Covid 19 Delta outbreak: Keeping kids safe in the pandemic

With kids outside Auckland back at school, masks are encouraged - but not mandatory. Photo / Unsplash

Tamariki as young as 12 have been able to receive the vaccine in Aotearoa for more than a month. But with kids outside Auckland having returned to school, and the SuperCity cautiously optimistic about alert level reductions, concerns are circulating about how to keep our youngest Kiwis safe in a world with Delta.

Dr Jin Russell is a developmental paediatrician at Starship Children's Hospital, and PhD student at Auckland University's School of Population Health. She answered susbcribers' questions about kids' health and wellbeing in the pandemic in a live chat earlier today. Here's what she had to say - the Q&A has been edited lightly for length and clarity.

Q: Since there is a 99.995 per cent survival rate in children, why do we care if kids get Covid? Does anyone ever bring up the unintended consequences of mask-wearing and/or isolation in relation to children (abuse/trauma/mental illness etc)?

A: The majority of children who are infected with Covid-19 fortunately experience a mild or asymptomatic illness, but severe illness can and does happen. The AAP has calculated that approximately one in 1000 to almost two in 100 children are hospitalised due to Covid-19. Rarely, a very severe complication called MIS-C (multi-inflammatory syndrome in children) can occur, causing inflammation of the brain, heart, lungs, kidneys, skin and eyes, and can be deadly. More than 500 children have died in the US from Covid-19 ... Masking is important, although it is best used when complemented with other strategies, such as improving ventilation. Adults getting vaccinated is absolutely crucial to protecting children under 12 years old who are currently ineligible to be vaccinated, because studies show that children are more likely to catch Covid-19 from adults.

Q: Both of my children last year had a Covid nasal swab and found the experience really awful. Do you know of any movement to introduce saliva testing for our tamariki?

A: Firstly, good on you for taking your children to be tested. Saliva tests are unfortunately not perfect and PCR testing of nasal swabs is the gold standard for accuracy. As we progress I expect that we will have further public discussion regarding the uses and limitations of different tests, and comfort for children (and others) should be a consideration.

Q: How far away do you think the vaccine is for 5-12-year-olds in New Zealand?

A: The short answer is that it is hard to tell as we have not yet seen the Pfizer trial data for children 5-to-11 years. Medsafe is the group that approves use of vaccinations, and then the Government determines any vaccine rollout strategy. As we saw with the initial vaccine rollout, sometimes the timeframe is determined more by supply, than by approvals and decisions.

Q: The Government has said that there is no requirement for teachers to be vaccinated, but where does this leave vulnerable kids who are too young to be vaccinated?

A: We all want to keep children protected and safe. Studies show that children are more likely to be infected by adults in their households or schools than by other children (although this happens). Delta is highly transmissible. In a recent CDC study, an unvaccinated schoolteacher worked two days while infected and unfortunately 12 out of 24 exposed children later tested positive for Covid-19. I recommend that all adults working with children are fully vaccinated to prevent school and other outbreaks that disrupt education.

Q: Why are teachers being singled out as being required to be vaccinated to work? Surely it should still be a choice.

A: I appreciate that teachers have a lot on their plate! As we progress the vaccine rollout, children who are under 12 years will remain the single biggest susceptible group in the population. Studies have shown that children are more likely to be infected with Covid-19 via the adults around them, than from other children. Because we all want to protect children and keep schools open, I recommend all eligible people are vaccinated. If you are concerned about the vaccine, do speak with your medical professional, and check out this website.

Q: If healthy children are at such a low risk from the virus, and immunity is greater from them actually having Covid, what is the benefit of them having the vaccine that appears to wane in efficacy after 6-9 months? (Myself, partner and all grandparents are vaccinated) I am asking this with the concern of potential long-term effects that we can surely not be aware of.

A: Vaccination of children will reduce the risk of severe illness. While most children experience a mild or asymptomatic infection, up to 1.9 per cent are hospitalised (American Academy of Pediatrics), and rarely severe disease or complications can occur. In the US alone, last month, more than 9 million doses of vaccine had been administered to children 12-15 years with an excellent safety profile and it would be very unlikely to find new side effects as time goes on. Risk of myocarditis in this age group from Covid-19 is six times higher than after vaccination, and very rare.

Q: Is there an internationally recommended interval between vaccine doses to reduce the risk of myocarditis in teenage boys?

A: It's important to emphasise that myocarditis is a very rare side effect (approximately four cases per 100,000 second doses in 12-29 age group according to the CDC) and typically mild and resolves without specific treatment. The CDC provides a helpful detailed analysis of this rare side effect, and did not recommend increasing the interval between doses (three weeks apart in the US) at that time ... The recommended spacing for vaccination is six weeks as this timeframe gives the optimal immune response. The minimum interval is 21 days. Here's some further info.

Q: What are the risks associated with the vaccine for 12-year-old girls?

A: Adolescents tend to experience the same side effects as adults after the Pfizer vaccination, and these include headache, fatigue and fever which typically clear in 48 hours. Some are worried about myocarditis. This is typically mild and children get recover without needing specific treatment. The risk of myocarditis (which is rare, approximately five per 1 million doses) is smaller for girls than boys. You can find more information about side effects here.

Q: The MoH has confirmed reports of 11-year-olds getting the Pfizer vaccine. What are your views on that?

