July 5, 2021

This is the common query among most of the parents as many media reports are suggesting that COVID19’s third wave will severely affect children.

Coronavirus disease-2019 (COVID-19), due to severe acute respiratory syndrome, coronavirus -2 (SARS CoV 2) infection is the biggest public health crisis of recent times. Wherein elderly tend to have severe disease, children are relatively spared till date.

Why children seem to be less affected by COVID-19 compared to older age group?

Following scientific evidence presently available suggest that it may not affect the children as predicted by a few media reports.

Immune systems of children and adults are different both with respect to their composition and functional responsiveness.

Looking at studies on various respiratory viruses, children were less susceptible to coronavirus group of infections like SARS CoV-1 (severe acute respiratory syndrome corona virus-1), MERS-CoV (Middle East respiratory syndrome coronavirus) and SARS CoV-2 (COVID-19) as compared to other viruses like influenza and RSV (Respiratory syncytial virus).

Covid-19 virus, enters our body through mouth and nose. There are protective mechanisms in children which do not allow the virus to enter easily and damage the lungs as it does in adults.

Trained immunity due to routine live vaccines against polio, measles, mumps, rubella, influenza and frequent viral infections, could be an important protective mechanism against SARS-CoV-2 infection in children.

BCG vaccination is associated with reduced viral infections, decrease in acute upper respiratory infection (URI) in elders and decreased mortality in under-5 children, but the protective effect of BCG against infections is unlikely to last beyond 1-2 years.

As coronavirus infections are common causes of URI (upper respiratory tract infections) in children, antibodies produced against other coronavirus infections can be protective against SARS-CoV-2.

Excellent regeneration capacity of paediatric alveolar epithelium (lung) could explain overall less severity and early recovery of COVID-19 in children compared to elderly patients.

Children less frequently have risk factors such as co-morbidities, smoking and obesity.

Spread of infection among children can easily be controlled by early closure of schools and day-care centres.

Fewer children were admitted to hospital and intensive care units (ICU) in the first two waves. It is only 0.1% children compared to overall 2.27% mortality among adults.

Due to greater upper airway resistance in children, aerosol particle deposit more in tracheobronchial tree than alveoli. This could lead to more bronchiolitis like infections and less pneumonia with SARS-CoV-2 infection in children.

Most of the infection among children, spread from infected adult family members. Among studies of household contacts, odds of infection in children were significantly less than elderly and gradually increasing with age.

These findings suggest that overall children are less affected and have milder illness than adults.

Most of the children recover following initial short flu like illness without progressing to critical phase.

Which children can be at risk?

Following group of children can be at risk. Parents need to take care of these children with utmost care till the pandemic is over.

Infants (children less than one year) with presence of prematurity, co-existing heart disease and recurrent uncontrolled wheezing.

Children with Neurological disorders, kidney diseases, pulmonary disorders including asthma, genetic disorders and cardiac diseases.

Children on immunosuppressive medication

Second hand smoking (passive smoking) could be a risk factor for children.

Ways to protect our children

Vaccination against COVID-19 of adults and children is the only key to prevent this disease.

At present, only adolescents above 18 years are recommended to be vaccinated as per the national guidelines. There are vaccine trials approved for children above 2 years. Hopefully, we will be able to vaccinate these children in the near future.

Proper use of masks, frequent hand washing, social distancing, and avoiding closed gathering including family functions are the best practices which should be followed strictly till this pandemic gets over.

Continue routine vaccination of your children as per the schedule, which will keep their immunity in robust status. Do not delay.

Avoid self-medicating your kids, always consult your doctor even in case of mild symptoms.

The possibility of a change in spectrum of paediatric diseases, as the pandemic evolves further, should also be kept in mind while upgrading our health infrastructure.

We can fight this pandemic together with knowledge and not fear.