Will Covid become a disease of the young? The world is watching England to find out
Few issues seem to provoke such a range of opinions among experts as Covid-19 and children. When the WHO-China Joint Mission first reported on the virus in February 2020, one of the nuggets of good news was that children seemed to be relatively unaffected by it. This was surprising; like other acute respiratory infections, coronaviruses usually spread among and infect younger children. China’s strong suppression of the virus meant cases remained extremely low, preventing the virus spreading into other age groups. At the time, Covid appeared to be a disease of elderly and overweight people and those with underlying health conditions.
One year into the pandemic, richer countries embarked on a mass vaccination programme to protect not only older age groups but entire adult populations.
The success of vaccines in weakening the link between hospitalisations and deaths is clear (although the link is not completely broken). With vaccinated adults now largely protected from the severe consequences of Covid-19, the questions for children have changed. In the UK, there has been a surge of infections among children and adolescents. These will only increase when the school year starts again in the autumn.
Is it better for children to catch SarsCoV-2, as they do the common cold, or is it better to protect them through vaccinations, and measures such as social distancing and face masks? This is the question many countries are now asking. Some may worry about potential side-effects from vaccines, but these are extremely rare and clearly outweighed by the benefits. Fortunately, healthcare regulators in the UK and US have approved the Pfizer/BioNTech vaccine as safe for use in children between 12 and 15. Already 25% of 12to 15-year-olds across the US are fully
vaccinated, while a third of them have received one dose. Elsewhere, Israel, Italy and France are steaming ahead with vaccinating children in this age group, while Germany gives parents the ability to “opt-in” for the vaccine based on informed consent.
The current approach in England seems to be to let teenagers get on with it and see what happens once they’re infected. The result will be an uncontrolled epidemic among younger age groups. Some British scientists aren’t alarmed by this, pointing to other diseases such as seasonal flu, which cause more hospitalisations among children than Covid-19. By contrast, paediatricians in the US argue that exposing children to a new virus with potentially long-term complications is a major risk that should be avoided. Covid-19 was among the top causes of child death in the US in 2020. Though I’m not a paediatrician, I struggle to understand how a disease considered risky to adolescents in the US can be considered innocuous in Britain.
Children under 12 are a trickier challenge for scientists and governments. No vaccine has been approved for use in this age group, although the results from early trialsare promising. In Israel and the US, health authorities hope that vaccinating enough adults will suppress Covid-19 among children. While this seemed a valid approach against earlier variants, it may prove more difficult with Delta. The Delta variant is more transmissible. It has pushed up the threshold for herd immunity; for this to be achieved, some estimate that as much as 98% of the population would need to be vaccinated.
Paediatricians appear split over how dangerous Covid-19 is in younger children, too. Long Covid is a major risk here: recent studies suggest it can cause long-term illness, physiological changes to the body and issues with the heart, kidneys, blood vessels and lungs in children. How common is long Covid in children, and will those who have it get better? Are some children at greater risk than others? Answers to these questions will emerge over time as science progresses, but there is currently no obvious consensus. The prevailing view is that long Covid is a major challenge – but the details are still unclear.
For all countries, schools are the major minefield that lies ahead. It is hard to understate the harms endured by children during the pandemic. Sexual and domestic abuse, child hunger and mental health problems have all risen. The widening education gap will take years to close. Children need to be in school for their social, mental and physical wellbeing.
But Delta means children now transmit the virus more than before, meaning clusters are likely to emerge, particularly in secondary schools.
There are things that can be done. Improving ventilation can help stop the spread of both Covid-19 and seasonal infections. Current mitigation measures in schools are also far from ideal; weekly lateral flow testing is uncomfortable and voluntary, which has resulted in low uptake. And requiring children to wear masks all day when adults have been told in England they can go to nightclubs without masks seems contradictory and unfair.
The alternative of letting the virus spread among young people seems reckless. England is alone in doing this. It is acting as a laboratory for other countries, which are watching to see what happens before they decide on their own policies towards children. The UK government’s comparatively relaxed attitude may also create a petri dish for Covid variants. The consequence could be a new variant that makes our current vaccines less effective, or has more severe outcomes for unvaccinated children.
Will Covid become a disease of the young? Will children who suffered under restrictions for 18 months now have to face a wave of infections with unknown consequences? There’s no good path forward until we have approved vaccines for all age groups. Until then, we need to continue to have an open and honest debate about how to put children first, protect their health, education, and general welfare, and listen and learn from other countries discussing this same issue.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh