Coronavirus in children

Overview

• Risk of contagion through children: Children seem to be just as contagious as adults.
• Corona symptoms in children: Cough, fever, runny nose, general feeling of illness, sore throat, shortness of breath, gastrointestinal complaints, pneumonia; Children with covid often show no or only one symptom.
• Development of the disease: 43 percent of 0 to 5-year olds are infected without symptoms, 57 percent show only one symptom. The severity of the disease is milder than in adults.
• Consequences of the infection: Long Covid (Post-Covid Syndrome), some children develop the multi-inflammatory disease PIMS.
• Risk factors: Heart and lung diseases, children under one month of age.
• Protection against infection: vaccination (approved in most countries from twelve years of age), keep your distance, hygiene measures such as correct and thorough hand washing, everyday life with a mask. Reduce contacts, meet in fresh air environments or well-ventilated rooms.

How contagious is the coronavirus in children?

Children seem to be just as contagious as adults. This is shown by the data of a current study. The virologist Christian Drosten from the Berlin Charité and his colleagues evaluated the data of 25,000 Covid-19 patients. They determined the viral load of all patients and thus the risk of infection.

Effect of Corona Mutations on Children

How does the UK (Alpha) corona variant affect children? Since the coronavirus mutations have also spread in Germany, more young people have fallen ill there too. In the third wave of the coronavirus pandemic, the under-15 age group was the second most affected. Most of the positive tests came from the 15- to 34-year-old age group.

A study from the UK compared the infection rate of the original coronavirus variant with the British Alpha mutation (type B.1.1.7) even before the population was protected by vaccination. The result shows that overall, more people are infected with the coronavirus – regardless of age.

However, children are also least affected by this coronavirus mutations. Kindergarten and elementary school children have so far been less likely to fall ill than infants or older children.

Overall, even with the British mutation, children become less seriously ill – and only a few have to be hospitalised. A severe or even fatal development of the disease is also very rare with the British virus mutation.

Note: Children with certain previous illnesses are at a higher risk of developing the disease more seriously – regardless of the type of mutation.

Corona: symptoms in children

Children with covid often have different symptoms than adults. This makes the infection harder to spot. Covid-19 causes the following symptoms in children:

• cough
• fever
• general feeling of illness
• Sore throat
• Shortness of breath ( dyspnoea )
• Gastrointestinal complaints
• Inflammation of the lungs (pneumonia)

Coughs, runny nose and shortness of breath occur less often in children than in adults. On the other hand, children with covid suffer more often from gastrointestinal complaints.

Note: A significant proportion of children and adolescents only show a single symptom of the coronavirus infection.

Depending on the age group, the symptoms of the disease vary in frequency. The following table shows the recorded covid symptoms in children and adolescents during the first wave in Germany:

symptom	0-4 years	5-19 years
to cough	40%	42%
fever	48%	34%
sniffling	23%	30%
General signs of illness	18%	30%
Sore throat	8.5%	8.5%

Symptoms in children are harder to recognise than in adults. If your child shows any of the listed complaints, they should stay at home and not go to school nor day-care. It is important to remember not every child who has a cough has Covid-19. Let your doctor or paediatrician clarify the symptoms – preferably by phone first.

Development of the disease in children

Many children have Covid-19 with mild or no symptoms. According to the Corona-KiTa study, around 43 percent of 0 to 5-year-olds show no signs of illness. More than half (57 percent) of children ages 0-5 experienced at least one symptom. The development of the disease in children is, therefore, less severe than in adult patients.

However, coronavirus infection in children can also be severe. In rare cases, children also need to be treated in a hospital. Children with severe Covid-19 usually suffer from fever and general symptoms.

In infants, the disease is more severe, for example, with loss of appetite. In addition, there may be an infection of the upper respiratory tract with coughing, runny nose or shortness of breath. In rare, severe cases, children develop severe diarrhoea, pneumonia and even lung failure.

Note: If your baby or toddler is infected with the coronavirus and is showing severe symptoms, see a doctor straight away.

Long Covid / Post-Covid in Children

With the increasing number of infections in children, more and more long-term consequences are observed after infection. Two clinical pictures are known. Like adults, children can also suffer from long covid (also: post-covid syndrome). Despite the infection subsided, the following occurs:

• Exhaustion
• Difficulty concentrating
• Muscle and limb pain
• Sleep disorders
• Shortness of breath
• Palpitations

Long Covid does not only occur after a serious illness. Children who have had few or no symptoms can also be affected. That makes diagnosis difficult. How many children are affected by long-term consequences after the coronavirus infection is still unclear.

Multi-inflammatory disease: PIMS

In rare cases, children develop complications during coronavirus infection. One of them is PIMS (“paediatric inflammatory multisystem syndrome”). This is a multi-inflammatory disease that affects children.

