An expert panel has submitted a plan to bolster India’s preparedness for possible future outbreaks of pediatric Covid-19 although all available evidence indicates that only a small proportion of children require hospital care, a top health official said on Monday.

The plan seeks to strengthen the nationwide capacity to manage pediatric Covid-19, said Vinod Paul, the chair of the national Covid-19 task force and member of Niti Aayog, the Centre’s apex think tank, and a senior paediatrician.

“The latest medical evidence and our national experience suggest that only two to three per cent of Covid-19 infected children require hospital care,” Paul said. “But our preparedness will be for two-fold or 2.5-fold of that level.”

“We’re working systematically, comprehensively to address paediatric Covid disease for now and the future,” Paul said. “We will strengthen facilities, do an audit of what might be required in a worst-case scenario. Steps will be taken and put into action.”

Medical studies from across the world suggest that the vast majority of children infected with Covid-19 develop only minor symptoms such as mild fever or cold or sore throat. But a small proportion might develop pneumonia and require hospital or even critical care.

A tiny proportion of children who have recovered from Covid — even after mild illness — have been observed to develop a serious inflammatory condition marked by high fever, body rash, diarrhoea and vomiting, or bleeding.

The Indian Academy of Paediatrics had last month asserted that children made up only a small proportion of hospitalised cases during the country’s first wave of Covid-19 last year as well as the current wave. “There has never been any extra or unusual burden on our paediatric care infrastructure,” Paul said.

“But we need to keep all future scenarios in mind… the virus can change its behaviour or some other epidemiological dynamics may change,” Paul said. “We’re increasing preparedness through guidelines that will be adopted in a day or two.”

Senior paediatricians not involved in the exercise to create the guidelines said there is need to both disseminate guidance for clinical management of Covid-19 and post-Covid inflammatory syndrome and improve skills and infrastructure in geographic regions with shortages of paediatric specialists.

“Paediatric care, including paediatric nursing, needs special training and some interior parts of the country may not have adequate specialist staff,” said Dhanya Dharmapalan, a paediatrician in Mumbai and member of the IAP’s Covid-19 committee.

Paediatric doses of medicines, for instance, need to be finely calibrated according to a child’s weight, Dharmapalan said. “Even drawing blood from a child for a test requires special care. A plan to improve the paediatric infrastructure would be welcome.”

While the number of Covid-infected children needing hospital care has been higher during the second wave than during the first wave, doctors attribute this to the much larger epidemic in the second wave compared with the first.

“When overall numbers rise three-fold, so would the absolute number of children,” Dharmapalan said. “But we have not so far observed any increase in the proportion of the children falling seriously ill.”