SARS-CoV-2 in Children

In about 160 countries, the rise in cases of COVID-19 among children is primarily linked to the Delta variant. Cases are rising especially quickly in communities with low rates of COVID-19 vaccinations.

Rapidly increasing infection rates among children and teachers have forced many schools to halt in-person learning and turn to hybrid models of education.

Although children generally have milder COVID-19 symptoms than adults, the fact that few studies have investigated how the disease affects children means that many questions remain unanswered. For example, why are so many children being hospitalized with COVID-19? Which children are most at risk? And what can parents and authorities do so that children can return to school safely?

Pediatric Hospitalizations due to COVID-19

The Delta variant of COVID-19 is more than two times as contagious as previous variants. Globally ,alongside school reopenings, this may partially explain the increase in pediatric hospitalizations due to COVID-19.

The Delta variant that is circulating widely is more contagious, and children are getting infected more often than previously during the pandemic. Also, mitigation measures such as masks, reduced occupancy indoors, physical distancing, etc., all ended around the same time.

Now, we have a more contagious variant with fewer mitigation measures in place. With the rising number of cases, unfortunately, we will see more hospitalizations. As an example, if 2% of children need hospitalization, then it’s a big difference between 2% of 10,000 cases vs. 2% of 100,000 cases.

Another reason for rising COVID-19 hospitalizations among children may be that children cannot get the vaccination yet.

Vaccines remain effective at preventing severe illness, hospitalization, and death from SARS-CoV-2 infection, even Delta strain infection. In the USA, the overwhelming majority of hospitalizations and deaths during the recent surge are occurring in unvaccinated inpiduals.

Early in the pandemic, those over 65 accounted for more severe disease and hospitalization. Now that this age group has a higher percentage of vaccinated persons, the disease burden will be seen in the younger, unvaccinated population. In Florida, there has been over a four-fold increase in child SARS-CoV-2 infections in the past month.

How Dangerous Is the Delta Variant?

It is unclear whether the Delta variant of SARS-CoV-2 is more severe for children than previous variants. There are some indications to suggest that COVID-19 from the Delta variant is more severe in children than with earlier strains.

A greater number of children are seen , particularly unvaccinated adolescents, with more severe COVID-19 resulting in respiratory failure that is requiring intubation and sometimes ECMO (heart-lung bypass machine), ARDS (a very serious lung condition that develops as a result of the inflammation associated with COVID-19), and other COVID-related problems — all complications we more commonly see in adults.It may be that the increased number of hospitalizations among children is a result of both of these factors — more cases combined with a higher chance of severe disease.

Children at Higher Risk of COVID-19

Children with underlying medical conditions, such as congenital heart disease or genetic, neurologic, or metabolic conditions, could have an increased risk of severe outcomes from COVID-19.This higher risk also applies to children with obesity, diabetes, asthma, chronic lung disease, sickle cell disease, or immunosuppression.

Children who are at higher risk of adverse outcomes from COVID-19 are those under 1 year of age, those with underlying conditions, and those with immunocompromising conditions. Most of the hospitalized patients with COVID-19 are teenagers. Many of these teens are quite ill, and their only risk factors are obesity and/or asthma. Teenagers with a body mass index of 25 or above and infants under the age of 1 year have a higher risk of hospitalization. Many families think their children are healthy and, therefore, not at risk of severe COVID-19. Children without underlying conditions sometimes do develop severe disease.

We are still learning what causes some children to develop more severe COVID-19 than others, but it is important to know that perfectly healthy children can develop severe COVID-19.

Long COVID in Children

Post COVID-19 condition, also sometimes referred to as ‘Long COVID,’ is a term used to describe symptoms persisting for weeks or months in some people after the initial recovery from COVID-19 infection.

More research is needed to better understand the long-term effects of COVID-19, but young adults and children without underlying chronic medical conditions, as well as those who experienced mild symptoms during acute COVID-19 infection, have also been affected. The number of children with Long COVID is unclear, but surveys suggest symptoms in children can include fatigue, gastrointestinal problems, sore throats, headaches, and muscle pain and weakness.

Children and adolescents may also be affected by multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition that appears to be linked to COVID-19. If your child or a family member is experiencing new or persistent symptoms following acute COVID-19 infection, you should consult your healthcare provider.

COVID-19 Vaccines for Children

The CDC currently recommends COVID-19 vaccines for everyone over the age of 12 years. This advice came after Pfizer announced that its vaccine is 100% effective in children aged 12–15, and Moderna reported that its vaccine is 100% effective in those aged 12–17.

Clinical trials for COVID-19 vaccines for children aged 11 years and younger are underway. Pfizer, for example, is currently carrying out a trial of its vaccine among children aged 6 months to 11 years.

Prevention of SARS-CoV-2 among Children

Anyone who is eligible to receive a COVID-19 vaccine should be vaccinated — this includes parents, household members, teachers, staff, etc.

Schools reopening does not mean a return to normal. There will be lots of restrictions and changes, such as closing playgrounds, to reduce transmission risk. Studies of transmission in schools as they reopen will also be important. Universal mask-wearing for all students, teachers, and staff regardless of vaccination status. Practicing social/physical distancing with desks in the classrooms at least 3 feet apart.

Good hand hygiene. Cover mouth and nose with flexed elbow or tissue when coughing or sneezing. Dispose of used tissue immediately. Regularly clean and disinfect frequently touched surfaces like phones, doorknobs, light switches and countertops.

Cohorting students, teachers, and staff into smaller groups or pods. Discouraging large gatherings of students, teachers, and staff — e.g., staggering pickup and drop off times, increasing the number of lunch hours to prevent large number of people from being in the cafeteria at the same time, and having students eat at their desks. Good ventilation in classrooms or using outdoor space if possible. Seek medical care early if you or your child has a fever, cough, difficulty breathing or other symptoms of COVID-19.