lighter. Write a letter, listen to music or repeat positive affirmations – the aim is to feel happier.

Be empathetic with yourself: Blaming yourself or being too hard on yourself will only make the pain seep deeper into your heart. Instead, acknowledge your efforts and learn from your mistakes. Give yourself time and space to heal from the grief. 

Trust and faith: No matter what happens, the first and foremost thing is to retain your trust in yourself and faith in the universe. When you trust yourself, your brain starts to release signals to your heart – ‘Everything will be okay’. This mindset shift will bring a major shift in your life. 

If you know someone who has recently suffered a loss, support them. A genuine & compassionate conversation can help people cope with difficult times faster. Being in physical isolation does not have to mean emotional isolation as well. Stay connected to your loved ones through video calls, texts and prayers. 

The writer is a renowned life coach, consultant, speaker, and author.

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Health & Wellness

HOW TO TAKE CARE OF COVID-POSITIVE CHILDREN

Doctors simplify the clinical guidelines around Covid management in children by the Union Health Ministry and tell us how certain therapies help in the treatment of kids with severe corona illness.

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The Union Health Ministry recently issued certain guidelines to manage Covid-19 in children. This comes amid speculations that children can be a possible target of the third wave of Covid. The Ministry, in the guidelines, has said that Remdesivir is not recommended for children, and steroids should be used to treat only moderately severe and critically ill Covid positive children.In the recommendations, the government has stressed the use of a six-minute walk test on children above 12 and oxygen therapy as well as the Corticosteroids therapy in cases of children with severe Covid-19. Let’s understand what the terms in the guidelines mean and how they are going to be beneficial in treating Covid positive children.

Talking about Covid-19 in children, Dr Sarthak Chakravarty, General Physician, Dr Sarthak’s Clinic, New Delhi says, “Usually, children from 2 yrs to 12 yrs of age do not show many symptoms with regards to Covid-19 infection. Children with Covid may be an asymptomatic, mildly symptomatic, moderately sick or severe illness. Asymptomatic children are usually identified while screening if family members are identified. Such children do not require any treatment except monitoring for the development of symptoms and subsequent treatment according to assessed severity.”

“Children with mild Covid may present with sore throat, rhinorrhea, and cough with no breathing difficulty. Few children may have gastrointestinal symptoms also. Such children do not need any investigations. In such mild and moderate cases where children may display a slight fever or cough that may not last for more than two to three days, only symptomatic treatment and home remedies are required. For fever, give paracetamol syrup as required (can be given every five to six hours), for cold and cough give cough syrups two to three times a day,” adds Dr Sarthak.

Guidelines stipulated by the Government of India on the management of Covid-19 in children for the third wave are synonymous with the guidelines formulated by local bodies (Karnataka IAP chapter) and national bodies (central IAP) since the pandemic started which encompasses the role of radiology in the diagnosis of RT PCR negative Covid, says Dr Srikanta J T, Consultant, Paediatric Pulmonology, Aster RV Hospital, Bengaluru. 

“Fortunately, till now, less than 1 % of the children affected have had severe covid disease. Typically, children with the severe covid disease have background medical conditions and develop breathing difficulty with low oxygen levels. Treatment will warrant hospital admission with HDU/ICU facility. The mainstay of treatment is supportive care with oxygen, ventilation, fluid management, and timely judicious use of steroids,” shares Dr Sanjeeva Reddy, Consultant Paediatrics, PICU, and Neonatology, Manipal Hospitals Whitefield, Bengaluru when asked about his advice on treating children with severe Covid-19.               

Why is Remdesivir not being recommended for children with severe Covid-19? Dr Sarthak replies, “Remdesivir Injection is a broad-spectrum antiviral medicine. It is used for the treatment of suspected or laboratory-confirmed Covid-19 in adults hospitalised with severe disease. The medicine decreases the viral load in the body and speeds up the recovery process. It works by inhibiting an RNA-dependent enzyme called RNA polymerase that helps the SARS-CoV-2 virus make more copies of itself. It is given as an injection into veins under the supervision of a doctor. You should take this medicine only at the prescription of your doctor. Take it only as per the dose and duration suggested by your doctor. You should not self-medicate this medicine.”

