Everything you need to know about Coronavirus (COVID-19) in infants and children

Can infants and children catch COVID?

Even though the infection rates of COVID are similar in children and adults, we need to keep in mind that the severity of infection in children is not like it is in adults.
Even now, after many million of children were reported to have tested positive for COVID-19 since the start of the pandemic in the US (and I reckon the real number is probably double that), morbidity in children remains very low.
We have learned, over the past few years, about a new inflammatory disorder that develops in children after they have contracted COVID. See more about it below.
We have also learned about Long-COVID, which I will also write more about below.
We have learned that children may be harmed from the impacts of COVID in indirect ways, and that that this was probably what has affected them the most.
So please, read this chapter all the way to the end, and remember – it’s not like there hasn’t been or will never be any moderate-to-severe COVID-19 infections in children, but it is becoming more and more obvious now that these cases are rare and exceptional, and that they do not represent what is happening in the general population.

How many infants and children have had COVID-19?

Over 15 million COVID-19 cases have been reported in children in the US, most of which were asymptomatic or had very mild disease. Many of these children were found positive when screened for COVID-19 following exposure to someone who was ill (an older family member or a school classmate, for example), and not because they were showing any symptoms.
So many reported cases and such a small number of children who were actually ill?
Yes, yes, most of these children who tested positive were completely asymptomatic.

Why has the severity of the infectious illness decreased?

We don’t have a solid, scientifically-proven explanation.
Science expected an opposite effect in children, where children would be the more vulnerable population, just like they are more vulnerable when it comes to influenza virus, for example. What are the possible explanations to this?
One possibility is that the inflammatory reaction to viral illnesses, which is generally different in children when compared adults, is weaker in adults. This hypothesis has been demonstrated in the past through specific immunological mechanisms associated with other viruses from the coronavirus family and therefore I assume that similar mechanisms will eventually be discovered that will explain things for the new coronavirus.
An additional possibility, and one that is probably simpler to grasp, is that the sicker you are – the less healthy, too. What I’m trying to say is that this virus will cause more harm in people with underlying medial conditions, which is something that is less common in children.
Nonetheless, we still do not have a scientifically proven answer to this intriguing question.

What is the inflammatory syndrome (PIMS) that has been described in children who have had COVID-19?

In May 2020 we started hearing about a new disease in children. A severe syndrome that can occur in all ages (and sometimes even in the third decade of life) after a person has contracted COVID-19. It is not the respiratory illness that occurs in adults (and is rare in children), but an inflammatory reaction that causes children to get hospitalized and leads to significant morbidity.
In Britain, this syndrome was referred to as Paediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 (or in short, PIMS-TS). Later on, Americans gave it the name Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19.
If I had to summarize all the data and information that has been collected since, according to the available reports children present with a severe inflammatory reaction, something similar to Toxic Shock Syndrome and Kawasaki, which is an example of a common disease in childhood that causes inflammation in the large vessels (you can read more about Kawasaki here). Some of these children are PCR positive for COVID and some aren’t. Most of these children are found positive on serological testing, which may indicate that this syndrome is an autoinflammatory condition that is mediated by antibodies triggered by the COVID-19 infection that occurred several weeks prior to its onset.
Some of these children, especially the younger ones, fully fulfil the criteria for Kawasaki Disease (high fever, rash, conjunctivitis, enlarged lymph nodes and changes to the lips/oral cavity mucosa). Other children, especially those that are older, present in a way that is more like Toxic Shock Syndrome.
Some of these children have needed intensive care and significant anti-inflammatory therapy, including Intravenous Immunoglobulins (IVIG), steroids and more. Most of these children improved drastically after receiving these treatments.

Is there a reason to be frightened from PIMS?

