Got a child with COVID at home? Here’s how to look after them


Brendan McMullan, UNSW and Philip Britton, University of SydneyThe Delta variant is more infectious and is leading to more COVID-19 cases in children than previous strains.

Many parents are wondering whether Delta is making kids sicker, and how to care for their children if they get COVID.

It can be a nerve-racking time for parents, but there are practical things you can do to make your child more comfortable if they’re ill.

How common is COVID in kids, and how sick do they get?

There have been more than 50,000 confirmed COVID cases in Australia.

Of these, 4,625 cases have been in children aged 0-9, and 6,325 among those aged 10-19 — totalling approximately 20% of all Australian cases.

Symptoms in children are often like those of other viral infections and may include fever, runny nose, sore throat, cough, vomiting, diarrhoea and lethargy.

A small number of children have other symptoms such as tummy pains, chest pain, headache, body aches, breathing difficulties or loss of taste or smell. Up to half of children with COVID may be asymptomatic.

Despite evidence the more-infectious Delta variant is causing more severe illness in young adults, there’s no convincing evidence it has caused more severe illness in children to date.

Read more:
Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?

Most children can be cared for at home. Hospital networks, including children’s hospitals and local networks, are helping parents and carers to support this care at home.

In some cases, children and families may be transferred to special health accommodation to provide safe isolation and care.

How can I best care for my child at home if they get COVID?

Caring for a child with COVID will look similar to the general supportive care for children with other viral infections.

Children should be dressed in appropriate clothing, so they’re comfortable — not sweating or shivering.

Parents and carers should make sure the child drinks lots of fluids. They can also take paracetamol or ibuprofen if they are uncomfortable with pain or fever. These medicines should be administered as directed in the product information or by a health professional.

Read more:
Masks, ventilation, vaccination: 3 ways to protect our kids against the Delta variant

Warning signs of deterioration include prolonged fever (for more than five days), difficulty breathing or chest pain.

Some children get severe abdominal pain, vomiting and/or diarrhoea. It’s important to encourage these children to frequently drink fluids. It’s a concern if they’re drinking less or passing urine less than half of what they normally would, or if they are excessively sleepy or irritable.

For these or other serious concerns, parents and carers should seek urgent advice from their care team. In an emergency, they should request ambulance assistance, informing the operator the child has COVID.

Don’t some children end up in hospital or intensive care?

Yes, there’s a small risk of severe disease from COVID in children but this is very uncommon, even in children who have medical vulnerabilities.

Children and adolescents can develop inflammatory complications after COVID, though this is rare. Symptoms include persistent fever and rash, among others. These conditions, termed “Multisystem Inflammatory Syndrome in Children (MIS-C)” or “Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)” have been reported mainly in the United States and Europe.

Estimates from the US suggest these occur in around one in 3,000-4,000 cases of COVID in children. There’s only been a handful of cases reported in Australia to date.

Children aged 12-15 in Australia are now eligible for vaccination, and vaccination trials are ongoing for younger children.

Do children get ‘long COVID’?

There has been increasing concern about prolonged symptoms after COVID infection, sometimes called long COVID, even with mild disease.

Fortunately, this is rare in children. In a study of more than 150 children with mild or asymptomatic COVID in Australia, most symptoms resolved in 4-8 weeks and children generally returned to their baseline health within 3-6 months.

What if some people in the home aren’t infected?

The SARS-CoV-2 virus spreads easily from one person to another, particularly in close contact and for those living in the same household as someone who has the virus.

You can reduce the risk of spread by:

  • keeping more than 1.5m distance where possible
  • getting the child to use a separate bathroom, if this is available
  • wearing a mask (for adolescents and older children); younger children and others who cannot wear a mask can be encouraged to observe the other behaviours
  • covering coughs and sneezes
  • performing regular hand hygiene with soap and water or hand sanitiser.

Good ventilation is also a factor in reducing transmission, but not everyone can modify this in their living situation.

If someone in the household has COVID, high touch surfaces such as door handles, kitchen bench tops, switches and taps should be regularly cleaned.

Personal household items such as cutlery, dishes and towels should be washed before being shared. Regular household disinfectant is sufficient.

The authors would like to acknowledge Christine Lau, paediatrician, and Nadine Shaw, clinical nurse consultant, Sydney Children’s Hospitals Network, for their contributions to this article.The Conversation

Brendan McMullan, Conjoint Senior Lecturer, School of Women’s and Children’s Health, UNSW and Philip Britton, Senior lecturer, Child and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen


C Raina MacIntyre, UNSW; Greg Kelly, The University of Queensland; Holly Seale, UNSW, and Richard Holden, UNSWLast week the New South Wales government announced schools are scheduled to re-open in October. While face-to-face learning undoubtedly has benefits for both children and parents, the announcement left unanswered a series of important questions about how this can be done safely.

