The Food and Drug Administration is yet to authorise a COVID-19 vaccine for children younger than 12, and paediatric COVID-19 cases have been rising.

Contrary to findings early on in the pandemic, children are just as likely to become infected as adults. In fact, infection rates today are higher among children and adolescents than in older age groups, because they are the least (or not at all) vaccinated.

While there is a lot of parental concern amid rising COVID-19 rates among young people, the risk to children remains very low.

In children, a COVID infection is usually asymptomatic or only causes a short, mild illness.

A UK study of a year of COVID found the chances of a child fatality to be one in 500,000. The likelihood of a child falling seriously ill was one in 40,000. Most of the children impacted in the UK had significant comorbidities, according to the study led by researchers from University College London.

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Current data from the UK (see chart) confirms the low level of hospitalisations and extremely low number of deaths among children and young adults.

Although absolute numbers remain comparatively low, both in the UK and the US, the number of children hospitalised with COVID-19 has climbed back to pre-vaccination levels last seen at a peak in January.

This reflects the pandemic’s effect on unvaccinated groups, even when large parts of the population are vaccinated.

‘Don’t panic’

As infections are rising elsewhere and children are among the locally transmitted cases on island, parents are understandably anxious.

Local paediatrician Dr. Shyla Jehangir said the families and parents who were told to get tested today, because they were contacts of the COVID-positive George Town Primary School student, were very calm.

“If you don’t give in to that kind of panic, we are a small enough island that we can get on top of these things.”

A generally healthy child, even if positive for COVID, is going to have the most mild symptoms, Jehangir said.

“In terms of an illness, compared to the normal flu, this is a very mild virus for a child. It is a completely different matter for an adult.”

Children with severe underlying health conditions can be more affected, but the number of children who are immunocompromised or who have very bad asthma, for example, is small, she said.

One issue observed by the paediatrician is that many seasonal illnesses have symptoms that are similar to COVID and might give parents cause for alarm.

“Ever since school started three weeks ago, we’ve had a flood of children coming in with the usual colds, coughs, fevers, that all children get in September when they go back to school,” she said. “Today, everybody who came in or rang, said, should I take my child to get tested?”

The answer to that, she said, is no, because unless they have been in contact with anybody who has tested positive for COVID, the children are at very low risk.

Parents who want to protect their children from COVID should “100%” get vaccinated, Jehangir said. “Even if they are not concerned for themselves,” the paediatrician said, “they ought to be concerned about all the people in their household, young or old, who are unable to take the vaccine.”

Children’s hospitals in the US have reported that many of their older paediatric patients have not been vaccinated and in the cases of younger children, who are not eligible for vaccination, often their parents have not been vaccinated.

So far, the situation in Cayman is not even remotely comparable to the US or the UK. Case numbers locally are benign and vaccination rates among the eligible population are much higher in Cayman.

Vaccinating children

The UK only this week announced it would roll out COVID jabs to 12-to-15 year olds to help prevent disruption to their schooling this winter. In Cayman, the Pfizer-BioNTech vaccine has been available to the over-12s since June, when it was approved for the age group by the UK regulator.

The decision in the UK was delayed and so far has been limited to allowing only one dose of the Pfizer vaccine because of reported side effects.

These concern a small risk of myocarditis, an inflammation of the heart, predominantly in teenage boys. The symptoms are chest pain and an elevated heart rate but typically clear up after a few days.

US data from the Vaccine Adverse Events Reporting System (VAERS) showed that out of 1 million second doses of the Pfizer vaccine given to 12-to-17 year olds, 62 boys and eight girls were found to have the condition.

Myocarditis can, however, also be caused by COVID-19 and one US study concluded that young men were six times more likely to suffer from myocarditis as a result of a COVID infection than from the vaccine.

Vaccinating children would not stop the spread of COVID in schools entirely, but it can help keep cases down. Studies suggest a single dose of the Pfizer-BioNTech vaccine reduces the risk of catching the Delta variant, after coming in contact with it, by about 55%. The chances of falling sick or spreading the virus to someone else also diminish.

Governor Martyn Roper said at Tuesday’s government press briefing that vaccination rates in Cayman are high at more than 81% of the adult population, but he urged more younger people between 12 and 18 years, and those under 30, to get vaccinated.

“If every eligible age group was at 80% coverage this would give us the very best chance of stopping COVID in its tracks,” he said.

BioNTech co-founder Özlem Türeci told German news outlet Der Spiegel last week that the results of clinical trials on children between age 5 and 11 will be released in the next few weeks and the company will seek global approval to use the vaccine on this age group.

This means the Pfizer vaccine could soon be authorised for children younger than 12 years.

Cayman’s government is considering including children under 12 in its vaccination programme.

Premier Wayne Panton said at Tuesday’s briefing, “At this point, we are very much hoping that in the coming months, we will be able to have authorisation, and have the support of the United Kingdom, in implementing a vaccine programme for children.”

Until then, a higher vaccine uptake among the eligible population is the best way to keep paediatric COVID-19 cases low.

“We need to put a… vaccinated wall of safety around our children [who] cannot get vaccinated,” Panton said.

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