Can we agree to abandon the notion that COVID in children is “mild?” At least, as a medical community? We are taught to look at the data and guide our patients based on evidence. And the fact is, in a single week in January 2022, nearly 1 million pediatric cases were reported according to the American Academy of Pediatrics. Since the detection of the omicron variant, COVID-19 cases among children have surged across the nation and pediatric hospitalizations have followed suit. Over 1,000 kids have already died from the virus in the U.S., 250 of them under five years old.
As a general pediatrician, I routinely see children with COVID. Infants and toddlers commonly present with croup-like symptoms—a barky cough and stridor; some respond well to supportive care and/or a single dose of steroids, but others need repeat doses and trips to the emergency department for racemic epinephrine nebulizer treatments. I also care for children who are symptomatic well beyond a week, often with prolonged fatigue and poor appetite. In a large online community of pediatricians, multisystem inflammatory syndrome in children (MIS-C), a known complication of COVID, has been reported in patients as young as a few weeks old. More recently, the infectious disease community has raised the alarm about concerning neurologic symptoms labeled post-COVID encephalopathy. And there is still much we have yet to learn about the long-term sequelae of the virus.
It is time for the existing narrative about COVID and its effects on children to be re-written. Even in the case of non-severe disease, managing a child’s respiratory and gastrointestinal symptoms while navigating confusing and rapidly changing quarantine and isolation guidelines, scrambling to find childcare and taking unpaid leave, or attempting to work from home is not to be diminished. This experience, especially when played on a loop, is stressful at best. Even more so for families with children under age five who remain ineligible for vaccination. Throughout this pandemic, especially since the omicron surge, parents of young children repeatedly tell us that they are not okay. Minimizing the virus and its ripple effects within a family unfairly invalidates the experience of many Americans. It also leads to complacency and directs us away from solution-driven discussions.
To be clear, this is not about “doom messaging” or “fear-mongering,” it is about acknowledging the challenges and struggles of our fellow citizens and choosing to respond proactively. So, I will ask again: can we collectively perish the thought that COVID in children is “mild” and work toward the common goal of supporting families with young children through this grueling pandemic? Can we become a country that truly values the well-being of children?
A crucial step toward this goal is expediting the approval of a safe and effective COVID vaccine for children under 5. I urge the medical and scientific communities, the U.S. Food and Drug Administration, the Centers for Disease Control’s Advisory Committee on Immunization Practices, the American Academy of Pediatrics, vaccine manufacturers, and the current administration to work together to finally make this a public health priority for our nation. This includes improving transparency, which has been severely lacking throughout the process thus far. Transparency about expanding trials and increasing study participants, the age de-escalation policy, expanded access, and the general timeline. Our children deserve this. They have been left unprotected and vulnerable for far too long.
Alpa Patel Shah is a pediatrician.
Image credit: Shutterstock.com
