Covid In Children
We have learned a lot this past year and it seems just as we learn something new about this novel Coronavirus it goes and changes on us! What we do know is that children can and do get Covid. They can get sick from Covid and can spread Covid even if they have no symptoms. Many if not most infected children are asymptomatic, but some children will require hospitalization, ICU stays, mechanical ventilation or even die. As of June 2021 there have been over 4 million cases of Covid in children in the US, which is about 14.5% of all cases.
Symptoms of Covid in children:
Cough and fever are the most common presenting symptoms. Other symptoms include sore throat, shortness of breath, runny nose, headache, muscle aches, fatigue, diarrhea, and loss of taste and/or smell. When reading this list, it sounds an awful lot like the symptoms of many other childhood illnesses, like Strep throat, the flu, even the common cold. When should parents suspect Covid in their children? Mask use, social distancing and virtual school have significantly decreased the incidence of other common childhood infections making Covid the most likely cause of any of these symptoms. If your child develops any of the symptoms listed above assume it is Covid until proven otherwise. This is the best way to protect the spread of Covid to others.
Risk factors for severe disease in children:
Most children will have asymptomatic or mild illness when infected with Covid. There are several populations of children who are at risk for more severe disease and a higher risk of death from Covid. These risk factors include babies under one year of age, children with asthma or other chronic lung diseases, diabetics, children with neurodevelopmental disorders, genetic disorders, sickle cell anemia, metabolic disorders, kidney disease, heart disease, and those immunocompromised due to medication or genetic disorder. Finally, obesity, which has been on the rise during Covid is a known risk factor for more serious illness.
What to do if your child develops Covid symptoms:
If your child develops any of the symptoms of Covid the safest thing to do is assume it is Covid, keep them home and get them tested as soon as possible. Protect family members by wearing masks, washing hands, and staying six feet apart. Notify your child’s school or daycare if you suspect Covid. Get immediate medical attention if your child develops trouble breathing, chest pain, confusion, lethargy, or blue lips.
Covid tests available:
There are several different types of Covid tests. The Rapid Antigen Test looks for the presence of Covid surface proteins in the nose and throat. Results are available in about 15 minutes. This is not the most accurate test, but it is a good screening tool. If a Rapid Antigen Test is positive, it means someone likely has Covid. However, negative tests are not as accurate. If your child is symptomatic a PCR test should also be done. The PCR test looks for the presence of Covid RNA. This is a nasal swab or saliva test and can take several days. This is the most accurate test for Covid. A Covid antibody test looks for the presence of antibodies in the blood, which our bodies make in response to an infection with Covid. This test can only tell us that someone was infected but does not tell us when or if that person is still contagious. Antibody testing is not recommended for making the diagnosis of Covid.
Treatment:
Treatment for most children with Covid is simply supportive care. All children with Covid should quarantine for 10 days from the positive test, even those who have no symptoms. Encourage rest and lots of fluids and give acetaminophen or ibuprofen for fever. Children who are hospitalized may need supplemental oxygen, may be put in the prone position (lying on their stomachs) and may receive steroids or blood thinners if warranted. At the current time monoclonal antibody treatments and antiviral medications are approved for people over age 12.
Multisystem Inflammatory Syndrome in Children:
Multisystem Inflammatory Syndrome in Children or MISC is a disorder that has been discovered in children since the onset of the pandemic in which there is widespread inflammation of multiple organs requiring hospitalization. It has occurred only in people under age 21 with evidence of a recent Covid infection or exposure to Covid. It is thought to be caused by post Covid infection immune deregulation, in which the immune system starts attacking its own body. As of June 28, 2021, there have been 4200 cases reported in the United States. The CDC is concerned about rising cases. Cases have more then doubled since the beginning of March 2021.
Symptoms of MISC include fever greater than 100.4F for at least 1-day, abdominal pain, vomiting, rash, pink eye, enlarged lymph nodes, cracked red lips, swollen hands and feet and lethargy. Diagnosis is made by meeting the following criteria: age less then 21, fever for at least 24 hrs., blood tests positive for inflammatory markers (such as ESR, CRP, ferritin, and D-Dimer), evidence of multi-organ disease and a positive Covid test or known Covid exposure.
Treatment is mostly supportive. Patients are admitted to the hospital, often to the Intensive Care Unit to be closely monitored. They may be given medications to blunt the immune response and often given low dose aspirin to prevent blood clots. Anti-viral medications and Covid monoclonal antibody treatments are not helpful. It is unknown what if any long-term complications may occur as a result of MISC. Currently it is recommended that all patients follow up with a pediatric cardiologist on a regular basis.
Covid vaccination in children
The FDA has approved 3 vaccines for emergency use. The Pfizer vaccine, the Moderna vaccine and the J & J vaccine. Pfizer vaccine is approved for children aged 12 and up. Moderna and J & J vaccines are approved for people aged 18 and up.
The Pfizer and Moderna vaccines are an mRNA vaccine which works by inserting instructions into our cells to make the Covid spike protein which our immune system then mounts a response to. The cells then destroy the instructions so there is no lingering mRNA in our bodies, no altering of our DNA, and no live viruses. The Pfizer vaccine is given as 2 doses, 3 weeks apart. Moderna is given as 2 doses, 4 weeks apart. Initial studies found the vaccines to be at least 95% effective at preventing Covid. Additional data shows about 65 % effectiveness against infection with newer strains, however severe illness is uncommon in vaccinated people. Side effects include soreness, swelling, or redness at the site, muscle aches, fatigue, chills, fever, headache, diarrhea, and vomiting. Myocarditis, which is an inflammation of the heart muscle has been reported following both the Pfizer and Moderna vaccines. Cases are most common in young males between the ages of 16-30 and typically occur several days after the second dose and present with chest pain and/or shortness of breath. All reported cases have been mild and have resolved without intervention. Myocarditis appears to occur in about 12 people per one million vaccinated. Both companies are in the process of conducting studies in children younger then 12. Pfizer is anticipating completing their trial for 2–11-year old’s by the early fall. Moderna expects to seek approval for children 12-17 by September. Moderna has a trial underway looking a smaller dose for children under age 12 and is expected to complete that study in the winter.
The J & J vaccine is a viral vector vaccine in which a piece of covid RNA that makes the spike protein is spliced into the RNA of a harmless virus. When injected the harmless virus makes the spike protein that our immune system mounts a response to. There is no altering of our DNA and no chance of getting Covid from the vaccine. This vaccine is given as a single dose. It is 66% effective at preventing Covid, however no hospitalizations or deaths due to covid have been reported in vaccinated people. Side effects include soreness/redness/swelling at the site. Fatigue, muscle aches, headaches, chills, fever, nausea are less common. Fainting at the time of vaccination is more common than with the other 2 vaccines. Very rare blood clots have occurred in women under age 50. There have been 100 reports of Guillain- Barre syndrome out of almost 13 million doses given prompting the FDA to issue a warning about the rare risk of Guillain-Barre following vaccination. Guillain-Barre is a rare disorder where the immune system attacks nerves causing muscle weakness and in extreme cases paralysis. Clinical trials for children aged 12 and up are expected to be completed in the early fall.
Much has changed since the onset of the Covid pandemic over a year ago, not the least of which is that the virus itself has changed and will unfortunately continue to change until it can no longer find people to infect. We have seen this virus evolve and become more contagious in younger populations, especially those that are unvaccinated. It is extremely important for unvaccinated children to continue to wear masks and socially distance themselves from others. The safest way for unvaccinated children to play together is outdoors. When eating they should stay at least 3 feet apart. Continue to encourage them to practice frequent hand washing. Finally, when available get your child vaccinated.