Infants are being hospitalized with Covid at higher rates than most adults and seniors.
The first year of life is a dangerous time. Let’s vaccinate our youngest before the virus finds them.
The risk of severe or fatal Covid-19 rises with age. Children are the least likely to be hospitalized or die, followed by young and middle-aged adults, followed by seniors. In 2021, if you were age 85 and older, you were over 1,800-times more likely to die of Covid-19 than children ages 1-17 were.
But there’s an age group that often gets overlooked: infants under 1 year of age. Infants under age 1 are a high-risk group flying under the radar. And it’s getting worse.
Infants under age 1 account for nearly a third of pediatric Covid mortality in children under age 12. Within that age group, however, the first 6 months of life are particularly dangerous. During the pandemic, over 1% of all infants followed by COVID-NET (the CDC’s tracker which covers around 10% of the US population) have been hospitalized for or with Covid during their first 6 months of life. (The actual reported rate is 1,255 Covid-associated hospitalizations per 100,000 infants ages 0-5 months old). That’s around 78% as high as the rate observed in 50-64-year-olds during the pandemic.
Click below to watch animations which dramatically demonstrate how our youngest children have joined the high-risk groups for Covid-19 in 2022.
This next piece of information will shock you, as it shocked me. During the peak of early Omicron, and for much of the summer of 2022, infants ages 0-5 months were hospitalized at a higher rate than even 65-74-year-olds—that is, at a higher rate than any age group, other than seniors ages 75 and older.
Why is this happening? There are two likely explanations. First, these babies are fragile by definition. The first days and weeks of life are dangerous times. Though medicine has made colossal strides in reducing morbidity and mortality from all causes in newborns in the last century, the first year of life remains a high-risk period. Second, newborns are far less likely to have any immunity to Covid; they’re too young to have been vaccinated and they weren’t around for the last 30 months, during which a majority of Americans were infected with Covid and now, at least, have some protective immunity to show for it. This is why on the graphs, we see that the hospitalization rate in newborns has been accruing at a steeper rate since the early Omicron wave compared to all age groups (other than the oldest seniors, who clearly need more protection). Most of us have some degree of immunity to Covid by now, be it from infection, vaccination, or both. But newborns have no immune memory to this virus, and they just keep coming.
What can we do about it? Starting at age 6 months, children should be vaccinated. This should happen as soon as possible. That helps because, after the first 6 months of life, the 2nd riskiest time for children to get Covid is the next 6 months (that’s in terms of mortality—we don’t have hospitalization data for 6-12-month old babies, because that group gets lumped in with all kids up to age 4). But that doesn’t fix the problem in babies under 6 months of age.
To protect newborns, there are three actions we can take. First, we should ask the public to mask in crowded public settings like busses and subways, especially during surges. Parents don’t have a choice in these areas, and we should band together to help their babies through these risk corridors. Second, Pfizer-BioNTech and Moderna should begin to study vaccination safety and efficacy in newborns younger than 6 months of age. Third, pregnant mothers should receive Covid vaccinations or booster doses during the second half of pregnancy, as antibodies passed from mother to fetus seem to be protective to babies during the first few months of their lives. Researchers also need to study whether babies of recently vaccinated (or infected) mothers who breastfeed fare better, as research implies but has not yet shown definitively. Protective Covid antibodies in breastmilk line babies’ mucous membranes, where this virus likes to enter our bodies. It’s probable that breastfeeding provides a short-term layer of protection with each feeding. So for those who can’t breastfeed, donor milk from recently vaccinated mothers should be considered.
Vaccinating children has been controversial, although not for any particularly good reason. The main arguments put forth by doubters are that Covid does not seem to be that harmful to children, and misinterpretations (intentional or unintentional) of data on vaccine safety (they’re safe).
While it’s true that Covid is less dangerous to children than it is to seniors, Covid is not safe for children compared to other diseases that we routinely vaccinate children against. So far, Covid has killed somewhere between 875-1,300 US children, depending on which CDC numbers you use. That’s far more than mumps or rubella routinely killed in the years before those vaccines became available, and similar (corrected for population growth) to the yearly number of deaths caused by measles, smallpox, and tetanus during the mid-20th century. These are now all vaccine-preventable illnesses that kill almost no children. Covid should join that list.
One newer argument against Covid-19 vaccines for children is that most children already have immunity to Covid, resulting from prior infections. Because prior infections drastically reduce the risk of hospitalization for children who get reinfected (for how long, we do not know, as this fades), the argument against vaccinating children notes that we’d have to vaccinate tens of thousands of kids to prevent a single Covid-related hospitalization. Perhaps. But it’s still worth doing, on several grounds, as a risk-benefit analysis in a recent Inside Medicine showed. But the argument falls completely flat when discussing infants who haven’t been alive very long. The steady supply of newborns who are “Covid naïve” (i.e., have no immunity to it from vaccination or infections) are exactly the ones we need to vaccinate, and as soon as possible. Parents might be tempted to wait until their children are a bit older before vaccinating them against Covid. I understand why that may feel prudent. But as the data currently show, the opposite is true. These vaccines are most useful when given before a child first gets Covid. That means vaccinating our youngest children as soon as they become eligible.
We all know that Covid is worse for seniors than it is for everyone else. But newborns under 6 months of age are now being hospitalized at rates that exceed non-geriatric adults, and even some seniors. That speaks to the power of our vaccines and the incredible contagiousness of SARS-CoV-2. This virus will find virtually every newborn human, eventually. The key is for their parents to get them vaccinated before that happens. The more of our youngest children get vaccinated against Covid, and the earlier in life that happens, the fewer Covid-19 hospitalizations there will be.