Key Facts About COVID-19

  • COVID-19 infection is spread by droplet transmission much like the flu. A virus may travel from person to person through respiratory fluids when they cough, breathe, speak, sing, sneeze etc.  Masks and hand washing are important in stopping disease spread.
  • Disease in children is often mild but can be severe in some, especially the immune-suppressed and chronically ill.  Mildly infected children can infect others.
  • Illness may be acute (short lived) or long, and there is still a lot to be learned about “Long Covid” in children.  Even mild disease can have long term consequences for some.

What is COVID-19?

COVID-19 is a respiratory disease caused by a coronavirus.  We are constantly learning about the virus and how it affects different aged individuals and how effective vaccines are.  Will it someday be an infectious disease, we learn to live with like the flu or other corona viruses that cause the common cold?

When a disease circulates in the population year after year it is said to be endemic. It looks like COVID will evolve to become a milder endemic disease, but how long that will take is still guesswork. There is much we don’t know about COVID in children. The assumption that children do not get sick or do not die from COVID is not based in fact.

About the vaccine

Currently there is only one approved COVID-19 vaccine for children and adolescents, and that is the Pfizer/BioNTech vaccine. Dosing recommendations and booster requirements are frequently being updated as new information comes in. Talk with your provider or refer to the CDC for the most recent recommendations. There are more rigorous requirements to approve vaccines for children than for adults, so COVID vaccines for kids will always lag behind those of adults.

A note on vaccine effectiveness:  As a vaccine moves from the controlled trial environment and into the real world, the marker we use to judge how well it works is “effectiveness”.  Effectiveness of a vaccine will vary due to age, immune history, and other human factors that come into play.  The percentage associated with effectiveness is for an individual, and not for a group.  For example, if a vaccine is 85% effective that means those who received the vaccine are at a 85% lower risk of developing disease, not that 15% of a group will get the disease.

How did they make the vaccine so quickly?

The technology for mRNA is not new.  It just hasn’t worked on other diseases in the past.  At no point in our history has so much money, brain power, and political will been directed toward one disease.

Scientists have been studying coronaviruses for over 50 years, and a lot was already known about their structure, genome, and life cycle.  Most importantly, they knew about the “S” or spike protein on the virus which plays a key role in how the virus attaches to our cells and carries out replication.  That spike protein was a good starting place for vaccine development and treatment.

But it doesn’t fully explain how we got a vaccine to fight against a virus we had only met a year before, right?  Most vaccines are developed more slowly for a few different reasons.

  1. The research and development process used by companies, primarily large pharmaceutical companies, takes a long time. There are permits, recruiting, and FDA hoops to jump through. Plus it takes a lot of money.  In addition, when a vaccine is being developed, a company may not want to share a new technology or process with its competitors.
  2. In the non-emergency version of vaccine development, the process happens step-by-step. Each phase in the process is like a racer handing off a baton in a relay.

With the COVID-19 vaccine, the runners all ran in a sprint together. Especially unique to this vaccine is that it was manufactured before the clinical safety trials were completed.

What, you say?!?!  Yes, it was a huge gamble to take.  If the vaccine had proven to be unsafe or not effective against preventing severe disease, then they would have had to toss it all.  And with so many reputable scientists and groups watching carefully, it would have been pretty impossible to slip a dangerous or ineffective vaccine through the approval process.

The vaccine itself is fairly easy to make, but the containers, syringes, and labels all take time.  With factories shut down due to outbreaks, getting the vaccine as quickly as we did really is a miracle.

Did You Know

Mutation: A mutation refers to a single change in a virus’s genome (genetic code). Mutations happen frequently, but only sometimes change the characteristics of the virus.

Variant: A variant is a viral genome (genetic code) that may contain one or more mutations. In some cases, a group of variants with similar genetic changes, called a lineage, may be identified as a Variant of Concern (VOC) or a Variant of Interest (VOI).

Do mutations and variants matter?  It depends.  If they change the way the virus transmits (for example if a virus spread by droplet changes to one that remains airborne), then they matter.  But for the most part, viruses mutate constantly and they do not change the infectious pattern.


Infection vs. disease vs. severe disease

The medical community sometimes seems obsessed with pointing out that the vaccine doesn’t prevent infection — it prevents severe disease.  What is the difference and why does it matter?

Asking a vaccine to prevent against infection, meaning the virus can’t enter the body or enter cells, is a pretty tall order given how the immune system responds to invading organisms.  It takes a little time for the immune system to respond to a virus before it enters cells (antibodies do this) or to train killer T-cells to attack infected cells.  The vaccine gives the body a heads up and starts this process ahead of time. So while “infection” might still happen, the immune system is ready to mobilize quickly and shut down the virus.

Without the vaccine training in place, the body takes longer giving the virus more time to replicate (reproduce) and damage more cells. This can lead to “disease” or “severe disease,” which leads to hospitalization in some cases.

