March 2020 – it feels like a lifetime ago. At that time, just over 100,000 cases of COVID-19 had been reported worldwide. However, as of March 2021, the World Health Organization reports well over 120 million cases and sadly, the loss of nearly 3 million lives. In Canada, there have been close to 1 million cases and almost 24,000 deaths (1). There is a silver lining – we now have both a new and renewed understanding of how to contain and mitigate this virus in order to halt its spread and once vaccines become more readily available, mass vaccination should help usher in a new era of normalcy.

But what about our children? How have they fared during this time? First, the most obvious question: can children get COVID-19? The answer is a resounding YES. In fact, one European study reported that 14% of the cases reported involved children between the ages of 0-19. Household transmission was the predominant source of infection early in the pandemic, but the return of kids to school, even on a limited basis, inadequate social distancing and mask wearing, along with the poor ventilation of older school buildings, have contributed to higher child-to-child transmission rates. This is especially the case with the emergence of the more highly transmissible variants such as B117, now likely to become the dominant variant, making the need for mass vaccination programs that much more critical (2).  

For children who experience COVID symptoms, fever, cough or shortness of breath are the most common. Like adults, there is an array of accompanying symptoms that can range from mild headaches, stomach pain and the loss of taste or smell, to potentially serious neurological complications such as stroke. Thankfully, the more serious complications have been rare but the risk is still there. Also like adults, children can develop long-term COVID infection complications, the most notable being multisystem inflammatory syndrome (MIS-C) which occurs when varying organs such as the brain, kidneys and stomach become inflamed. Although the correlation between COVID-19 and MIS-C is still not definitive and the long-term effects of MIS-C have yet to be determined, there is nevertheless a link between instances of this inflammatory condition and the virus. And just like adults, children with more serious pre-existing conditions such as diabetes or congenital heart disease are the highest group at risk for COVID-19 (3).

Can the numbers help us better understand the risk of COVID-19 for our youth?  Perhaps. At the very least, they illustrate that although children can still contract COVID-19, they are less likely to succumb to it like someone in their senior years. The U.S. Centers for Disease Control and Prevention has provided a study using 5-17 year-olds as their reference group. Based on their study, those aged 18-29 are three times more likely to be infected with COVID-19, seven times more likely to be hospitalized and fifteen times more likely to die. Those 65 years and older are only twice as likely to be infected and 35 to 55 times more likely to be hospitalized. However the numbers regarding the risk of death are staggering - death is increased 1,100 to 2,800-fold amongst this older group (4). There are new developments and studies emerging daily and the data will evolve over time.  

Today, we need a better understanding and acceptance of virus transmission and how mask wearing, social distancing and better ventilated schools and indoor facilities can help to mitigate the risk of infection. Once more of us are vaccinated, the overall reduction in the spread of virus will mean fewer infections among children. Yes, we will still need to remain vigilant, but the hope is that our kids will finally be able to learn inside a classroom, participate in extra-curricular activities and spend time with their friends.