Children are not meant to die, so when people say the risk of a child dying of COVID-19 is very small, then yes, it absolutely should be. Unfortunately, we’ve been letting it spread quite freely in the UK, especially through schools. My child probably won’t die of COVID-19, and yours probably won’t either, but in the next few days, someone’s child might. We actively take precautions to prevent all of the commonest causes of child death, both as individuals and collectively. Suffocation causes similar numbers of deaths to COVID-19, but no responsible parent would leave plastic bags lying about, and almost all bags come with little holes punched in the bottom, and a written reminder to keep out of reach of children.
FALSE ASSUMPTIONS
When it comes to COVID-19, though, the measures we had in place through the first two waves have largely been removed. Most adults in the UK are protected by at least two doses of vaccine, but most children are not. Masks stopped being required in English secondary schools in May 2021, at roughly the same time that the Joint Committee on Vaccination and Immunisation (JCVI) were concluding that there was a low risk of child-to-child transmission. Measures such as bubbles, distancing, and isolation of COVID-19 contacts have also been removed or weakened since then, with predictable results. For most of the winter term, school-aged children had the highest prevalence of COVID-19, and whenever schools are open, the rates tend to rise. With the arrival of Omicron in the lead up to Christmas, schoolchildren were overtaken by young adults, extending up to the middle-aged. When the new term started in January 2022, older age groups seem to have peaked, but schoolchildren and preschoolers continue to rise. It has become clear that JCVI guidance suggesting the vaccine would only have minimal benefits for children was based on false assumptions. Children can and do transmit the virus when basic mitigation measures are removed. Similar patterns were seen in South Africa and New York, but it is still too early to say whether this increase in hospitalisation will translate into increased child mortality rates. Rates of long COVID from Omicron are also still unknown. The UK lags behind similar nations in vaccinating children. The JCVI was slow to authorise vaccination of 12–15 year olds, initially only permitting a single vaccine.
The Medicines and Healthcare products Regulatory Agency approved a reduced dose vaccine for 5–11 year olds on 22 December 2021, but the JCVI limited it’s use to children who are clinically extremely vulnerable (CEV) or have immunosuppressed family members. They finally approved ‘non-urgent’ use of the vaccine for all 5–11 year olds on 16 February 2022, but the UK government has stalled the roll-out, which in England is not planned to happen until April 2022. In contrast to the original adult vaccination campaign, and the booster programme last winter, vaccination of children has remained painfully slow. If vaccines are to be our main defence we need to step up the pace. With school transmission driving the pandemic during term time, rates of COVID-19 in parents and grandparents also tend to rise. The vaccine is very effective for most people, but it has a small but significant failure rate and not everyone can or will have it. If we choose to rely on vaccines alone with rates this high, the virus will find those who are susceptible.
MAKE SCHOOLS SAFER
For children with a clinically vulnerable parent or grandparent, the worry that they might bring COVID-19 into the home is often their biggest fear. In the UK, there are already an estimated 8000 children orphaned by COVID-19. Those who argue that being in school is the most important factor for our children are neglecting to consider these children. There is a huge difference between children in school with multiple layers of mitigation measures in place, and children in school where they are exposed to the virus without protection. The measures we need to make schools safe are quite simple: fast vaccine roll-out for all children aged 5 years and up; acceptance of significant airborne spread of the virus thus increase ventilation, FFP2 masks, CO2 monitors, and HEPA filters; awareness of physical distancing; awareness that the number of people you transmit to depends on how many people you share air with, so bring back bubbles, avoid assemblies, and return to fully isolating cases and contacts; acknowledging that children are connected to the rest of the community and we need a return to stricter measures across the rest of society to get background COVID-19 rates down; and, perhaps the most complex measure, the one we are least likely to achieve, is a change to the public messaging about COVID-19 in the UK. We are all connected and have a responsibility towards each other. My choices and actions could have unknown consequences for you, or for someone else, somewhere.
Consequences may be unknown, but they are not unforeseen. In the case of infectious diseases, even a small change can make a very big difference over time, so every little helps. The actions in our power are smaller and simpler than those our government could have chosen, but they are still significant. Open windows, wear a mask, keep your distance, and stay home when you’re ill. You’ll never find out, but your actions could avoid harm to a child.
Footnotes
Editorial note: This article was corrected on 5 February 2022 (https://bjgplife.com/our-children-are-sitting-ducks) and misleading figures were removed after the figure of 133 child deaths was clarified as including 18 and 19 year olds by a FullFact article. We apologise for not spotting this mistake and correcting it sooner, and would like to thank FullFact for this and the work that they do and Leo Benedictus who wrote the article. We would also like to thank Samar Razaq and Helen Salisbury for independently contacting us about these figures. We welcome comments and critique on all our articles by letter, email, and (ideally) the response box below all BJGP Life articles (https://bjgplife.com). We encourage our readers to read the FullFact article here: https://fullfact.org/online/133-covid-deaths-children
This article (with reference information) was first posted on BJGP Life on 3 February 2022; https://bjgplife.com/ducks
- © British Journal of General Practice 2022