A simpler way to put it is that infection is when the virus enters your cells.  Disease is when you show signs and symptoms of that infection.  Symptoms such as fever and inflammation are results of the immune system attacking the invading virus.  Sometimes this response can get out of control and a child might experience Multi-system Inflammatory Syndrome (MIS-C).  See below for more information.

What about medications?

Antivirals either make it harder for the virus to get into a cell or they prevent the virus from reproducing once they are inside of your cells. Antivirals and other treatments, such as monoclonals, are still being developed.

COVID and mental health in children

There is still much to learn about the mental health effects of COVID-19 on children.  It is fairly easy to assume that the social and mental health impacts of social distancing and pandemic restrictions will have an effect on children.

For most children, being isolated from friends and extended family is not conducive to social and mental well-being. There are of course exceptions to every rule, but to say that children (especially adolescents) have not fared well during the pandemic would be an understatement.  New research is beginning to shed light on how a COVID infection may cause neurological damage that impacts children and adult mental health as well.

Multi-systemic Inflammatory Syndrome (MIS-C)

MIS-C is a rare but serious complication of a COVID infection. In the simplest terms, it is an immune response against your own blood vessels causing organs (heart, kidneys, brain, skin, eyes, intestinal system) in the body to become inflamed.  What actually causes MIS-C to occur is unknown, but children with MIS-C also have blood tests indicating an infection by the virus that causes COVID-19.

The most commonly affected age group is school aged children, specifically 8-9 year olds.  Infants and older children can also develop MIS-C ,although less commonly.

The symptoms of MIS-C include high fever, fatigue, stomach pain, rash, red eyes, diarrhea, and dizziness. They commonly show up about four weeks after a COVID infection, and may occur after a mild or severe infection. Kids showing symptoms of MIS-C should be seen by a doctor promptly to avoid long term damage to organs.  The condition is treatable and full recovery is possible in most children.

It’s too early to make definitive statements regarding vaccine protection against MIS-C, but early indicators do show that most of the children who develop this particular complication of COVID are unvaccinated.

Can children get long COVID?

Long COVID, or post-acute sequelae of SARS CoV-2 infection, refers to a condition in people who experience four or more weeks of ongoing symptoms following a COVID infection.  For some people, these conditions may last nine months or even longer.

It is still unknown how the coronavirus can impair the heart, lungs, skin, kidneys and brain — but it does.  The symptoms are not all physical.  Mental health is also affected in many children and adolescents who may experience anxiety or depression, or what is becoming known as “COVID Brain Fog.”

Long COVID can be especially hard for parents as well.  There is not much known about why it happens, why it only occurs in some children and adults, or how to cure it. The best way to prevent the suffering of Long COVID is to prevent COVID in the first place.

Preventing COVID is done through vaccines.

What about myocarditis associated with the vaccine?

Simply put, myocarditis is an inflammation of the heart muscle.  You may have never heard of this condition until recently, but it is diagnosed in thousands of people every year.  The most commonly affected population is young adult males who are often otherwise young and healthy.

Several different viral infections cause myocarditis including flu, colds, and COVID. Symptoms can be mild or severe, with severe cases requiring hospitalization and sometimes resulting in permanent damage to the heart.  The symptoms of myocarditis might be the same as the illness that brought it on such as fever, shortness of breath, and chest pain.  Most cases resolve on their own.

Myocarditis is an excellent example of comparing risk of vaccine side effects versus risk for possibility of a complication of a disease.  The CDC has identified myocarditis as a rare (about 4-7 out of 100,000 vaccinated kids), but real, side effect of the mRNA vaccine. Exactly why this happens is not clear, but it is most likely related to a hyper immune response. Current observations suggest that myocarditis after a vaccination tends to be mild and resolves quickly.

It’s difficult to compare numbers in these situations, but people who are infected with COVID are much more (17 x more) likely to have myocarditis than those who are not.  If you took a group of 100,00o people (from which 4-7 have a risk of the vaccine’s side effect), about 5,500 unvaccinated people would become infected with COVID-19 in a 3 month time-frame.  Of those 5,500 people, about 50 would end up hospitalized due to serious disease.  (Example taken from CHOP: Myocarditis Get the Facts)

Choosing to not vaccinate your child is not how you prevent myocarditis.

Bringing It Home

COVID-19 will impact our lives and the lives of our children for years to come. It has reminded us we are not invincible, but we are clever and courageous.  It has shown us where our society has weakness, where our public health systems need to be strengthened, and how quickly facts can be lost in conversation.  What has held up under all this uncertainty and confusion is that the scientific process of asking questions, collecting data, examining that data, and drawing conclusions. We’ve also seen up close — and personally for many — that vaccines work.  Vaccines save lives.