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Omicron variant: Children among the most vulnerable

KUALA LUMPUR: Children are one of the most vulnerable groups in the current Covid-19 Omicron wave, especially the unvaccinated.

Experts therefore said besides immunising children, the government should put in place added protective measures and ensure schools strictly comply with the existing standard operating procedures (SOP) to reduce the risk of Covid-19 spreading.

Schools, they said, should encourage students and staff to wear double mask or use KN95 or N95 masks, which provide robust protection against Covid-19; observe one to two metres of physical distancing; and maintain good ventilation in classrooms.

Molecular virologist Dr Vinod Balasubramaniam, a senior lecturer (microbiology) at the Jeffrey Cheah School of Medicine and Health Sciences in Monash University Malaysia said despite having 90 per cent of children from the age group of 12 to 17 vaccinated, a steady surge of cases was expected with the Omicron wave, with education clusters contributing a significant number.

He said the Omicron variant (both BA.1 and BA.2 sub-variants) was capable of evading immune responses mounted by vaccines at a much better rate than the highly pathogenic Delta strain, hence the chances of reinfection in the vaccinated was higher than the previous waves.

"While vaccines offer protection from disease severity and mortality, it alone will not be enough to stop the chain of transmission.

"Public health measures such as masking (with Omicron, at least KN95 or N95), proper hand hygiene, and physical distancing at all times are of utmost importance in combating the Omicron wave," he told the New Straits Times.

According to the ministry's CovidNow portal, the education sector recorded the highest number of active Covid-19 clusters in Malaysia, where of the 314 active clusters, it represents the majority at 182.

Dr Vinod further said recent studies indicated that children infected with the Omicron variant had a 20 per cent higher risk of hospitalisation compared to those with the Delta variant.

In the United States, for example, paediatric Covid-19 admissions rose by 48 per cent in the final week of December 2021 alone with a majority of the children belonging to the unvaccinated or under-vaccinated group, he shared.

He cautioned that young patients were at risk of developing multisystem inflammatory syndrome in children (MIS-C), a serious complication characterised by inflammation in multiple organs such as the heart, lungs and kidneys.

"They are also at risk of developing 'long Covid', or sustained symptoms for up to 12 weeks or more which cannot be explained by any alternative diagnosis.

"One possibility is the infection makes some people's immune systems go into overdrive, attacking not just the virus but their own tissues. That can happen in those who have very strong immune responses.

"The virus itself getting into and damaging our cells might explain some symptoms like brain fog and a loss of smell and taste, while damage to blood vessels, in particular, could lead to heart, lung and brain problems."

Dr Vinod said it was therefore imperative for the Education Ministry and schools to implement added measures.

Among other suggestions, he said schools should ensure three to six-foot distancing and use face masks at all times like KN95 or N95, especially in indoor spaces, including cars and buses.

Additionally, he said keeping students in groups, or cohorts, and limiting contact among cohorts might reduce the potential for widespread transmission.

Dr Vinod said the management of ventilation during transport to school (buses or vans) and in classrooms were crucial, noting that most classrooms were confined or enclosed, which posed the risk of aerosol transmission should someone be infected.

Protective ventilation practices and interventions can reduce the airborne concentrations and reduce the overall viral dose to occupants, he said.

He said spaces, where there was potential for long-duration exposure over several hours within the same group, should have regular breaks, ideally with purge ventilation or airing of the room.

Also, ensure ventilation systems operate properly, open windows, and ensure restroom exhaust fans are functional and operating at full capacity when the building is occupied, he said.

Dr Vinod proposed the use of Carbon Dioxide (CO2) monitoring systems in each classroom to ensure good air quality.

"As virus-carrying aerosols are exhaled, so too is CO2. And when ventilation is poor, CO2 accumulates along with the virus and with this, SARS-CoV-2 infection risk rises along with CO2 concentration indoors, especially when there is no air change.

"For example, countries like Taiwan, Norway and Portugal, have laws that limit indoor CO2 to 1,000 p.p.m. (parts per million).

"Setting clear CO2 limits would help to ensure that ventilation is adequate to reduce infection risk. If the CO2 limit exceeds recommended levels, mitigations for proper ventilation can be done immediately to reduce the risk of aerosol transmission."

He added that it was not feasible in the long run to continue online learning as the previous lockdowns had resulted in extreme psychological burden and stress to school-going children.

Health director-general Tan Sri Dr Noor Hisham Abdullah had earlier said the reasons for the exponential increase of Covid-19 education clusters include failure to adhere to the SOP, and disregarding quarantine rules, where symptomatic people attended classes, crowded spaces were not cleaned and disinfected periodically; and, poor ventilation systems in classes and hostels.

Public health expert and epidemiologist Datuk Dr Zainal Ariffin Omar noted that it was impossible to get "zero cases" in schools and zero complications of Covid cases among schoolchildren. He advised parents and children to take their own precautions in addition to the general SOP.

"Get children (above 5 years) fully immunised (including booster jabs, if necessary), preferably use N95 or K95 masks at all times, avoid crowded areas, frequently wash hands, do self-testing at home at regular or timely intervals."

Dr Zainal also called on the health ministry to make public details of the category of cases (Cat 1 - Cat 5), vaccination type and status, and the vaccination coverage of school clusters by age group.

Epidemiologist Professor Datuk Dr Awang Bulgiba Awang Mahmud of Universiti Malaya said vaccination would reduce the risk of severe disease among children.

However, he said the Omicron variant was more infectious where it was unlikely that transmission protection could be optimal with vaccination alone.

Therefore, he said non-pharmaceutical interventions (NPI) like mask-wearing, physical distancing, and ventilation need to be combined with vaccination to protect children.

"I am not surprised that education clusters are cropping up. This is to be expected when schools reopen and with the Omicron variant spreading.

"What is more important is the severity of the disease in these clusters. If the disease severity is low, then the number of cases is less concerning."

Dr Awang Bulgiba, who is the Science, Technology and Innovation Ministry's Covid-19 Epidemiological Analysis and Strategies Task Force chairman said virus transmission usually occurs when mask-wearing is not possible like eating during recess or during sports, and in hostel dormitories when students are sleeping.

"Although N95/KN95 masks are better at filtration and are better fitting than surgical masks, these are expensive, and it may not be possible to resort to these for large families.

"A cheaper alternative would be double-masking (inner surgical mask covered by an outer reusable and good-fitting cloth mask) as that ensures better fit rather than surgical masks alone."

He noted that short periods of school closure were possible when clusters happened in schools, but continued school closure would not be a sustainable strategy as children's education had been severely disrupted during this pandemic.

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