COVID-19 has changed all of our lives…. Even the world’s children have been impacted in catastrophic ways. Until recently children have been less affected physically by COVID-19 as compared with adults. Sadly, just as children are returning to school (some for the first time in almost 18 months), the Delta variant appears to be infecting children more and causing a more severe form of the disease. Experts state that the increase in pediatric cases is due to the variant’s hypertranmissibility, circulating in a population left unvaccinated and therefore more vulnerable to the virus. Other factors are the reopening of schools, businesses and activities, sports resuming and the expiration of mask mandates.
Since the beginning of the pandemic, more than 4.1 million children worldwide have been diagnosed with COVID-19 (14.3% of all cases). According to the latest data from the American Academy of Pediatrics (AAP), there has been a 10% increase in the cumulative number of pediatric Covid-19 cases since the beginning of the pandemic. Whereas children comprise 22% of the US population, they now represent 26.8% of the weekly Covid-19 cases. Thankfully, the majority of pediatric cases are mild, but those with severe illness are increasing and according to the US Department of Health and Human Services now comprise almost 3% of all hospitalizations. In addition, one in four of these hospitalized children require intensive care. While the numbers are much smaller than in adults, emerging data does suggest that children of color are disproportionately affected which is similar to what has been reported in adults.
As with their adult counterparts, children with underlying medical conditions are also at increased risk for severe illness. Current evidence shows that children with medical complexity, with genetic, neurologic, metabolic conditions, or with congenital heart disease are at increased risk for severe illness from COVID-19. Similar to the adults of the world, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, anemia, severe malnutrition or immunosuppression are also at increased risk for severe illness from COVID-19.
According to the AAP, signs and symptoms of COVID-19 in children are similar to that of adults with the most common symptoms being cough and fever.
As with adults, treatment consists mainly of supportive care. This can include over the counter medications, oxygen therapy, bed rest and ensuring adequate caloric and water intake. Remdesivir, an antiviral agent, is the only drug that has received full approval from the Food and Drug Administration (FDA) for treatment of COVID-19 in children aged 12 years and older. An emergency use authorization (EUA) remains in place to treat patients younger than 12 years. Convalescent plasma was also granted EUA for adult patients but its safety and effectiveness for those under age 18 has not been evaluated. In addition, EUAs have also been granted for outpatient monoclonal directed therapies for individuals aged 12 years and older who test positive and are at high risk of severe COVID-19 or hospitalization.
With the increase in pediatric COVID cases, there has also been an increase in children who continue to have health concerns after COVID. This is called Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C is a rare systemic illness involving persistent fever and extreme inflammation following exposure COVID-19. It can rapidly lead to medical emergencies such as insufficient blood flow and failure of one or more organs. Families need to seek urgent medical assistance as most affected children will need intensive care. Of those children who develop MIS-C, 61% are Hispanic or Black (non-Hispanic), over half are between the ages of 5 and 13 and 99% had a positive COVID test with the remaining 1% having been in contact with someone with COVID within the last four weeks.
Common signs and symptoms of MIS-C include:
- persistent fever
- skin rash
- rapid heart rate and/or breathing
- red eyes/conjunctivitis
- redness and/or swelling of lips and tongue
- excessive tiredness
- redness and/or swelling of hands or feet
- headache, dizziness or lightheaded
- enlarged or swollen lymph nodes
Emergency warning signs of MIS-C include:
- inability to wake up or stay awake
- difficulty breathing
- new confusion
- pale, gray or blue-colored skin, lips or nail beds
- severe stomach pain
Access to healthcare:
As the world’s healthcare resources are being overwhelmed due to COVID patients and nursing shortages, many children are not able to see their physician for other healthcare concerns or to receive their recommended vaccinations. Many states have even run out of ICU beds in the last couple months. Children, especially those in the poorest households and the poorest parts of the world, risk losing their lives to pneumonia, diarrheal diseases, malaria, HIV and other preventable diseases unless urgent action is taken to mitigate the spread of COVID-19 and free up healthcare resources.
Physical effects are not the only way that children are being affected by COVID. Our next blog will focus on the effects the pandemic has had on the education, mental health and overall safety of the world’s children.
American Association of Pediatrics (AAP). Multisystem Inflammatory Syndrome in Children (MIS-C) Interim Guidance (aap.org)
Centers for Disease Control and Prevention (CDC). https://covid.cdc.gov/covid-data-tracker/#demographicsovertime
Cable News Network (CNN). Covid-19 and kids: What the data shows about cases, hospitalizations and deaths – CNN
National Institutes of Health (NIH). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444649/
The Good Men Project. Four Ways Covid-19 Has Changed Our Society – The Good Men Project
United Nations Educational, Scientific and Cultural Organization (UNESCO). UNESCO Institute for Statistics (UIS). 2020. “UIS.Stat.” April 2020. http://data.uis.unesco.org
United Nations Educational, Scientific and Cultural Organization (UNESCO). 2020. “COVID-19 Educational Disruption and Response.” April 2020. https://en.unesco.org/covid19/educationresponse
United Nations International Children’s Emergency Fund (UNICEF). https://data.unicef.org/resources/how-covid-19-is-changing-the-world-a-statistical-perspective/
World Economic Forum. How we’re grappling with a world changed by COVID | World Economic Forum (weforum.org)