“Children don’t get as sick with COVID-19” and “only children with comorbidities get very sick from COVID-19” are two statements that have concerned me during the pandemic. They have been used as statements to support loosening COVID-19 prevention measures for children, like wearing masks, and rationalizing arguments opposing vaccinating children against COVID-19. It is true that children, for the most part, do not get as sick from COVID-19. Nevertheless, while they are at low risk, they are not at no risk for severe disease or even death from COVID-19. Additionally, there is merit to the statement that children with comorbidities are affected more severely from COVID-19, but that assertion does not reveal the entire story of children afflicted with adverse sequelae from COVID-19 disease. By minimizing how children are medically affected by COVID-19, the welfare of one of our most vulnerable segments of society is compromised. At the end of the day, our society will be judged by future generations about how it protected one of its most vulnerable groups, its children.
For the most part, children do not get as sick from COVID-19. But, this statement is usually made in comparison to the adult population that has suffered greatly with significant morbidity (the condition of suffering from a disease or medical condition) and mortality (death) from COVID-19. In the U.S., the Children’s Hospital Association and the American Academy of Pediatrics have published cumulative weekly summaries of the publicly reported state data from 49 states, New York City, the District of Columbia, Puerto Rico, and Guam. As of August 19th, 2021, children have accounted for 14.6% of all COVID-19 cases (4,593,721), 2.3% of all COVID-19 hospitalizations (18,315), and 0.07% of all COVID-19 deaths (402). The hospitalization rate and death rate among children is 0.9% and 0.01%, respectively. Multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition associated with COVID-19, accounts for 4,404 cases and 37 deaths in children. While these numbers are definitely smaller than the adult population, they are not insignificant. Every child’s life has value. As a pediatric intensivist who has witnessed the deaths of critically ill children, each death is unfathomably painful and traumatic for a family. And, while mortality is often used as an ultimate metric of the severity of a disease by many, one must not forget morbidity. There is not a trivial amount of suffering from contracting COVID-19 for some children, and being hospitalized is a significant complication of any disease, even if it is not life-threatening.
It is often brought up that healthy children are not at risk for getting very sick from COVID-19, and the vast majority of severe illness from COVID-19 in children has been in those children who have comorbidities. While this is true, the statement needs to be put into some perspective. A study evaluated data from patients aged 18 years or younger from March 1, 2020, through January 31, 2021, at 900 geographically dispersed U.S. hospitals with a COVID-19 discharge diagnosis. Underlying medical conditions were present in 28.7% of children with COVID-19 infection and 62.9% of children with COVID-19 who were hospitalized had an underlying medical condition.
Some of the conditions that were found to increase the risk of hospitalization in this population included Type 1 diabetes, obesity, epilepsy, neurodevelopmental disorders, and asthma. Type 1 diabetes, epilepsy, and obesity, amongst others, were found to increase the risk of severe illness when a child was hospitalized. Severe illness in this study was defined as experiencing an intensive care unit or step-down unit admission, invasive mechanical ventilation, or death. In the U.S., obesity affects approximately 19.3% of children (14.4 million children and adolescents). About 6 million children have asthma in the U.S. There are approximately 470,000 children with epilepsy and 187,000 children with Type 1 diabetes. All in all, comorbidities that put children at risk for hospitalization and/or severe illness due to COVID-19 are not rare in the U.S. pediatric population. Moreover, children without comorbid conditions comprised 37.1% of the children who were hospitalized with COVID-19 in the study. In a separate investigation, evaluating 45 hospitalized children with MIS-C, another study found that a majority of these children had no underlying medical condition (84%, [n = 38]) and 6 children had asthma (14%). While the data support the fact that children suffering from COVID-19, with comorbidities are at a higher risk for hospitalization and severe illness, one must recognize that a significant number of our children actually have comorbid conditions, and a non-inconsequential portion of children, who are infected with COVID-19 and suffer severe illness, have no comorbidities at all.
When we minimize the importance of our children’s risks during this pandemic, it demonstrates that we do not fully prioritize this vulnerable population. The data suggest that children are at low risk for morbidity and mortality from COVID-19, but they are not at no risk. Children are the future of our society. Every effort should be made to mitigate the adverse effects of COVID-19 in this population. While no protective intervention is a perfect defense against COVID-19, the measures such as wearing masks, washing hands, distancing, and vaccinating against COVID-19 can reduce the risk and severity of COVID-19 infection in children. The potential risks of the protective interventions themselves are far outweighed by their benefits. Statements such as “children don’t get as sick with COVID-19” and “only children with comorbidities get very sick from COVID-19” are misleading, diminish the value of our children, and cannot be used as a rationale to not implement protective measures to prevent our children from contracting COVID-19. Our society will be judged by future generations on how it protected one of its most vulnerable groups: children. Every child’s life is sacred, and no child should suffer or die from COVID-19. By saving one child’s life, it is like saving the world and preserving our future.
David Epstein is a pediatrician.
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