COVID and kids
Disparate strategies point to need for vaccine

By Richard Sternberg M.D.

The amount of information regarding COVID in children and the risks and benefits of vaccination is overwhelming and as reported even varies from country to country.

There is no clear-cut consensus on anything in the younger age groups other than that the risk of developing a case requiring treatment, hospitalization, or leading to death is lower if the patient is younger. Still, the risks of vaccine complications in the very young have so far been trivial, with no deaths or hospitalizations in pre-clinical studies reported in the United States.

There have been arguments back and forth about vaccinating children and how young to go with this. Arguments against vaccinating children and the risks or benefits of not opening schools include more varied opinions from mainline physical and social scientists than do those regarding vaccinating adults; those clearly show that benefits to older age groups leave no room for considering avoiding vaccinations except in clearly stated situations.

Nevertheless, the preponderance of data and researchers’ opinions ultimately show that the benefits of vaccinating the young still heavily outweigh the risks for the individual and additionally significantly protect older generations of their families. The young, and anyone previously vaccinated, can get the disease, never show symptoms, and still transmit it — though the vaccinated have lower viral load and seem to clear the virus more quickly.

In the United States last week, some 900,000 children between the ages of 5 and 11 received the pediatric version of the Pfizer vaccine (one-third the dosage of the adult version). This week, there are already more than 700,000 scheduled to be vaccinated. More than 20,000 sites nationally give shots to children aged 5 to 18. Some 28 million youngsters are eligible.

Polls show that only a fraction of parents plan to get their children vaccinated immediately. Many want to wait and see how things go, some are adamant that they are never going to allow their children to be vaccinated. In the U.S. in the last year alone, there were 2 million cases of documented
pediatric COVID-19, from which there were 66 deaths documented to be due to COVID and not to other concomitant illnesses.

Plans for rolling out vaccines for children and adolescents vary throughout the world. Some of this is due to availability, some to different countries’ analyses of the situation. Many countries are waiting to see results of the United States rollout.

Mexico currently has no plans to inoculate those under 18. The country’s president accused the drug companies of pushing the vaccine on the young to make more money. In China and some South American countries, children as young as three are being vaccinated. Other countries say limiting the risk of Long COVID and other complications — as well preventing spread to the elderly and other more vulnerable — outweighs the risk of rare vaccine side effects. Colombia’s Health Minister stated that children are vaccinated for diseases less dangerous than COVID-19 and the number of children who have already died of the disease is not insignificant. Throughout Europe, the current recommendation is to vaccinate children 12 and older, though younger children with risk factors are also getting the vaccine. In Great Britain, 12-15 year-olds are getting vaccinated with a single dose of the Pfizer vaccine; in the European Union, those 12 and older receive two doses of either Pfizer or Moderna.

In Israel there is a great deal of debate in vaccinating those younger than 11, despite rapidly vaccinating most of their population before anyone else. China states that vaccinating as young as three is necessary for herd immunity. Cuba and Venezuela vaccinate as young as two. Many African countries are not vaccinating those under 16, but this is because they haven’t had enough vaccine to inoculate their most valuable.

In England, which has a much better handle on medical records because almost 100 percent of the population is treated by the National Health Service, out of 3,105 deaths in children and adolescents between March 2020 and February 2021, 61 were SARS-CoV-2 positive. Of those, a panel of physicians determined that 44 of those cases COVID was incidental and in 25, death was caused by COVID.

Underlying co-morbidities were considered the main risk factor for death.

Therefore, of all deaths in children in England during that period, 0.8% were caused by COVID. There was no information regarding long-term symptoms or complications from the infection. Children who died of SARS-CoV-2 were older than the average of this group, and all of those with MIS-C were between 10 and 14 years old. The mortality rate was 0.2 per 100,000 of all children in this group versus 25.5/100,000 for all causes. This does not include neonatal deaths in total but no neonates died from COVID.

Currently in the U.S., cases per day and rolling averages are increasing and this is of concern to public health officials — because cases are assumed to increase because of the upcoming holidays as they did last year.

Scientists estimate that 10 to 30 percent of COVID survivors will have Long COVID. This is defined as when one has symptoms that otherwise cannot be explained greater than four weeks after initial infection. Long COVID is now also being call PASC, Post-Acute Sequelae of SARS-CoV-2 infection. Potentially fourteen million people have this in the U.S, according to the American Academy of Physical Medicine and Rehabilitation. Long COVID is now an official disability under the ADA (Americans with Disabilities Act).

It is clear that there is no international consensus on what to do but in the majority of countries with adequate supplies of the vaccines, the recommendation is to vaccinate children.

Dr. Richard Sternberg, retired Bassett Hospital orthopedic surgeon, is providing his professional
perspective during the COVID-19 threat. Also a village trustee, he lives in Cooperstown.