A: Children aged 12-15 are eligible to be vaccinated. The reason is that we have been waiting for trial data for Pfizer for younger age groups to be released, and for approval to be sought from Medsafe. I encourage parents who have younger children to wait for official decisions on the younger age group.

Q: Why are we vaccinating young children? WHO recommends down to 16 only after the old and at-risk have been protected. The long-term safety trials are not completed yet. The risk of children dying from Covid is less than their risk from the vaccine.

A: The WHO, CDC, European CDC all recommend vaccination of children at 12-15 years to protect them from Covid-19. While most children infected with Covid-19 tend to experience a mild or asymptomatic illness, severe illness can occur (see other responses). In the US alone, as of last month, well over 9 million doses had been administered to children 12-15 years with excellent safety profile. Finding vaccine side effects that we don't already know about becomes less and less likely as time goes on. Unfortunately the same cannot be said of novel viruses like SARS-CoV-2.

Q: What are we doing to improve the collection of vaccine adverse reactions so that the safety in children and teens can be monitored effectively?

A: Monitoring for side effects of vaccination is done in multiple overseas jurisdictions, not only our own. In the US alone, as of last month, over 9 million vaccine doses had been administered with an excellent safety profile. Any severe side effects that require hospitalisation, for instance, tend to be picked up and reported when children present for medical care. This should give us confidence that the vaccine is indeed safe.

Q: Do we have to worry about long Covid in children?

A: We are still learning about long Covid in children. A recent study on long Covid in the UK, the CLoCk study (which is still in preprint form) estimated that approximately 1 in 7 children who tested positive for Covid-19 may still have symptoms 15 weeks later. Check out this BMJ article. I have not seen specific studies relating to long Covid rates for breakthrough infections after full vaccination. However, breakthrough infections in children will typically be even milder, and infrequent after full vaccination, which is encouraging.

Q: Our son is 7 and has Down syndrome as well as a history of respiratory issues including bronchiectasis. We have been advised to try and just have him around vaccinated people. My understanding is vaccinated people can still get and pass on Covid, so why is this helpful?

A: Being fully vaccinated reduces the risk of infection and therefore, transmission onwards. Fully vaccinated adults who experience a breakthrough infection have reduced levels of viral RNA, which suggests that they are less likely to transmit the virus onwards. Children are more frequently infected by adults around them, rather than by other children, which is why vaccinating adults becomes important to protect children who are not yet eligible.

Q: My grandson had a stroke when he was 1 and is now 3. We desperately want to keep him protected from Covid but also need to ensure the vaccine will not have adverse effects for him. I assume testing of the vaccine in under-5s will only cover standard scenarios?

A: We do need to have good evidence of safety and efficacy in under-5s before vaccination of this group can occur, and we await vaccine trial data for this group. Generally trials tend to include more healthy participants first, and then more evidence comes in on groups with comorbidities. Medsafe makes the decision to approve after reviewing the data. Sadly, children with neurological conditions are also more at risk from severe illness from Covid-19, so I hope that we have answers soon.

Q: One of the results of vaccination is to weaken the natural response of the body to a wider range of viruses. The UK advisory body JVCI has advised against vaccinating 12-15-year-olds believing that the downsides outweigh the benefits. So what is the compelling arguement to vaccinate children?

A: The US has seen more than 500 deaths in children aged under 18 from Covid-19, and up to 1.9 per cent are hospitalised after infection. The Pfizer vaccine provides an opportunity for the immune system to practice neutralising SARS-CoV-2 and strengthens it. In older patients with Delta infection, while there is a similar Ct early in infection, the amount of RNA declines much more rapidly in those fully vaccinated. JCVI has very recently recommended a single dose for 12-15-year-olds. The WHO, US CDC and European CDC, as well as many countries, recommend vaccination for 12-15-year-old adolescents.

Q: How does the virus affect kids on immunosuppressants?

A: If your child has a specific medical condition, I recommend discussing any concerns with your child's paediatrician so that advice is tailored to your child's health. It is important to say that there is no contraindication to children on immunosuppressive medication being vaccinated, but do contact your child's paediatrician to discuss the timing of vaccination. Here is a helpful guideline.

Q: Is there any data relating to young children (1-5) that have chronic lung disorder and Covid outcomes?

A: In general, children with underlying respiratory disease are at higher risk of hospitalisation and severe illness compared with their healthy peers. Vaccinating children with underlying comorbidities can be protective. Do speak with your child's paediatrician if you are concerned about your child's specific medical condition and Covid-19.

Q: What is the hospitalisation rate of children who contract Covid during the course of their illness?

A: The American Academy of Pediatrics estimates that between 0.1 to 1.9 per cent of children infected with Covid-19 are hospitalised. At a population level, that means a high number of children needing hospitalisation.

Q: Why aren't masks compulsory at schools for over 12-year-olds? Making it a recommendation is crazy as teens do not want to be odd ones out.

A: It is strongly recommended that all children 12 years and over wear masks at schools, especially indoors.

Q: The coronavirus measures an average diameter of 80 to 120nm (smaller than smoke particles) and can easily get through a medical facemask. If Delta is airborne, how does a facemask filter the virus on children and adults?

A: There is a good summary of the evidence for universal mask use on the CDC website.