By the time NSW lifts restrictions (estimated to be around October), only 60-70% of the population in NSW — and possibly less in Australia — who are 16 years and over may be fully vaccinated.

The Australian Technical Advisory Group on Immunisation (ATAGI) has recommended vaccination for children 12 and over, but most of these children will not be fully vaccinated by October, and children under 12 will remain unvaccinated for now.

In NSW, with well over 1,000 cases a day and rising, there will still be substantial community transmission when schools open. It is unclear when schools in Victoria (where cases are also on the rise) will open, but there may still be some transmission in the state when they do.

So, what do we need to do to make sure kids are as safe as possible at school?

The Conversation, CC BY-ND

1. Vaccinate the adults around them

In California, a primary school outbreak occurred when an unvaccinated teacher, who came to work despite symptoms, read to students with their mask off. Most kids who became infected were well over 2 metres from the teacher, which confirms the 1-2m distancing rule is not effective for an airborne virus.

Every child and teacher in a classroom or childcare centre with an infected person is at risk. Shared air is the major way SARS-CoV-2 — the virus that causes COVID-19 — spreads.

Children often get the virus from the adults around them, so vaccinating adults in a child’s household, and teachers, can help protect them.

Vaccination is now mandatory for teachers in NSW, but around 67% have had one dose. This probably corresponds to less than 40% of the NSW population being fully vaccinated.

Teacher reading books to kids sitting on the floor.
Anyone in the same room with an infected person, especially if that person isn’t wearing a mask, is at risk of catching the virus.

One dose of vaccination gives about 31% protection and two doses gives 67% (AstraZeneca) to 88% (Pfizer) protection against the Delta variant. Most kids will still be unvaccinated if schools in the two largest states re-open for the last term of the year. This means it’s even more important to ensure the adults are vaccinated.

2. Mandate masks for teachers and students

We can mandate masks in schools for teachers and students, and highly recommend mask use for younger children in childcare.

The American Academy of Pediatrics recommends masks for children two years and up; children over this age can wear masks without much trouble.

As mask use in schools has been more common overseas, there are now numerous toolkits (including translated versions) and recommendations to support children to wear a mask. For example, your child is more likely wear a mask if it has their favourite colour, sports team, character or special interest on it.

Importantly, a DIY cloth mask can be made to fit your child’s face and be high quality if key design principles are followed. It is important to ensure children have choices and understand the reason why they are wearing a mask (for instance: “When we wear a mask, the virus can’t jump from person to person.”

Read more:
Can’t get your kid to wear a mask? Here are 5 things you can try

3. Ventilated classrooms

Classrooms can be ventilated by opening windows (ideally two windows at opposite ends of the room). If there is only one window, a fan can help move the dirty air out. If opening windows is not possible there is fortunately a cheap fix available — portable air purifiers, which dramatically reduce the viral load in classrooms.

Read more:
Poorly ventilated schools are a super-spreader event waiting to happen. It may be as simple as opening windows

There are DIY methods for making air purifiers, too.

4. Reduce numbers of people indoors

Reducing the number of people packed together in a classroom can reduce the risk of COVID. For example, during high epidemic periods, if the decision is made to open schools, a group of kids can come in every second day and learn online on alternate days.

We have shown this approach, when combined with masks, reduces the risk of transmission on university campus.

Use of outdoor spaces for lessons is also a smart move as the weather gets warmer. While Delta can transmit outdoors, the risk is likely much lower.

5. Test school kids

Finally, rapid point-of-care testing in schools will help reduce transmission, and self-testing kits (when approved in Australia) can help.

Saliva tests are also a practical way to test children. These tests are now available in official health settings, so governments could make them available to schools.

What about childcare centres?

We also need to consider childcare centres. Contrary to popular narrative, a new study shows kids up to three years old transmit more than older kids. So, vaccinating childcare workers and parents of young kids is also essential.

All the measures above, except masks for 0-2 year olds, can easily be used in childcare settings.

Girls getting swabbed in the mouth.
Rapid testing in schools could help reduce transmission.

Record numbers of children are being hospitalised with COVID-19 in the USA. It remains unclear whether the high numbers of sick children are due mostly to Delta’s increased transmissibility, or whether it also causes more severe disease in children, as it does in adults. Although the risk of severe disease remains much lower in children than adults.

Read more:
Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?

