Mostly ignored since the start of the pandemic, children are now being considered an important part of the COVID-19 jigsaw.

Dr Karl Gruber (PhD) explains.

Since the start of the COVID-19 pandemic, our main concern has been the health impact on adults and the elderly. Children, however, did not seem to catch the virus or get seriously ill from it and have mostly been ignored when it comes to the health advice, including vaccine strategy and mask wearing for those under 12 years.

But more than a year later, we have learnt a thing or two about COVID-19 and how it affects children and the findings are troublesome.

Children do get sick

Fortunately, most children seem asymptomatic or have only mild presentations compared to other respiratory viruses. 

“Usually with respiratory viruses, children tend to become more unwell than adults, and are responsible for transmitting more illness, however, this doesn’t appear to be the case with COVID-19,” Associate Professor Asha Bowen, paediatric infectious diseases specialist at the Telethon Kids Institute and Perth Children’s Hospital, said in a statement.

“We are seeing lower numbers of children infected compared to what we’d normally see with other respiratory viruses.”

For more serious outcomes, data so far shows that only a small percentage of children infected by COVID-19 have died – about 0.3% of all COVID-19 deaths which translates to about 8,700 children. 

But children do get the virus and can pass it to others just as efficiently as adults. In Europe, studies suggest that schools were a significant driver for the so-called second wave of COVID-19 infections. Added to this is the problem of the virus going undetected in children, who don’t normally get tested or vaccinated. 

While the initial presentations of COVID-19 infection do seem to be mild in children, research is now showing that long-term effects may be a different story. 

One international study that surveyed the parents of children with long COVID (mostly from the UK and US) found multiple health issues were affecting children. Among 510 children, 87% experienced tiredness and weakness, nearly 80% complained of headaches and abdominal pain, and muscle and joint pain affected over 60%.

“Symptoms like fatigue, headache, muscle and joint pain, rashes and heart palpitations, and mental health issues like lack of concentration and short memory problems, were particularly frequent and confirm previous observations, suggesting that they may characterise this condition,” Sammie Mcfarland, one of the lead authors of the study and a founder of the community-led Long COVID Kids, UK, wrote in the report. 

COVID-19 ripple effect

Beyond the inherent health problems caused by COVID-19, there are many other detrimental consequences we don’t normally hear about. For example, data from the United Nations International Children’s Emergency Fund (UNICEF), shows that up to 7 million additional children under the age of five may have suffered from wasting or acute malnutrition during 2020. Likewise, stunting among poor children has been more than 2.4 times higher during the pandemic, compared to previous years. 

Due to COVID-19 restrictions during 2019, nearly 14 million children did not get any vaccines and it is estimated that about 80 million children under the age of one may miss out on life-saving vaccines. One specific example is with measles, with cases reaching 870,000 in 2019 across 26 countries, the highest in 23 years. 

Violence, exploitation and abuse is also likely to increase due to the pandemic, due to factors such as added stress, economic uncertainty, job loss, and social isolation. In some countries, the economic impact of the pandemic, school closures and interruptions in support services may have led to 10 million additional child marriages occurring before the end of the decade.

“Thus, school closures such as those triggered by COVID-19 may, in effect, push girls towards marriage since school is no longer an option,” the UNICEF reports.

The path ahead

What all studies are showing is that children should not be excluded from any effort to control the pandemic. While most children seem to experience only mild or no symptoms from the original COVID-19 virus, new strains are emerging. 

Throughout the pandemic, the SARS-CoV-2 virus has evolved, accumulating genomic mutations forming troublesome strains such as the Delta strain (B.1.617.2) that is now widespread and seems to be more efficient at transmission. Other variants such as the Beta strain (B.1.351) seem more efficient at re-infection. 

Evidence so far shows that, while there is an increase in children affected by this virus, it is not clear that it is due to a specific variant. 

“There is no convincing evidence that any of the variants have special propensity to infect or cause disease in children. We need to be vigilant in monitoring such shifts, but we can only speculate at this point,” Dr Stuart Ray, vice chair of medicine for data integrity and analytics at Johns Hopkins Hospital, said in a statement.

Dr Andrew Miller, an anaesthetist and immediate past president of the WA branch of the Australian Medical Association, explains that in the case of the Delta variant, it may be a case of both adults and children experiencing higher levels of infection. 

“The predilection [for the virus] to attack children is probably the same as it is in adults,” Dr Miller said in a recent news report. “We don’t have enough information yet that’s reliable to say the disease [caused by the Delta strain] is more severe in terms of hospitalisation and death — but that will only come with time.”

What is becoming clear is that children need to be considered as an integral part of our efforts to control the COVID-19 pandemic. In the US, Canada and the United Kingdom, children as young as 12 are now being vaccinated.

In Australia, the Therapeutic Goods Administration is yet to approve either the Pfizer or AstraZeneca vaccines for use in children. On May 11, the TGA granted a provisional determination to Pfizer Australia for their COVID-19 vaccine called COMIRNATY. Currently, COMIRNATY is provisionally approved for use in people 16 years of age or older.

Whether this vaccine or any other COVID-19 vaccine will reach the arms of any children or teenagers in Australia remains to be seen.