They have missed hugs from teachers, kisses from grandparents, playdates and soccer practice. Their education is suffering, and their routine vaccines and well checks are falling behind.
Children’s health, social, and educational needs are being neglected during this pandemic, as even pediatricians and children’s hospitals have been reassigned to focus on adults, to handle the surge of adult COVID-19 cases. That’s not all, though.
Children have been barely considered in discussions on how to dampen the spread of the SARS-CoV-2 virus and protect everyone from its effects going forward. Children are mostly excluded from research on new therapies and vaccines. Even as many communities focus on reopening businesses, scant attention has been paid to how we can safely reopen schools and daycare centers.
Ignoring children in the course of the pandemic is a mistake. We are learning children are not immune to serious effects of COVID-19 — and moreover, they are likely key to its endgame.
Children are not immune
We all took comfort in initial reports that children seemed to be largely impervious to severe illness from COVID-19. It remains true that rates of severe illness and death from the virus are much lower among youths compared to adults. But our understanding of this virus is still evolving. This month, for example, we learned that about 100 children in New York and New England have been severely sickened — and at least three children have died — from a multiorgan inflammatory illness linked to the coronavirus.
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Evidence also strongly suggests that children can actively spread the virus after they contract it, even in the absence of symptoms. Moreover, fall school openings pose a potential major threat to the gains in controlling spread of the virus. For all of these reasons, it is critical to consider children’s role as we progress toward building broad immunity across our society.
So how can we reformulate our approach to this pandemic to put children at the heart of the response?
Breaking the chain of transmission
First, as schools and daycare centers reopen, we need to put robust screening and testing in place to monitor the spread of the virus. Household interactions are an established transmission route for the coronavirus, and we need to reduce the chance of children bringing the virus home with them. We will need to rapidly identify any hotspots in viral transmission at schools and daycare centers to prevent reigniting community spread.
For that to succeed, schools will need protocols for how to respond when active cases surface. These plans should include recommendations for confirmatory tests, isolation practices and following the contacts of positive test cases. The guidelines must be careful to not promote absenteeism amongst specific groups of children, further widening disparities in education.
Second, this pandemic will end either with widespread herd immunity or distribution of a safe and effective vaccine that drives case numbers close to zero. Children will play an important role in achieving broad protective immunity for our society.
Because children rarely become symptomatic after contracting the virus, we must proactively gather information about how to screen for their infection status, to reduce the chance of transmission to high-risk individuals. That way, we will have clear indicators of when it is safe for them to resume activities like school and play.
Finally, we must also consider children in the development of coronavirus vaccines. Early trials of coronavirus vaccine safety and immune responses have excluded children. Once safety testing is completed in adult volunteers, however, leading candidate vaccines should be tested for safety and effectiveness in children. And once safety and efficacy are established, children should be among the first to receive the vaccine.
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This may sound counterintuitive. It’s tempting to assume that since children aren’t as prone to severe illness, they won’t need a vaccine as urgently as others. Yet, the newly recognized inflammatory syndrome makes it clear that children need protection from the effects of this virus as well. And from a public health perspective, there are a number of reasons to target children in vaccination campaigns.
Vaccines don’t just offer individual protection from illness; high vaccination rates within a community protect all community members, including the most vulnerable, by shutting down possible paths the virus could follow. Children could be key spreaders of this disease. Therefore, their immunity will have community level benefits. And if we’re lucky, a coronavirus vaccine will emerge that confers lifelong immunity, as the childhood measles vaccine does.
Finally, children tend to be vaccinated at much higher rates than adults. For that reason alone, including a coronavirus vaccine in routine pediatric vaccine schedules is our best hope for achieving high coverage in the U.S. and throughout the globe.
Children will play a critical role in the evolution of this pandemic — and the strategies to end it. If we prioritize children now in the steps we take to end this pandemic, we will protect them while protecting all members of our community. A critical metric in overcoming this pandemic will be how children fared. They will be its lasting legacy.
Dr. Sallie Permar is a professor of pediatrics, immunology, molecular genetics and microbiology at the Duke University School of Medicine, where she studies immune responses in children and pregnant women to infectious diseases.