COVID Wave That Hits Children Hardest Is Headed to the U.S.

David Axe | The Daily Beast | Mar 28, 2022

The United Kingdom is a month into its latest surge of SARS-CoV-2 infections. It’s not nearly as lethal as previous COVID-19 surges. But that doesn’t mean it’s no big deal.

The new wave of cases in the U.K., which is part of a wider wave across Europe and Asia that’s driven by the new BA.2 subvariant of the Omicron variant of the novel coronavirus, is disproportionately affecting children.

More pediatric cases. More hospitalizations. And possibly more long COVID, the poorly understood syndrome characterized by fatigue, brain fog, and other symptoms that can linger months or years after infection clears up.

Experts disagree on exactly how dangerous BA.2 is for kids. But they agree on the underlying factors that have driven increases in cases in younger people. Edwin Michael, an epidemiologist at the Center for Global Health Infectious Disease Research at the University of South Florida, blamed the U.K.’s spike in pediatric COVID-19 on “low vaccination rates in children and full reopening of not only schools but the whole society from prior to Christmas.”

Under-5s are the only age group in the U.K. that isn’t authorized for the vaccines. This same age group is also uniquely vulnerable to viral transmission at home. “Since children are dependent on their caregivers, it is very difficult to isolate an infected household member effectively,” Carlos Oliveira, a Yale Medicine pediatrician, told The Daily Beast. “It is also challenging to have young children consistently wear masks or maintain social distancing.”

Those factors are hardly unique to the U.K. That means that other countries, including the United States, should expect a whole bunch of sick kids once the BA.2 wave crashes on their shores.

Scientists first detected BA.2 last fall during the initial Omicron surge. The subvariant is highly mutated–even more so than BA.1, the first major Omicron subvariant to become dominant. Some experts described BA.1 as the most contagious respiratory virus they’d ever seen. BA.2 is even worse.

So it was inevitable that BA.2 would eventually outcompete other variants and subvariants and become dominant, with a commensurate surge in cases. Sure enough, BA.2 swept across Hong Kong and neighboring Shenzhen in China earlier this year. It then flooded into Europe, including the U.K.

The numbers tell the story. The U.K.’s BA.1 surge peaked in early January with a weekly average of 180,000 daily new cases then crashed, fast. By late February, the weekly average of daily new infections was just 40,000.

Then BA.2 arrived. Cases spiked again—to a recent peak of 125,000 daily new cases. Thankfully, a combination of vaccinations and natural immunity from past infection blunted the worst impacts of both Omicron subvariants. Three-quarters of the U.K.’s 67 million residents are fully vaccinated and more than half are boosted.

So hospitalizations and deaths didn’t increase nearly as much as cases did during both the BA.1 and BA.2 waves. On the worst day of BA.1 on Feb. 2, 535 Britons died with COVID-19. Compare that to the worst day of the surge in cases attributed to the earlier Delta variant back in January 2021, when 1,820 U.K. residents died.

But it hasn’t been all good news. Among the thousands of BA.1 and BA.2 patients, U.K. health officials have noted a growing proportion of younger people. Between late December and mid-January, the number of kids 17 or younger admitted to the hospital for COVID-19 swelled threefold to an average of 120 per day.

“Further analysis by age group shows that the rise is most rapid among children under 5 years, and highest in infants aged under 1 year,” the U.K. Health Security Agency stated in a Jan. 14 briefing. Kids now account for a higher proportion of COVID-19 patients than ever before in some countries.

According to the U.K. Office for National Statistics, 2-to-11-year-olds had the highest rate of infections of any age group in the country as of early March, with 4 percent testing positive during the week ending March 5.

That makes sense. While children generally have stronger immune systems than adults, they also come with unique lifestyle factors that can erase the benefits of a better immune response when it comes to COVID-19. They go to school—and schools have been wide open and largely unmasked in the U.K. and many other countries for months now. They also visit friends and extended family and travel with their parents.