The immune system is probably directed against the body’s own structures. Those affected develop severe abdominal pain and persistent fever. Some also develop toxic shock syndrome (TSS).

Note: If your child develops a high fever after a coronavirus infection, you should see a doctor immediately.

The combination of PIMS and TSS is similar to Kawasaki syndrome. This has already been observed in children in connection with other infectious diseases. The majority of those affected require intensive medical care. As a rule, the clinical picture is easy to treat. However, the condition can cause lasting damage. For example, heart disease or changes in the gastrointestinal tract, skin, mucous membranes and lower respiratory tract can occur.

Corona: risk factors in children

Among the children who had such a severe Covid- 19 infection that they had to be hospitalised, 15 percent suffered from lung diseases and eight percent from heart disease. Signs of lower respiratory infection are also considered risk factors for serious illness and intensive care treatment.

The age of the sick also plays a role: A Europe-wide study has shown that children under one month of age also have an increased risk of a severe infection of the disease.

Corona vaccination for children

Although children get sick less often than adults, vaccination can be useful in many cases.

Corona vaccination for children

Since May 28, 2021, the vaccine Biontech / Pfizer vaccine has been approved for children and adolescents aged twelve and over in Europe. The European Medicines Agency (EMA) has given the go-ahead for immunisation, as it also protects children between the ages of 12 and 15 from Covid-19 disease.

More than 1,000 children and adolescents vaccinated had no Covid-19 disease, according to a study in the New England Journal of Medicine. For comparison: In the unvaccinated and roughly the same size control group, there were 16 Covid-19 infections. After the vaccination, mostly minor side effects such as tiredness and headache occurred.

STIKO recommends vaccinations from the age of 12 only for previously ill children

For the Standing Vaccination Commission (STIKO), however, the proven benefits of vaccination for children and adolescents are not sufficient. The STIKO recommends vaccinations for 12 to 16-year olds only for adolescents with previous illnesses, i.e.:

• Obesity
• Congenital or acquired immunodeficiency or relevant immunosuppression
• Severe cyanosis
• severe heart failure or severe pulmonary hypertension
• Chronic lung diseases, with persistently impaired lung function
• Chronic renal failure
• Chronic neurological or neuromuscular diseases
• Malignant tumour diseases

Influenza protection for the sick

Children with a chronic illness, such as bronchial asthma, can get a preventive flu vaccination. The STIKO recommends annual vaccination against influenza.

The vaccination does not offer any protection against Sars-CoV-2, but it can prevent a dangerous double infection. A simultaneous infection can quickly put life in danger, especially for risk groups.

The RKI, therefore, recommends the annual flu vaccination in autumn and winter for all risk groups. Immunity to influenza can prevent the flu or weaken its course. The immune system can then concentrate on defending itself against the coronavirus.

Keep Distance: Children should also keep a distance of at least 1.5 meters from other people – even when playing with friends. While this is easier said than done, it is a great way to reduce the risk of infection

Observe hygiene rules: Regular and thorough hand washing protects against infections. Sneezing and coughing – namely in the crook of your arm or in a handkerchief – also protects other people from viruses. A hand disinfectant also kills pathogens effectively.

Everyday life with a mask: Children and adolescents from six to 16 years of age have to wear a medical mask in public spaces such as in school, in the supermarket or public transport. Surgical masks and FFP2 masks are permitted. The mouth and nose cover prevents the viruses from spreading further.

Washing hands properly: Washing hands protects against flu, colds, gastrointestinal infections. But only if you do it properly.

Fewer contacts: It is advisable to limit the number of contacts with other people. For example, reduce your child’s meetings to one or two friends. It is best to let your child decide which contacts are most important to them. Your offspring can talk to other friends over the phone or virtually.

Conclusion

Vaccinating children is routine and widely accepted – measles, mumps, polio, diphtheria, rotavirus, multiple strains of meningitis, whooping cough… the list goes on. All this starts from just a few weeks old.

So, what about Covid-19?

Some countries are moving ahead- the US has already immunised around 600,000 children, aged between 12 and 15. It expects to have enough safety data to go even younger next year. The UK is rattling through the adults – who should all have been offered their first dose by the end of July – but has yet to come to a decision on children. There is a scientific question – will vaccinating children save lives? – which is complex as the answer may vary from country to country. There is also a moral and ethical dimension if doses destined for children would save more lives if they were given to health workers and vulnerable adults in other countries where vaccines are still in short supply.

While the United Arab Emirates (UAE) has initiated a Sinopharm “immune bridge study” for children aged three to 17 years. The UAE is the first country in the Middle East and North Africa region to conduct a study of the vaccine’s effectiveness for this age group. Vaccinating children will protect them and preserve the health of those around them, as well as accelerate herd immunity needed to curb the spread of the virus.