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COVID-infections in children: What do we know?

Julia Vergin
March 12, 2021

COVID-19 cases in children are rare and usually less severe than in adults. But it's not clear how new variants might change this, and whether there'll be a vaccine suitable for children anytime soon.

A green virus plushie in an elementary school
Schools in Germany have partially reopened, but experts are concerned about the COVID risk for childrenImage: Peter Kneffel/dpa/picture alliance

"The number of cases among the under-15-year-olds is rising sharply," Lothar Wieler, president of the Robert-Koch-Institute, Germany's disease control and prevention agency, said in a press conference with Health Minister Jens Spahn on Friday.

There are signs that the B.1.1.7 variant first discovered in the UK is a driving factor behind the growing number of outbreaks in kindergartens, Wiehler added.

The news comes just as schools and kindergartens are starting to either fully or partially reopen in Germany ― which is why Johannes Liese, head of pediatric infectiology and immunology at university hospital Würzburg, says he isn't exactly surprised by the rise in cases.

"Of course there are more transmissions when we open schools and kindergartens," Liese told DW. He is researching how COVID spreads in preschools and kindergartens. The results of his study are currently being evaluated.

"So far the kindergarten population was exempt from the virus," ge explains. But now, more and more young COVID-19 patients are showing up at the university hospital in Würzburg. Liese, just like Wieler, believes that the British variant is to blame.

A wooden toy-truck in a kindergarten
Shortly after children in Germany fully returned to kindergarten, the number of COVID infections in young patients increasedImage: Sina Schuldt/dpa/picture alliance

COVID-19 prevalent among adults

So far, after one year of the coronavirus pandemic, the takeaway has been that "children catch COVID-19 less frequently and have milder cases," said Markus Knuf, director of the children and youth clinic at the Helios Dr. Horst Schmidt Klinik in the central German city of Wiesbaden and a board member with the German Association for Pediatric Infectiology (DGPI). The DGPI has initiated a registration system for children's hospitals so that COVID cases in children and youth that require hospitalization can be collected nationwide.

"Until March 7, 2021, there have been a total of 1,051 children who required hospitalization," Knuf told DW. "Only 5% of these young patients had to be admitted to the intensive care unit."

It's mostly the youngest kids that are hit hardest, he added. "Almost two thirds of these patients are babies and toddlers." Roughly 30% have a pre-existing condition, Knuf said, for example respiratory diseases.

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Even though not all hospitals in Germany participate and thus not every child hospitalized with COVID is recorded, one thing is becoming clear when looking at the comparatively low number of affected children: COVID mainly hits adults. During the second wave in December 2020, 11,564  were hospitalized in a single week. That's more than 10 times the total number of children who've been entered into the DGPI's registration system so far.

Kawasaki-like syndrome is rare

Most children leave the hospital almost as good as new after they fought the infection. "Contrary to what we see in adults, there are only few children who struggle with long-term effects," Knuf said.

There's a second registration system on the DGPI website for severe COVID cases, which can also occur in children. The "Pediatric Inflammatory Multisystem Syndrome" (PIMS) is characterized by multiple symptoms that stem from inflammations. It manifests similarly to Kawasaki disease, which results in a fever and comes with inflammations of the arteries. 

So far, a mere 223 children with the disease have been recorded in Germany. Their prognosis is quite a bit darker. Less than half of these young patients leaves the hospital fully recovered, according to Knuf. "Around 10% are left with long-term effects."

It's not clear yet what kind effect the B.1.1.7 variant will have. But experts say COVID-19 may well not remain an "adult" disease.

'Scandalous' lack of protection

Knuf and Liese regret that there is no child-approved vaccination on the horizon at this time.

"We have large groups of actual high-risk patients among children, like preemies or children with trisomy 21," Knuf said, adding that there are no prevention strategies to keep these patients safe. "I find that almost scandalous!"

Baby getting vaccine shot
Children can be vaccinated against a number of illnesses like measles and whooping cough, but so far, there's no COVID shot in sight for them.Image: Hans Wiedl/dpa/picture alliance

Liese is in favor of a vaccine for children ― not just so that the individual child is protected from a potentially severe course of the disease, but also to stop the spread of COVID-19. He believes schools and kindergartens should remain open, even though the bad news shared by the Robert-Koch-Institute in Friday's press conference could mean that everything will have to be shut down again soon.

"We need free, regular tests in schools and an adherence to the hygiene rules," Liese said. And accelerated research into finding a vaccine that can be given to children sooner rather than later.

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