“I do think that this increased rate of pediatric patients being hospitalized is due to more contact with people and to lower vaccination rates in this population,” Cindy Prins, a University of Florida epidemiologist, told The Daily Beast. “I think that it’s not just the reopening of schools that is causing more exposures among children, but also may be due to families participating in more activities, like travel and social activities.”

And kids have also been the last to get authorized for the vaccines, owing in part to the need to do additional trials focused on younger subjects. The U.K. authorized the vaccination for 12- to 17-year-olds last August, nine months after approving the leading vaccines for adults. Authorization for 5- to 12-year-olds followed in February, but only vulnerable children in that age group have been offered vaccines so far. Under-5s still don’t have the green light.

Even among kids who are cleared to get the vaccines, vaccine uptake has been awful. In the U.K., just a quarter of 11- to 15-year-olds are fully vaccinated.

The fear isn’t necessarily that thousands of children are going to die from COVID-19 in the U.K. and other countries as BA.2 runs its course. All COVID-19 variants and subvariants tend to cause minor illness in younger people with their tougher immune systems and fewer comorbidities. “Pediatricians are not reporting Omicron to be a more serious or severe disease in children and young people in the U.K.,” the U.K. Health Security Agency said.

The main worry is long COVID. Even if it doesn’t kill them, SARS-CoV-2 could make a lot of kids very sick for a very long time.

As many as half of all adults who catch SARS-CoV-2 deal with some form of long COVID.

Long COVID in adults tends to manifest as lingering fatigue and confusion, and sometimes a cough. There’s also risk of long-term damage to the heart, lungs, and brain.

It’s not clear whether children are at the same risk. Up to one-third of kids who had COVID-19 could suffer long-term symptoms, according to the University of California-Davis pediatrician Dean Blumberg.

Emphasis on could. There haven’t been many high-quality studies on long COVID in children, ones that feature a good control group for comparison between kids with COVID-19 and those who are COVID-free. That lack of good scholarship makes Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, reluctant to draw firm conclusions about the danger long COVID poses to kids. “We need to figure this out better,” Offit told The Daily Beast.

Other experts are less reluctant. Oliveira cited a long list of long COVID symptoms he’s seen in children. The worst outcome for kids, post-COVID, is an inflammatory disease called Multisystem Inflammatory Syndrome in Children, or MIS-C.

“This inflammatory condition is rare, occurring in approximately one out of 3,000 infections, yet it is quite severe, often leading to injury in multiple organs like the heart, kidney, and liver,” Oliveira said. “Fortunately, most recover with aggressive immune therapy, though some children with MIS-C can have lingering cardiac and neurocognitive issues.”

It’s going to take more time and more study to clarify exactly how at-risk children in the U.K. and other countries are as BA.2 and other recent novel-coronavirus subvariants put more and more young people in the hospital.

Studying long COVID in under-5s is particularly difficult, Oliveira said. “Because pre-school children tend to be less verbal, it has been difficult to characterize the extent of symptoms post-infection.”

“I’m also concerned about the more long-term consequences of infection that may not show up for many years and may cause chronic health problems as these children age,” Prins chimed in.

While we wait for more data, the potential for disaster might only grow. “From a policy perspective, governments need to ensure that they can reintroduce mitigation and surveillance measures if and when a new variant of concern emerges,” Duncan Robertson, a policy analyst at the U.K.’s Loughborough University, told The Daily Beast. But there doesn’t appear to be any political will in the U.K. or other rich countries to close schools again. Mask mandates are becoming unpopular, too.

And there’s no rush to authorize vaccines for under-5s. The U.S. Food and Drug Administration appeared to be ready to authorize shots for the youngest kids back in February before abruptly changing course and calling for more data.

So it should come as no surprise if kids continue to account for a growing share of COVID-19 hospitalizations on both sides of the Atlantic Ocean. They’re mostly unprotected by vaccines and are mixing it up at school and on vacation while the most contagious subvariant becomes dominant in more and more countries.

“Politicians and governments are trying to downplay this as they are desperate to keep economies open,” Michael said. “This generation might pay for these types of policies with their health later in life.”

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*Children under 5 are now eligible for the COVID-19 vaccine (as of June 2022).