Think of these main points:
– It is obvious that the higher the rates of COVID-19 infection in adolescents, the more cases of PIMS will we see. On the other hand, when it is a wave of younger children that contract COVID-19 – the prevalence of PIMS decreases.
– Even though it seems like this is a “new” syndrome, and new diseases are always more frightening, we are well familiar with the two syndromes that this new syndrome is similar to. And we have treatment for both of them.
– The number of children who have had PIMS around the world is actually not very high
– The prevalence of the disease varies depending on region and population – just like Kawasaki is more prevalent in Asians, it seems like there are some populations that have different rates of occurrence of this new syndrome. What I’m trying to say is that some countries have had it/will have it more than others. And indeed, we have seen higher rates in Afro-American children.
– Vaccinating children – ever since we have begun vaccinating our children, in particular those aged 12 and over, the number of PIMS cases has decreased.
– New variants – it has been scientifically proven that the new COVID-19 variants these days are “less aggressive” and are causing less PIMS.
So, is this new syndrome a reason to stay at home or isolate? Absolutely not.
Is it a reason to seek medical attention if your child has had a high fever for over 3 days? Absolutely (yes), especially if you know that your child tested positive for COVID-19 in the previous month. Even though I believe you would seek medical attention if your child had 3 days of fever also in the pre-COVID-19 era.
Was it a reason to get vaccinated (for those who can)? Absolutely (yes). Vaccinations in teenagers aged 12-16 prevents the development of PIMS, and I believe this is also true for younger children, where this complication is not as prevalent.
Additionally, it is definitely good reason to learn more about this syndrome through scientific literature (and not through the conventional media), to entertain your interest and to stay up-to-date.

What about Long-COVID?

This is very interesting. Long-COVID is the name given to the syndrome that is similar to “chronic fatigue” in children and adults, after they have suffered from a COVID-19 infection. After the publication of a vast amount of medical literature, we can certainly say that this condition occurs in both children and adults, regardless of whether or not they had a symptomatic or an asymptomatic infection.
It is a combination of signs and symptoms that last for several weeks or months after the COVID infection and may include fatigue, headaches, difficulty with physical efforts and more symptoms of this sort.
This syndrome does not have any specific treatment or solution other than giving it time and putting effort into having the child return to their regular activities and routine as soon as possible.
It is not a condition that the child is imagining, and it is also not due to depression, it is a real medical condition without a physician explanation or solution at this time. Fortunately, the prevalence of this condition in children is quite low, and it is especially low in the younger population.

What do we know about Omicron in children?

In the past 2 years we have been constantly exposed to endless fear-instilling information about the infection itself, the variants, the vaccinations, and what-not. It is true that the first cases of PIMS that were reported occurred following infections that resulted from the Omicron variant. Obviously, when the rates of infection were so high, the chances of children getting PIMS were going to be higher. Nonetheless, it has been scientifically proven that Omicron, and its variants have actually caused less cases of PIMS.
Fortunately, the Omicron variant does not cause severe infection in children, no matter what the media says about pediatric departments being filled with COVID-19 patients.
It is, of-course, important to follow the news and reports about what is happening around the world and to be alert and aware. Fortunately, however, the Omicron variant does not cause any more morbidity in children than any of the other variants.

What was the indirect morbidity that is caused by COVID-19 in children?

It is really impossible to cover everything. There’s just too much.
Missing other illnesses – I have seen some terrible cases where families with children with real infections (anything from an ear infection to a testicular torsion) avoided seeing a physician because of fear of being exposure to COVID, or because they were unable to see a physician due to quarantine.
Schools being shut down/inability for children to take part in regular activities/isolations/lock-downs – horrible.
Mental illnesses – an increase in rates of all the different mental disorders from depression to social disorder and eating disorders.
What I’m trying to say is that the harm that has been inflicted on children as a result of this pandemic were not due to the virus itself, but everything that happened as a result of it. And we are now all well-aware that the beast (who-shall-not-be-named) is not as bad everyone thought it was. Not for children, anyway.

So, what has COVID-19 caused or what can it cause in children?

1. An acute infection – and if there are any symptoms at all, then they are usually very mild.
2. PIMS – rare
3. Long COVID – uncommon
4. Indirect morbidity – this was very common and significant. Thankfully it is not as significant nowadays.
All in all, one can say that children, when compared to adults, ‘had it easy’.
So don’t let anyone scare you parents! This pandemic has pretty much left our children out.
And now, after time has passed, and no one is too phased by COVID-19 anymore, I would like to emphasize the things I wrote here a couple of years ago – “continue to show your kids that life is normal, take them out for ice-cream and shows, let them see their friends, give them hugs and kisses”. They need it now, more than ever.