28 May Considerations around COVID-19 in children
After a year of living with the pandemic and studying the effects of COVID-19 on adults, it is now imperative to shift our focus towards children.
Since August 2020, more than 580 thousand children under the age of 10, and more than one million adolescents (10 to 19 years) have been infected with COVID-19. While this number may appear smaller when compared to adult cases (especially when considering fatalities and hospitalizations), it must not stop us from addressing the overall impact of the pandemic on children.
To this end, NO-FEAR organised a webinar “COVID-19 in Children: Considerations on the Current Situation” to discuss the implications that come with differential diagnoses, the role that children play in the spread of the infection, presentation of severe cases as well as vaccination and testing strategies with pediatric experts from France, Spain, Italy and Israel. This blog summarises our discussions and findings from the webinar.
New inflammatory syndrome in children
While most COVID positive children display only mild or asymptomatic symptoms, recent reports suggest that there may be a more severe and dangerous complication that requires our attention – multisystem inflammatory syndrome in children (MIS-C).
MIS-C was first identified in the United Kingdom in April 2020, prompting an alert issued by the Paediatric Intensive Care Society describing a recognized increase in critically ill children presenting with hyperinflammatory shock and evidence of SARS-CoV-2 infection.
While early reports compared MIS-C to Kawasaki disease, an inflammatory illness that leads to heart problems, quite a few differences have been noted between the two:
- MIS-C commonly affects older children and adolescents, whereas Kawasaki typically affects infants and young children.
- Gastrointestinal symptoms are very common in MIS-C, whereas these symptoms are less prominent in Kawasaki.
- Myocardial dysfunction and shock occur more commonly in MIS-C.
While this complication is quite worrisome, it is rare and treatable. However, it also requires us to be vigilant, monitoring the situation at all times.
How can schools reopen safely?
One of the many points discussed at the webinar was the role of schools in the transmission of COVID-19 among children. Since children spend most of their time in schools, it is crucial to ensure proper preventive measures to keep them protected. Physical distancing, hand hygiene, respiratory etiquette, and the use of masks where feasible, are important steps toward curbing virus transmission in schools. However, proper ventilation along with these measures, is just as important.
The simulation designed by The New York Times emphasizes this importance based on multiple different scenarios:
- Window closed
- Window open
- Fan and air cleaner
While these simulations are based on specific inputs, they demonstrate how ventilation and filtration need to work alongside other measures in order to reopen schools in a safe manner. This, in turn, lightens the load on healthcare facilities.
However, should we consider shutting down schools during a surge in COVID-19 cases? If appropriate measures are put in place, it is highly unlikely that schools will play a substantial role in transmission. Since schools are also an essential part of society and play an important role in shaping children’s lives, closing them down must be looked at as a last resort.
Vaccinations in children
While early studies suggested that children do not contribute much to the spread of the virus, more recent studies have raised concerns that children could be capable of spreading the infection; and complete protection against the virus cannot be achieved unless most adolescents and children are vaccinated.
However, is it safe to vaccinate children? The ethics of giving out COVID-19 vaccines to children has sparked intense debates in recent times– do children need to be vaccinated? Is it for their own benefit or for the benefit of the society? These questions will eventually strengthen vaccine skepticism and hesitancy among parents. Despite these apprehensions, a number of countries have begun considering approval of vaccinations for children, as this would contribute to ‘herd immunity’, which would in turn prevent mass transmission and allow life to return to normal.
In fact, Israel is now on the path to vaccinating 12 to 16-year-olds. Children who live with a house member(s) with severe immune suppression or those that fall in the ‘high risk’ category will be eligible to get immunised. There is also evidence that children who have been inoculated did not experience any major side-effects, which gives us hope for vaccine safety in children.
Vaccinated mothers – breastfeeding
Even though COVID-19 vaccine trials did not include breastfeeding women, many of them, especially healthcare workers, were encouraged to receive the vaccine. Apart from the many benefits of breastfeeding to both the mother and the infant, many studies seem to suggest that milk of mothers who are vaccinated or mothers who have tested positive for the virus containantibodies specific to the virus.
A research paper by Perl and colleagues published on JAMA stated that antibodies found in breast milk of vaccinated women showed strong neutralizing effects, suggesting a potential protective effect against infection in the infant.
All of the above considerations are important factors in ensuring that children are protected from the virus, which will take us a step closer to ending the pandemic for good.