One thing we do know is that as vaccination rates increase in adults, unvaccinated groups, the largest of which is children, will be proportionally more at risk. The 70-80% targets for vaccination of eligible adults for relaxing restrictions corresponds to 56-64% of the whole population, which leaves plenty of room for Delta to spread like wildfire in unvaccinated adults and kids. So there is good reason to protect kids if we open schools.

In addition, the productivity losses from lockdowns are an important component of the estimated A$220 million daily economic cost in NSW alone. Sick kids make it harder for their parents to work productively, if at all. And they make it more likely parents themselves become sick and are unable to work.

Read more:
Introducing OzSAGE, a source of practical expert advice for how to reopen Australia from COVID safely

The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Greg Kelly, Senior lecturer, The University of Queensland; Holly Seale, Associate professor, UNSW, and Richard Holden, Professor of Economics, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?


Nicholas Wood, University of SydneyIn July Australia’s Therapeutic Goods Administration (TGA) provisionally approved the Pfizer COVID-19 vaccine for kids aged 12-15.

The Australian Technical Advisory group on Immunisation (ATAGI) subsequently recommended kids in this age group with underlying chronic medical conditions, Aboriginal and Torres Strait Islander children and kids living in remote communities should be prioritised.

We’re expecting advice from ATAGI as to whether the rollout should be extended to all 12 to 15-year-olds, as countries like the United States and Canada have done.

But where does that leave children under 12? We know they’re making up a large proportion of new infections in Australia’s current outbreaks, which was not the case last year.

Do they need to be vaccinated? What are the benefits of vaccinating children, both for the child and the community? And how will we know the vaccines are safe and effective for young children?

COVID in kids

Throughout the pandemic, fortunately, we’ve seen children are very unlikely to get severely unwell or die from COVID-19.

Australian data from January 1 to August 1 this year show 2.5% of children aged up to nine and 2.9% children and teenagers aged 10-19 who contracted COVID were hospitalised. This is compared to 7.7% of young adults aged 20-29, with the rates continuing to increase with age.

Cases are on the rise among children in New South Wales, but to date this hasn’t been accompanied by a large increase in paediatric hospitalisations.

Recent data show increased rates of hospitalisation among children in the US with COVID-19 compared to last year, alongside rising infections with the Delta variant.

But even though the rate has gone up, it remains low. In children and adolescents aged 17 and under the rate is 0.38 per 100,000 people, well below the rate in adults aged 60 to 69 (5.63 per 100,000) and those over 70 (8.07 per 100,000).

However, some kids who have chronic medical conditions are at a higher risk of getting really sick from COVID, which is why ATAGI has listed them as a priority group.

Read more:
Should we vaccinate children against COVID-19? We asked 5 experts

One of the complications of COVID-19 is long COVID where a person experiences lasting symptoms such as breathlessness, anxiety and “brain fog” (reductions in attention and concentration).

Reassuringly, a recent study found only a small proportion of children had symptoms beyond four weeks after their initial COVID infection, and almost all children had recovered by eight weeks.

So what are the benefits of vaccinating kids?

While the Delta variant is more infectious than other strains of the coronavirus, and more kids are becoming infected, there’s not a scientific consensus at this stage that it’s causing more severe disease in children.

That said, a small minority will get sicker than others and need hospital care.

If vaccines are found to be safe and effective for younger children there would be benefit in protecting the individual child.

A teenage boy with a mask on and a band-aid on his arm.
The TGA has approved the Pfizer vaccine for ages 12 and up. But we don’t yet have a COVID vaccine for younger children.

What about collective benefits? Will vaccinating young children reduce transmission in the community and improve our herd protection?

Recent modelling from the Doherty Institute doesn’t appear to consider whether vaccinating children under 12 would or wouldn’t contribute to reducing community transmission.

Other modelling has suggested vaccinating younger children and adolescents will be important if Australia is to reach the elusive “herd immunity”.

Trials are under way

Clinical trials of the mRNA vaccines from Pfizer and Moderna in children aged 12 and up have shown good results (though at this stage Moderna is only approved in Australia for adults).

Before we move to vaccinating children under 12 we’ll need safety and efficacy data from trials in this age group.

It’s important to conduct clinical trials specifically in children because their immune systems are different. For example, children may experience different side effects following vaccination, and may need a smaller dose.

Read more:
How to prepare your child for a COVID test

Trials of the COVID-19 mRNA vaccines in younger children are under way. The Moderna trial KidCOVE is currently recruiting in the US. So far close to 7,000 kids are enrolled.

