It IS safe for children to go back to school next month: Landmark government-funded study rules it is ‘exceptionally rare’ for healthy youngsters to die of coronavirus
- Study in the British Medical Journal finds ‘strikingly low’ death rate in children
- Scientists found 1% of children in hospital died, compared to 27% of adults
- Research comes amid a debate about whether it’s safe for schools to reopen
Healthy children do not die of coronavirus and only those who were seriously ill before they caught the disease are at risk, a major government-funded study has confirmed.
Research found that the Covid-19 risk to children is ‘strikingly low’, only a tiny proportion of them end up in hospital and deaths are ‘exceptionally rare’.
Six children under the age of 15 have died of coronavirus in England and Wales since the start of the pandemic, along with nine 15 to 19-year-olds. This compares with 52,082 victims in all other age groups up to August 14, according to the Office for National Statistics.
Scientists led by the University of Liverpool found that one per cent of hospitalised children died, compared to a significantly higher 27 per cent of adults. This means that while one in four adults who ended up in hospital with Covid-19 died of it, only one in 100 children did.
The research, published in the prestigious British Medical Journal, comes amid a fiery debate about whether children in England should return to school in September, with critics saying there is not enough evidence they will be safe.
Parents should be reassured that their children will not be put in danger by returning to school, the scientists who led the study said.
But unions and other experts are concerned that schools reopening will not put children at risk but their parents, grandparents and adult staff at the school as children transport it between households.
The latest study, published in the British Medical Journal, comes amid a fiery row about the Government’s pledge to force children to return to school in England in September (Pictured: Prime Minister Boris Johnson visiting a school in Coalville, Leicestershire)
‘The study is reassuring,’ said Dr Liz Whittaker, an infectious disease expert at the Royal College of Paediatrics and Child Health.
‘It echoes other studies which have reported low numbers of Covid infection over a six month period – 651 children out of a paediatric population of 16million.
‘Very low numbers of children have been admitted to critical care and the researchers reported a very low death rate – particularly in comparison to adults, but also in comparison to the death rate due to other infections and other causes of childhood death.’
Professor Calum Semple, an expert in outbreak medicine and child health at the University of Liverpool who led the study, said: ‘Severe disease is rare and death is vanishingly rare.
‘They should be confident that their children are not going to be put at direct harm by going back to school and we do know that they are harmed by being kept away from school because of the lack of educational opportunities, and that’s affecting mental health.’
The team was funded by the National Institutes of Health Research (NIHR), which is funded by the UK Government, and also the Medical Research Council.
They considered the cases of 651 children and teenagers under the age of 19 who were admitted to one of 138 hospitals in the UK between January and July.
All had Covid-19 and were followed up by doctors for at least two weeks after they were admitted.
The most common symptoms among the youngsters were fever, coughing, breathlessness and vomiting.
Six of the children (one per cent) died in hospital. All of them, the researchers said, had ‘profound comorbidity’.
This means they were seriously ill with long-term health conditions even before they caught the coronavirus, making them especially vulnerable to infection.
Professor Semple added: ‘We did not have any deaths in otherwise healthy school-aged children.’
He said that the types of conditions children had were very severe and not common conditions like asthma or even cystic fibrosis.
In general, the researchers said ‘the in-hospital case fatality rate for children and young people was strikingly low’.
CHILDREN ‘LESS LIKELY TO GET SICK’ IF THEY CATCH COVID-19
Data shows children have an almost non-existent chance of dying of Covid-19 and scientific evidence, although still in early stages, suggests youngsters are also less likely to get sick at all or to spread it.
Researchers at the London School of Hygiene & Tropical Medicine published a study in June that found only two in 10 children with coronavirus have any symptoms of it.
They saw that under-20s are half as likely to become sick with Covid-19 as over-70s, and only 21 per cent of infected 10 to 19-year-olds had symptoms.
In comparison, the rate of symptoms among over-70s — the group most vulnerable to the disease — was three times higher at 69 per cent.
The LSHTM experts said understanding that children are less affected by the disease could influence how strict school closures have to be in the future.
In a meeting in May with members of the House of Lords, LHSTM infectious disease experts Dr Rosalind Eggo and Professor John Edmunds explained that children appear to be less likely to spread the disease as well.
Dr Eggo said: ‘We think that children are less likely to get it so far but it is not certain.
‘We are very certain that children are less likely to have severe outcomes and there are hints that children are less infectious but it is not certain.’
Scientists cannot say why children seem to have some level of natural protection from COVID-19.
There have been suggestions that it because they don’t have as much age-related lung damage or ill health, or because they have considerably lower rates of illnesses which increase the risk of complications, such as diabetes and high blood pressure.
Professor Edmunds, who is a member of SAGE, the group of scientists advising the government, today told members of the Lords: ‘It is unusual that children don’t seem to play much of a role in transmission because for most respiratory viruses and bacteria they play a central role, but in this they don’t seem to.’
Office for National Statistics data shows that, in England and Wales, 15 people under the age of 20 have died of Covid-19 during the entire outbreak up to July 10.
This was just 0.03 per cent of the total 51,096 counted by that date.
Around one in five of the children (18 per cent) had to go into intensive care at some point. These children were more likely to be younger than one month old, between the ages of 10 and 14, or of black ethnicity.
In total, around 11 per cent of all hospitalised patients in England, Wales and Northern Ireland ended up in intensive care. However, far fewer children have been diagnosed with the disease because it barely affects most of them, meaning only the sickest children are hospitalised in the first place.
The paper noted that black children appeared to become seriously ill more often than white ones, but the reasons for this were not clear.
Studies of adults have found that non-white people are worse affected. It has blamed this on poverty, higher infection rates in their communities, more people with conditions like diabetes and obesity, and a lower likelihood of seeking early medical treatment.
