When we first visited the topic of the novel coronavirus in March 2020, just over 100,000 cases had been reported worldwide. At this time, in late March 2021, the World Health Organization reports well over 120 million cases and regrettably, the loss of nearly 3 million lives. The global pandemic that is COVID-19 has affected 223 countries. In Canada, we are closing in on 1 million cases and almost 24,000 deaths (1). We have already discussed the economic and social devastation wrought by the virus. The good news has been both a new and renewed understanding of containment and mitigation to halt the spread of human-to-human viruses and the unprecedented speed of delivery of what appears to be highly effective vaccines. Mass vaccination should help usher in a new era of normalcy.
But what about our children? How have our kids fared during this time? Let’s look at COVID-19 and its’ impact on the youngest members of our society. First, the most obvious question: can children get COVID-19? Yes. One study out of Europe reports 14% of cases in those aged 0-19 years. Early in the pandemic, household transmission was likely predominant. With return to school, even on a limited basis, inconsistent safe distancing and mask wearing, along with poor ventilation in older school buildings, have contributed to child-to-child transmission rates. This is especially the case with the emergence of the more highly transmissible variants such as B117, now likely to become the dominant variant and increasing the need to accelerate mass vaccination programs (2).
For children who experience COVID symptoms, fever, cough or shortness of breath are most common. Like adults, there is an array of accompanying symptoms that can range from mild headaches, stomach pain, loss of taste or smell to potentially serious neurological complications such as stroke. Thankfully, more serious complications are rare but the risk cannot be ignored. Like adults, children can develop long-term COVID infection complications. Most notably is multisystem inflammatory syndrome (MIS-C). This is defined as a condition where different organs such as the brain, kidneys and stomach become inflamed. Understanding of the cause between COVID and MIS-C is still not definitive other than many children with this inflammatory condition have had the virus. Like adults, the highest risk groups in children to develop and suffer the most from COVID-19 and MIS-C are those with more serious co-morbid illnesses like diabetes or congenital heart disease, to name just two. It is still too early to determine the long-term outcome when MIS-C has been diagnosed (3).
Do the numbers help us understand the risk of COVID-19 for our youth? Can that understanding help forge a sound underwriting perspective as we move hopefully into a post-pandemic environment? Let’s start with the numbers for cases, hospitalization and death. The Centers for Disease Control and Prevention in the United States has reported on this by age group with fascinating findings. Using 5 to 17-year-olds as the reference group, the next studied group, aged 18-29, are 3 times more likely to be infected with COVID, 7 times more likely to be hospitalized and 15 times more likely to die. At the other end of the age spectrum, those 65 and up, the findings are nothing short of staggering. In this group, who are only twice as likely to be infected, the hospitalization risk increased by 35 to 55, the latter number for those aged 75-84. The staggering part is the death risk, increased 1,100 to 2,800-fold among these older ages (4). There are new developments and studies emerging daily and the data will evolve over time.
As a result, some think children are simply not at high risk for COVID-19. This view is supported by a better understanding of virus transmission and how mask wearing, distancing and better-ventilated schools and related indoor facilities also help mitigate the risk. The same view argues that being a child is very much like being a fully vaccinated adult. The risk reduction is 95% for getting really sick or dying. Once more of us are vaccinated, the overall reduction in the spread of virus will mean fewer infections among children. Though vigilance will still be required, kids of all ages can spend time with friends, family and schoolmates. The isolation of the past year will hopefully fade along with risk of infection.
- World Health Organization. Coronavirus. World Health Organization. N.D.
- Oster, Emily. Your Unvaccinated Kid Is Like a Vaccinated Grandma. The Atlantic. March 18, 2021.
- Centers for Disease Control and Prevention. Multisystem Inflammatory Syndrome (MIS-C). CDC. February 25, 2021.
- Centers for Disease Control and Prevention. Risk for COVID-19 Infection, Hospitalization, and death By Age Group. CDC. February 18, 2021.
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