Children and Covid-19. An update.

From illness to orphanhood, we need to protect kids better.

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Around 6 million American children have had documented coronavirus infections since the Covid-19 pandemic broke out. Among US children ages 0-17, over 68,000 Covid-19 hospitalizations have occurred, and nearly 700 have died. Vaccines are available for children 12 and older and yesterday, Pfizer submitted its request for emergency use authorization of its vaccine for children ages 5-11 years old, after it found that providing that group with a smaller dose (1/3 the dose used in adults) generated what researchers believe is enough of an antibody response to provide adequate protection.

The Covid-19 burden on children has been difficult to fully encapsulate. In addition to the burden of acute disease, approximately 5,200 children have been hospitalized several weeks after their coronavirus infections due to a condition known as multi-system inflammatory syndrome in children (MISC). This condition is similar to another pediatric condition, Kawasawki Disease, which can also occur after other viral illnesses. Both conditions can cause significant heart damage.

A new paper in the journal Pediatrics provides follow-up information regarding 50 children who were hospitalized for MISC in a major New York hospital earlier this year. Among these cases, 79% required admission to an intensive care unit. A majority of the hospitalized children had measurable heart dysfunction. In particular, the efficiency of the heart was markedly reduced among 52% of the cases. Hefty medications, including ones that counteract dangerously low blood pressure, steroids, immunoglobulins, and immune system modulating drugs were used in most cases. The good news is that there were no deaths in this cohort and that most of the heart damage resolved within a few weeks. However, some problems persisted in a small number of children. Nationwide, 46 children are believed to have died from MISC.

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The irony is that anti-vaxxers point to myocarditis—a rare inflammatory condition of the heart that has occurred after a small number of vaccinations—as a reason not to vaccinate children. After all, we all want to protect pediatric hearts, right? But as the CDC data and this paper show, the best way to protect our children’s hearts is to reduce the burden and prevalence of Covid-19; the best way to do that is to vaccinate them.

The data make this all quite clear. Around 1 in 1,200 children infected with SARS-CoV-2 have subsequently developed MISC. That rate is around 5.6 times greater than the rate of vaccine-associated myocarditis observed in teens. Additionally, the vaccine-related adverse effects on pediatric hearts have been far less substantial than those seen in MISC, and the outcomes have almost always been significantly milder. While we do not yet know if the vaccine-associated myocarditis rates will turn out to be higher in younger children (the condition is simply too rare for the Pfizer and forthcoming Moderna studies to detect, so we won't know the rate until hundreds of thousands of children under 12 have been vaccinated), it’s unlikely that the benefits of vaccination would be overshadowed. In fact, further tipping the scales towards vaccination are other recent data showing the Covid-19 itself causes myocarditis 6 times more often than vaccines do. That finding is likely to hold up in younger children, who are more likely to develop myocarditis for other reasons (such as other infections) in general.

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In addition to the devastating pediatric deaths and hospitalizations caused by Covid-19, we should not ignore the tremendous mental health strains that the pandemic has placed on kids. While many pundits have spent most of their mental energy worrying about the effects of temporary school closures and mask use, the greatest mental health tragedy for children during this pandemic has clearly fallen on the more than 120,000 American children who have lost a parent or other primary caregiver to Covid-19, according to a new report. For anyone worried about the mental health of children, this statistic should be their most pressing concern by far.

Too often, people focused on the pandemic and its effects on the mental wellbeing of kids seem to forget that the virus itself is the major problem, not our responses to it. In fact, when researchers asked children about their mental health during the early lockdown periods in the United Kingdom, the most common source of their anxiety was not related to missing school or even their own health, but rather about the safety of their parents and older relatives.

Kids get it. The way to end both the physical and mental health burdens placed on our children, and on all of us, during the Covid-19 pandemic is to fight the virus causing it, not our responses to it.

Pediatric vaccines will likely soon be expanded to younger children. What are your questions?