One in 10 of the children in the study (11 per cent) had Multisystem Inflammatory Syndrome in Children (MIS-C), as defined by the World Health Organization.
In the UK this is known as Paediatric Multisystem Inflammatory Syndrome (PIMS).
It is a rare condition that develops in a tiny minority of children with Covid-19, in which their illness worsens quickly and they need intensive care.
The Royal College of Paediatrics’ Dr Whittaker, one of the doctors who first discovered the condition, said: ‘As reported in other studies, despite two or three of the children with presumed PIMS in this cohort becoming unwell and requiring critical care, the outcomes were good.
‘As in other studies, those children of black ethnicity are more commonly affected with the very rare PIMS condition. This reflects the higher incidence of SARS-CoV-2 [coronavirus] infection in these communities.
‘On the whole, parents and paediatricians should be reassured by the findings of this paper.’
Dr Olivia Swann, from the University of Edinburgh, echoed the sentiment and said: ‘The absolute risk of any child in the UK being admitted to hospital with Covid is tiny. The absolute risk of them being admitted to critical care with Covid is even tinier.
‘Nothing is ever risk free, but for myself as a parent, as a children’s doctor and as a researcher, I find this study and these numbers extremely reassuring.
‘I hope that they do reassure parents throughout the UK.’
The issue of whether children spread coronavirus and whether it is safe to return them to school has been contentious in recent weeks.
Teaching unions have argued there is not enough scientific evidence to say it’s safe, while the Government insists keeping children at home is harming them more than Covid-19 ever will.
Boris Johnson this week issued a fresh plea to parents to send their children back to classrooms in England next week.
The Prime Minister insisted ‘schools are safe’ and warned that pupils had ‘lost too much time’ in the classroom already.
The Government announced that face masks will be compulsory in the communal areas of secondary schools in parts of England which are subject to local lockdowns.
A decision on whether to wear masks in non-lockdown area schools will be left to individual head teachers.
The change came after days of ministers and Government experts insisting there were no plans to change the guidance in England which had said masks were not necessary if all other hygiene measures were adhered to.
But Mr Johnson’s hand appeared to be forced after Nicola Sturgeon said secondary school pupils in Scotland will be required to wear a mask when travelling between lessons.
Speaking during a visit to a school in Leicestershire on Wednesday, Mr Johnson said pupils and staff wearing masks in communal spaces in hotspot areas ‘does make sense’.
He also appeared to concede that the UK Government had shifted because of action taken in Scotland where schools have already been back for two weeks.
Teachers have warned the masks decision could lead to ‘mayhem’ amid fears of increased bullying, of pupils wearing dirty reused masks and of it being harder to challenge bad behaviour in corridors because it may be unclear which children are responsible.
WHAT DO WE KNOW ABOUT PIMS?
WHAT IS IT CALLED?
The illness has been likened to Kawasaki disease, which mainly affects children under the age of five.
But it has been named Paediatric Inflammatory Multisystem Syndrome Temporally (PIMS-TS) because it is new and distinct from Kawasaki.
WHAT SYMPTOMS DOES IT CAUSE?
The majority of the children being hospitalised with the condition have suffered from a high fever for a number of days, severe abdominal pain and diarrhoea.
Some develop a rash and red eyes or red lips, while a very small group go into shock, in which the heart is affected and they may get cold hands and feet and have rapid breathing.
The symptoms are similar to those caused by Kawasaki disease, a rare but treatable condition that affects around eight in every 100,000 children each year in the UK.
WHO DOES IT AFFECT?
PIMS-TS appears to be more likely to affect older children than Kawasaki disease (average nine years old versus four years old respectively), British researchers recently wrote in the Journal of the American Medical Association.
Up to 80 per cent of affected children in a study of 78 children by the Royal College of Paediatrics and Child Health were from black, Asian and minority ethnic backgrounds (BAME).
Similarly, more than half (57 per cent) of 21 youngsters diagnosed in a Paris hospital were of African heritage, compared to 29 per cent of European descent.
Dr Sara Hanna, medical director at Evelina London Children’s Hospital, said 70 to 80 per cent of children seen in London hospitals have been BAME.
WHEN DID OFFICIALS FIRST START TO SEE CASES?
The NHS sent an alert to doctors on April 27, warning them to look out for signs of the syndrome.
At the time they said cases had been appearing in tiny numbers in London for about three weeks. Since then they have spread further across the country.
There have been less than 200 cases of PIMS-TS reported in England so far, according to researchers at the Imperial College Academic Health Science Centre. Figures for the UK are not clear.
IS IT CAUSED BY SARS-COV-2, THE CORONAVIRUS?
Doctors are almost certain the illness is being caused by the coronavirus but they haven’t yet been able to prove it.
Cases began appearing as the UK’s coronavirus outbreak hit its peak and similar conditions have been reported in China and Italy during the pandemic.
However, not all children with the Kawasaki-like syndrome test positive for the virus. Swab testing has suggested some of the children have not been infected with COVID-19 at the time they were ill.
But all patients have tested positive for antibodies, doctors said, meaning they have had the coronavirus in the past.
They said this suggests it is a ‘post-infectious phenomenon’ which is caused by a delayed overreaction of the immune system, which may happen weeks or even up to a month after the child was infected with Covid-19.
IS IT TREATABLE?
Yes. But there have been some reported deaths – at least two, according to the RCPCH.
The only child known to have died with it, a 14-year-old boy, died of a stroke that was triggered by the life support machine he was on.
Doctors are currently treating the condition by using medications to calm down the immune system and dampen the overreaction.
Dr Liz Whittaker, a paediatrician at Imperial College Healthcare in London, said the sickest children are usually very ill for four to five days and begin to recover a couple of days after starting treatment.
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