The New York Magazine article on the risks to children from COVID-19 is accurate, but it would be helpful to have more context regarding the difference in risk between young and older children.

CLAIM

In children, “the mortality risk from COVID-19 is actually lower than that from the flu. The risk of serious illness or hospitalization is about the same.”

DETAILS

Exact: In general, children are at a lower risk of hospitalization and death from COVID-19 than adults.
Lack of context: As a population, children can span a wide range of ages. The article lacked nuance as to the age group it was referring to when discussing infant mortality risks. For example, the risks of COVID-19 faced by very young children are different from those faced by adolescents. Virus variants, like Delta, can also change the level of risk children typically face from COVID-19.

KEY TO GO

Overall, children are at a lower risk of serious illness and death from COVID-19 than adults. Compared to the risks of influenza, very young children indeed have a lower risk of death and hospitalization due to COVID-19. However, the same is not true for older children like adolescents, whose risk of hospitalization due to COVID-19 is higher than that of very young children. Long COVID, a condition in which people infected with SARS-CoV-2 continue to show signs of illness even weeks and months later, has also been documented in children. Definitive information regarding the prevalence of long COVID in children is lacking, but research is currently underway to answer this research question.

COMPLETE CLAIM: “[A]In children, the mortality risk from COVID-19 is actually lower than that from influenza. The risk of serious illness or hospitalization is about the same […] the children themselves are not at risk and never have been. » ; “A subset of long COVID research linking disease severity to the likelihood of persistent symptoms implies that the risk may be significantly lower in children than in the general population.”

REVIEW

On July 12, 2021, New York magazine published an article by journalist David Wallace-Wells, titled “Kids are fine: Why now is the time to rethink COVID safety protocols for children – and everyone else.” The article discussed the lower risks of hospitalization and death that children face from COVID-19 compared to adults. The article proved popular on social media platforms and has racked up more than 23,000 Facebook engagements to date, including more than 4,200 shares, according to social media analytics tool CrowdTangle.

Experts who reviewed the article’s scientific credibility found it to be generally accurate, although some instances in the article required more context for readers to understand the caveats of certain claims made in the article. article, in particular the different levels of risk faced by children. of different ages and our still incomplete understanding of the long COVID. [See scientists’ full comments.]

Alasdair Munro, a pediatrician and senior clinical research fellow at the University of Southampton, told Health Feedback that “These are controversial issues, but there is nothing incorrect or misleading in the article.” He agreed with the author that “there is no doubt about the low risk of mortality and severe disease in children”, but also pointed out that “comparisons with other infections are difficult due to poor or inconsistent data”.

William Hanage, associate professor of epidemiology at Harvard TH Chan School of Public Health, agreed with the author that the risk of death from COVID-19 is lower than from influenza, but that it comes with caution. “That may be true for the younger age groups, under the age of about 5,” he said, given that influenza is a disease that disproportionately affects the very young and the elderly. very old. But “the situation is different in older children, and especially adolescents,” he warned.

Indeed, a study by the United States Centers for Disease Control and Prevention (CDC) found that children aged 12 to 17 had a lower rate of hospitalization than adults, but higher than children aged 5 to 11 years old.[1]. About a third of hospitalized teens had no underlying medical condition.

Long COVID, a condition in which people infected with SARS-CoV-2 continue to show signs of illness even weeks and months later, has been documented in children. Some of these persistent symptoms include shortness of breath, fatigue, and cognitive problems. Both Munro and Hanage agreed on the still early stages of research on long COVID, particularly regarding its prevalence in children, which means there is not enough information to time to draw definitive conclusions.

While this review was being written, a study in the UK was published using self-reported data from a mobile app to monitor symptoms. Among 1,379 children aged 5 to 17 years who had a symptomatic infection, 1.8% had symptoms lasting at least 56 days. The study thus concluded that long COVID in children is “rare”[2].

The question of balancing the benefits and risks for children of protective measures against COVID-19 has been controversial during the pandemic. This is particularly the case with lockdowns and school closures, which have been put in place to reduce the spread of the virus, but which can negatively affect a child’s development.

In general, pediatricians agree that the benefits of in-person learning outweigh its risks. The CDC also states that “students benefit from in-person learning and the safe return to in-person instruction in fall 2021 is a priority.”

The question of protective measures to be implemented in schools has therefore become critical, given the increased transmissibility of the Delta variant and the fact that children under the age of 12 cannot receive COVID-19 vaccines for the disease. moment and are therefore vulnerable to infection. This issue is also divisive, as some parents oppose measures such as requiring their children to wear masks.

The CDC recommends wearing a mask indoors for anyone over the age of two, and the American Academy of Pediatricians recommends that children wear masks to reduce the spread of the virus, especially to protect children under the age of 12 years old, who are not vaccinated. But it’s still largely up to schools to decide whether or not to follow this recommendation, and some states have banned mask mandates for schools altogether.

Some hospitals in the United States have seen a spike in child hospitalizations for COVID-19[1], although it is not clear if this is because the Delta variant, now the dominant strain in the United States, is more likely to cause severe disease in children. The spike could simply be because young people now account for a greater proportion of infections and because those under 12 are still unvaccinated.

FEEDBACK FROM SCIENTISTS

Alasdair Munro, Senior Clinical Research Fellow in Pediatric Infectious Diseases, University of Southampton:
These are controversial issues, but there is nothing incorrect or misleading in the article. The low risk of mortality and severe disease in children is beyond doubt, although comparisons with other infections are difficult due to poor or inconsistent data on other diseases. This is perhaps the only thing that could be clarified in the article.

The article correctly highlights the inconsistencies in the field of research on post-acute symptoms of COVID-19 in children. People will see these risks from a different angle depending on their background (including political).

William Hanage, Associate Professor of Epidemiology, Harvard TH Chan School of Public Health:

Excerpt from the article:[A]In children, the mortality risk from COVID-19 is actually lower than that from influenza. The risk of serious illness or hospitalization is about the same […] the children themselves are not at risk and never have been.

This may be true for the younger age groups, around the age of 5. This is because the risk of serious consequences from the flu increases in this age group – the flu is worse at the extremes of age: the very young and the elderly. The caveat is that I don’t know how the new variants affect this age group. I don’t think they would make it worse, but that evidence should be collected. However, the importance of preventing infections in this age group stems more from their ability to transmit them to others. As vaccinations become very high, the importance of infections in this age group will decrease.

The situation is different in older children, especially adolescents.

From the article: “Some surveys have shown alarming numbers, but those finding long COVID in around a third or even half of those infected are almost certainly overestimated, and those suggesting 10% may well be too – since some of the symptoms being counted appear at the same rates among those who have never had COVID.

Long COVID is very difficult to study due to a lack of good control groups etc, clinical definition etc. That said, I don’t buy this argument solely on the basis of its quality. The correct assertion that the evidence base is not strong does not mean that reality necessarily supports the author’s position.

From the article: “A subset of long COVID research linking disease severity to the likelihood of persistent symptoms implies that the risk may be significantly lower in children than in the general population.”

I don’t see what that refers to. But it contains the “subset”, “implies”, and “may” red flags. Note that I am not passing judgment on whether the risk is actually lower than the population as a whole, only noting that you can’t come to a solid conclusion based on this evidence.

THE REFERENCES

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