It has been an eventful two weeks since my last post. I returned from my trip to Italy on Wednesday. It was amazing, but exhausting, and included forgotten passports, minor Vespa crashes, a cancelled flight that resulted in two unintended days in a rainy and cold Amsterdam, hauling luggage up and down countless flights of stairs, seemingly endless train and plain rides, two grumpy teenagers, and now severe jet lag. Naturally I wouldn’t have changed a thing, except for perhaps the two mile sprint through the crowded streets of Florence to retrieve our passports and make the train to Cinque Terre on time.
Today’s post will be short and, sadly, not so sweet. Though I wouldn’t dare compare the impact of the SARS-CoV-2 pandemic on children to adults, particularly those who are older and in certain minority groups, it hasn’t exactly been a picnic either. I’ll run through a few facts and figures that paint a picture of how things have gone so far.
The first cases of COVID-19 were reported in January of 2020 in the United States and on March 13th of that year a national emergency was declared. During the past three years, there have been at least 16.6 million diagnosed cases in the pediatric population. This is a huge undercount, however, as millions of cases have undoubtedly gone untested and thus unreported.
Of the reported pediatric cases of COVID-19, 186,035 cases required hospitalization because of severe disease. Though a fraction (0.2%) of the total seen in higher risk populations, the death of 2,122 children as a result of COVID-19 over the past three years is horrific and on par with how many children drown every year. Of course, death isn’t the only outcome we care about and there have been at least 9,445 cases of MIS-C, with 78 deaths because of this unusual inflammatory complication of SARS-CoV-2 infection.
But wait, as I discussed in a post in December on the negative impact of the pandemic on childhood vaccinations, there is a lot more:
Adding to the possibility of that severe and even life-threatening inflammatory condition, even children with only mild COVID-19 are at increased risk of developing diabetes, to give just one of several more examples. There have also been significant increases in ED visits and hospitalizations for mental health crises in our teen and young adult populations. This really is just the tip of the iceberg as there are a number of post-COVID-19 conditions that have been seen in children, with as many as 25% still having symptoms a month after diagnosis. Between 2% and 10% of children diagnosed with COVID-19 will ultimately develop the more disruptive syndrome of post-acute sequelae of COVID (PASC), also known as “long COVID”.
Cases continue to be reported but they are decreasing. Though pediatricians, myself very much included, had one of the worst respiratory virus seasons in memory, it was largely because of RSV and not SARS-CoV-2. The last significant pediatric surge of COVID-19 cases occurred during the previous winter, when 2,000 of every 100,000 16- to 17-year-old children were diagnosed. Things are definitely much better now.
What about the vaccines? I’m afraid I don’t have great news on that front. Only 43% of all children, and less than a third of children under the age of 12 years, have received at least one dose of a COVID-19 vaccination. Older kids were the most likely to have received a dose, with 72% of teens rolling up their sleeves. On the other end of the spectrum, that number falls to only 8% in kids less than 2 years. This is an unfortunate reality, with vaccine-hesitancy and even outright anti-vaccine propaganda having become much more mainstream than before the pandemic.
Sadly, I’ll end on a rather tragic note here. One of the more insidious problems faced by children during the pandemic, and one that I haven’t seen much emphasis placed on by our government leaders, is the loss of a parent or other meaningful caregiver. As of this month, nearly a quarter-million children have lost one or both parents because of COVID-19.
Unsurprisingly, because of disparities in who has been more likely to die from COVID-19, nearly two thirds of these children are Black or Latino. And more than half of them live in just 5 states: California, Texas, Florida, New York, and Georgia. The list of potential acute and long term negative effects of losing a parent is long and includes, but is certainly not limited to increased risk of mental health problems, abuse, unstable housing, and household poverty. The course of their lives has been irrevocably altered and resources should be dedicated to helping them.