Collecting comprehensive data on how children are affected by Covid-19 has been neglected in favor of competing priorities during the pandemic. Yet as overall cases currently decline in the U.S., an increasing percentage of cases are children, the issue demands urgent attention. As Covid-19 restrictions are rolled back across the country, unvaccinated and unprotected children will be casualties of complacency towards the virus. There is an immediate need to prioritize the vaccination of children and remain vigilant about public health measures such as masks and social distancing.
The American Academy of Pediatrics reported that as of May 27, 2021, children represented almost a quarter (24.3%) of the new U.S. weekly cases. Cases as always can also be unreported, with the true number being higher. Research from the CDC also shows that over 90 percent of Covid-19 cases under the age of 18 may have been missed during a surge in Mississippi in August 2020. In early April, the case rate in young children and early teens began surpassing that of those 65 and older, according to the CDC. And hospitalizations for children with Covid aren’t falling as much as for those 18 and up. The increase is likely related not only to a return to in-person learning and the country’s reopening but also to the higher transmissibility of the circulating variants.
A new preprint study confirms this hypothesis, providing evidence that children can be significant carriers of more contagious variants, such as the UK and California variants. The study’s authors sequenced the genome of 2,119 tests from Covid-19 patients age 18 or younger, from March 2020 to April 2021, to identify variants of concern, along with key mutations that increase transmissibility or help the variants hide from the patient’s immune system. In total, the researchers identified 560 of these mutations, and 75% (420/560) were in children less than 12 years of age. The tests came from nine different children’s hospitals representing a diverse geographic and socioeconomic population within the U.S.
Similar warnings have emerged out of Singapore, where several children were infected through a Covid cluster at an education center and schools are presently closed to avoid further outbreaks. Singapore Education Minister Chan Chun Sing was quoted in Reuters saying “some of these (virus) mutations are much more virulent, and they seem to attack the younger children,”. Health Minister Ong Ye Kung also stated that the B.1.617 strain “appears to affect children more”.
The threat of Covid-19 and the current variants to unvaccinated and unprotected children is currently understated. Many have dismissed the danger citing “only” 300 children dying from COVID-19 , but any preventable death of a child is a tragedy. There is also much we are still learning about Multi-Inflammatory Syndrome and Long Covid in children.
A small preprint study from Italy of 129 children, suggests that more than half of children with COVID-19 have at least one persisting symptom over 17 weeks after being diagnosed. Among them, 43% reported being impaired by their symptoms during daily activities.
Yet many children struggle to have their unusual symptoms diagnosed as Long Covid or access treatment and therefore we cannot glean an accurate picture of how widespread the disease really is. “The pediatric piece of this is pretty neglected,” Amy Edwards, associate medical director of pediatric infection control at University Hospitals in Ohio told Bloomberg, “Kids with long haul have brain fog, chronic fatigue, fevers on and off, weird rashes. Long-haulers don’t go to the hospital. They suffer at home.”
The symptoms of Long Covid are wide-ranging from anxiety and cognitive difficulties to extreme fatigue, chronic pain, and shortness of breath. This makes it difficult for parents to access the multidisciplinary team needed to treat their children. The Children’s Hospital in Cleveland and Yale New Haven Children’s Hospital are both working to change this with respective dedicated clinics and programs that are focused on treating Long Covid in children and provide access to experts in multiple specialties in one visit. But even with proper treatment, many children still have a long, painful, and likely expensive recovery ahead. With so much at stake, we must be doing everything in our power to protect children from being exposed to Covid-19.