How does Covid-19 affect children and how can we keep them safe?

As Covid-19 immunization coverage is increasing among older groups, an increasing proportion of cases will occur in children.

Children under 12 cannot yet be vaccinated in New Zealand – Medsafe assesses application for use The Pfizer vaccine for 5-11 year olds, and doses may be available by the end of January.

From Friday, children under 9 years old can make up 19 percent of cases of the New Zealand Delta epidemic – 1,723 cases. Another 1,516 cases (17%) were between 10 and 19 years old.

So what do we know about Covid-19 in children, and how concerned should we be about infection in this age group as cases continue to spread across the country?

READ MORE:
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* Global Studies Long Covid and ‘Needlessly Worrisome’ Children, Researchers Say
* Covid-19: Pfizer-BioNTech vaccine approved by the US FDA for children aged 5 to 11
* People under 12 are increasingly catching Covid-19. How sick do they get and when can we get them vaccinated?

What is the impact of Covid-19 on children?

Auckland-based developmental pediatrician Dr Jin Russell said that when children are infected with Covid-19, they usually suffer from mild or asymptomatic illness, similar to a cold. Many won’t even know they have it.

The acute risk to a child’s health is similar to that of other common viruses, she said.

In September, the Murdoch Children’s Research Institute in Australia, said Covid-19 disease in children and adolescents is “rarely severe”, and very rarely causes death.

Typical symptoms include fever, cough, sore throat, stuffy or runny nose, sneezing, muscle pain, and fatigue. Changes in smell or taste, diarrhea and vomiting are less common.

However, there are risks at the population level.

If you have a lot of community transmission you can expect a lot of children to get infected because they cannot be vaccinated yet (health service user data shows that there are 791,434 children under 12 in New Zealand).

Even if the majority have mild or asymptomatic illness, there will be “rare” cases where children become seriously ill, Russell said.

What about serious illnesses and hospitalization?

Thirty-seven Kiwi children between 0 and 9 were hospitalized with Covid-19 (2% of cases in this age group).

Fourteen young people between 10 and 19 years old were hospitalized.

Nowadays, no children children under 9 need intensive care assistance.

In Australia, around 1 to 2% of children with Covid-19 present to hospital, Russell said.

Hospital admissions are often mild, brief, or preventive, involving fluids for hydration or observation – and often not as severe as in adults.

However, children living with pre-existing health conditions, disadvantage, low socioeconomic or ethnic minority status – such as Maori and Pasifika children – are at higher risk of contracting serious illness from Covid-19.

There is also a rare but potentially serious complication of Covid-19 – multisystem inflammatory syndrome in children (MIS-C) – which may require intensive care assistance or even be fatal. MIS-C is treatable and most children make a full recovery, Johns Hopkins Medical Reports.

Childhood Covid-19 deaths are “extremely rare,” Russell said.

In November, the CDC reported that between October 2020-2021, 66 children aged 5 to 11 died from Covid-19 in the United States.

This figure was high enough to be among the top 10 causes of death in this age group, but still lower than the number of children. who died of the flu over a similar period in 2019.

And the long Covid?

There is new evidence that some children take longer to recover from Covid than others, and symptoms can persist for several weeks.

A large study in children aged 5 to 17 with mild Covid from the UK found that out of 1,734 children, 4.4% reported persistent symptoms 28 days after the onset of their illness.

It found that 1.8 percent of the children had symptoms by day 56 – mostly headaches, fatigue, and loss of smell.

Preliminary results of another study (CLoCK, led by Public Health England) found up to one in seven children and youth (14%) who may have symptoms 15 weeks later.

However, a recent systematic review of 14 long-term Covid studies in children found that almost all had “major limitations” – including a lack of a clear case definition, inclusion of children without confirmation of infection, and low response rates.

Why is it important to keep transmission low to protect children?

University of Otago (Wellington) epidemiologist Dr Amanda Kvalsvig has said that a highly infectious disease like Covid will reach “almost all children sooner or later”.

“Even though only a small percentage of these children experience poor outcomes, a small percentage of a very large number (an entire population) translates into a significant number of children with rare outcomes that are life changing or even limiting. their life.

“We can and must do better. “

Kvalsvig gift polio for example. For almost all children, polio is a very mild and problem-free infection – only a “tiny” percentage will develop paralysis.

But like Covid, it is highly infectious, and when it is endemic you can have very serious consequences – this demographic burden is the main motivation for universal polio vaccination, she said.

We also do not yet know what the effects of the “course of life” of Covid-19 could be: “It makes sense with a new pathogen to use the precautionary principle and to say that we do not want this new virus infects everyone. of our children, at least until we know a little more about it.

Russell said it is important to balance the fact that the majority of children who contract Covid will not suffer from serious illness with the fact that “we don’t want to expose children to this in large numbers.”

Evidence Abroad Shows Children Do Not Transmit Covid-19 As Easily As Adults in the school. However, children transmit “clearly” to others in their family bubble.

A pre-Delta study of 6,280 households with a pediatric index case (the child was the first infected) in Canada, found that 27 percent had experienced secondary transmission.

“For me, the biggest concern is transmission to members of a child’s household” – such as those in older groups who may be unvaccinated or fully vaccinated but still vulnerable – “rather than worrying about the acute risk to the health of the children themselves, ”Russell said.

This is why we must “urgently” vaccinate those under 11, she said.

What to do while waiting for the vaccines?

Russell said it was “crucial” for everyone to follow public health guidelines about not congregating indoors, to reduce the risk of transmission in all age groups.

Since we cannot immunize children, rapid antigen test could also be used as a screening tool in this age group to make schools safer, thereby maximizing the in-person school time children can have, she said.

The government has “a second chance for fairness” in the roll-out of immunization to children, she said.

Children with pre-existing illnesses, those with vulnerable household members, as well as Maori and Pasifika should be prioritized, Russell said.

Kvalsvig said New Zealand could see the number of cases in children rise exponentially if we don’t take preventative action “quickly”.

Mitigation measures, including ventilation and masks, “really work” and can minimize transmission in schools.

“There is no room for fatalism here: we have an array of effective tools in the toolbox to keep children safe. “