Talking about the side effects of this medicine, he says, “Anaemia, fever, acute kidney injury, increased blood glucose, and increased transaminases are some of the most common side effects of Remdesivir. If you experience any allergic reactions after taking the medicine or if any of the side effects bother you, you should let your doctor know. Since the side-effects are life-threatening and medicine is very strong it is not at present being recommended in children.”

Dr Sarthak warns that at the age of development, such side effects can cause a lot of damage to the body. There is no FDA/ICMR/WHO recommended safer alternatives at present for children. But viral diseases usually last for a few days in children and tend to disappear after completing their course. Symptomatic treatment helps in any viral disease — whether Dengue, Chickenpox, or Covid-19.

Why the government has advised doctors to be selective in prescribing high-resolution CT scan to children? What can be its adverse effects? Dr Srikanta explains, “As compared to adults in whom CT thorax is used to both diagnose and triage patients in Covid management, it cannot be applied to children as appropriately 95% of them have either asymptomatic or mild symptoms that do not require even a simple chest Xray. Even in those who present with moderate to severe Covid, unless we are looking at disease progression or complication, doing a CT doesn’t value add to already existing evidence for treatment. So, all the guidelines in both resource-rich settings like in Delhi, Bengaluru, where all investigations are at our disposal, we still don’t do even a CXR for 95% of children. In resource-poor settings like villages where RT PCR isn’t available or likely to get delayed, there we can ask for CXR followed by CT thorax for triaging purposes only depending on symptoms.”

He informs that the other concern is radiation. However, with the current technology of ALARA (As low as reasonably achievable) the dose to take an HRCT is very small. But again, with clear guidelines about when and where to use one makes the use of these modalities that much more ethical.

At what point is the oxygen therapy initiated and why the fluid and electrolyte balance should be maintained? Dr Sanjeeva replies, Normal children maintain oxygen levels of over 94% while breathing atmospheric air. Supplemental oxygen becomes necessary when the levels drop to less than 92% consistently. Adequate fluid intake is necessary to distribute oxygen and other nutrients to body tissues and maintain energy levels. However, too much fluid especially through the intravenous route can lead to accumulation in the lungs due to their sponge-like nature and make the already difficult breathing worse. Proper balance is essential.”

During the Covid-19 pandemic, there have been discussions around diagnosis, investigations, treatment, and complications. Dr Abdul Bashir Khan, Senior Consultant, Pediatrician, Masina Hospital, Mumbai highlights two bedside ways to monitor lung functions that can be done at home, “Checking the oxygen levels of blood and heart rate with a pulse oximeter. Even more important is to see this same level after a six-minute walk. The walk should be at a normal pace inside the house and any drop in saturation recorded at this time is the first sign of lung function compromise. This is the time when the CT scan can be advised. It is a simple test to be done two to three times a day. Normal oxygen saturation on pulse-oximeter in a human being is always above 95% at rest and should be above 95% even after a walk for six minutes at a normal pace.”

Talking further about the six-minute walk test, Dr Abdul adds, “It is a very early predictor of detecting any changes in pulmonary parenchyma (Pneumonia). All adults and children above 12 yrs suffering from Covid can be told to perform this test.” 

DOS & DON’TS 

 1. Isolate children when the elders in the family turn Covid positive. 

2. If children show any symptoms do not give any medicine without consulting a paediatrician. In case there is no symptom present then only give multivitamin/zinc syrup and vitamin C chewable tablets once daily. 

3. Keep children hydrated and give plenty of water and protein-rich food. 

4. Do not give steroids unless prescribed by a paediatrician

—By Dr Sarthak Chakravarty, General Physician, New Delhi

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