Meanwhile, Pfizer is aiming to enrol 4,500 children under 12 across the US and other countries.

The studies are divided into children aged six to 11, aged two to five, and six months to less than two years old. They are aiming to assess safety and immune responses after two vaccinations with three different dose sizes.

For Pfizer, the three doses being trialled are 10 micrograms, 20 micrograms, and 30 micrograms (the latter is the dose given to older teens and adults).

A trial of AstraZeneca’s COVID-19 vaccine in children aged 6-17 commenced in March 2021 in the United Kingdom. However this trial was paused as a precautionary measure following reports of blood clots in adults who received this vaccine.

A young girl in a mask with a teddy bear.
Children who contract COVID-19 don’t usually need hospital care.

What now?

You may be wondering when children under 12 will be able to be vaccinated. The short answer is we don’t know for sure.

We need strong safety and efficacy data from the clinical trials before considering vaccinating young children. Currently, it’s anticipated the first data on children younger than 12 may be available for review later this year.

For now though, it’s reassuring to know children still appear less likely to end up in hospital with COVID compared to adults.

Read more:
Is it more infectious? Is it spreading in schools? This is what we know about the Delta variant and kids

Further, it seems many of the cases we’re seeing in children are due to transmission in the household, often from an infected adult to the child.

So the best way to protect younger kids for now is to ensure as many adults as possible are fully vaccinated.

High vaccine coverage in the community will also benefit children by reducing the need for lockdowns and school closures, which we know can have negative effects on their education, socialisation and mental health.The Conversation

Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Masks, ventilation, vaccination: 3 ways to protect our kids against the Delta variant


Katrina McLean, Bond University and Natasha Yates, Bond UniversityLast year in the COVID-19 pandemic, children were not catching or spreading the virus much. The main focus was on protecting our elderly and vulnerable.

But the Delta strain has changed things. Children around the world are contracting Delta in high numbers and some frontline doctors believe they may also be getting sicker from this strain.

Many parents and schools have concerns about how to best protect children from COVID-19. There’s also the worry children will catch the virus at school and take it back to their families and communities.

While many children are now well-accustomed to washing and sanitising their hands, this is simply not enough to tackle the spread of COVID-19, especially now we know the virus is airborne. We need a whole toolbox of strategies.

There are three key areas to focus on that we believe are evidence-based, easy to implement and will help protect our children: masks, ventilation and vaccination.

1. Masks

In certain Australian states, children aged 12 and above are currently required to wear a mask in public areas (schools included).

Meanwhile, Victoria’s chief health officer Brett Sutton has recommended children aged five and up wear masks in the face of rising Delta transmission among children.

As GPs, parents often ask us if it’s safe for children to wear masks. While we understand concern from parents, we reassure them masks have been found to cause no harm in children over the age of two. When children wear masks it doesn’t affect their breathing or reduce their oxygen levels.

Importantly, when worn properly, masks are effective at reducing the spread of COVID-19, for adults and children alike.

Read more:
Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?

A few quick tips. Fabric masks should be treated like underwear: wash them regularly, ensure they cover everything, and don’t share. These are a better option for the environment.

Label fabric masks like school hats — they will go missing!

Surgical/disposable masks are single use. Like using a tissue to blow your nose, make sure it goes in the bin once used and then wash your hands.

And masks should fit snugly — the less gaps there are the better they will work.

Like anything new, getting used to masks can take time. Children may initially be anxious, especially if their parents are too. Though most kids adapt really quickly (much quicker than adults, in our experience).

While the majority of children will adapt quickly there will be some who have specific and legitimate concerns, for example disabilities and sensory issues. GPs and paediatricians can help work out what the safest approach is for these children.

2. Ventilation

SARS-CoV-2, the virus that causes COVID-19, can float in the air like smoke. If you’re inside in a small enclosed room with other people and the ventilation is poor, it will only be a matter of time before you’re all breathing in each other’s air.

Schools have lots of children inside enclosed classrooms, often for hours, so what can be done?

Ventilation is something schools can and should address. Some simple strategies include:

  • get outside as often as is practical. Call children into the classroom only once the day has started. Hold some lessons outside the classroom. During breaks and lunch time children should be outside whenever possible too
  • open doors and windows
  • set air conditioning or heating systems to bring in as much outdoor air as possible
  • check the air with carbon dioxide monitors. This is occurring overseas.

Why do we care about CO₂? Well, we breathe in oxygen and breathe out CO₂. In confined spaces with lots of air that has been “breathed out”, monitors will detect higher levels of CO₂.

All that “breathed out” air could be full of viral particles, so if the monitor is measuring high, airflow needs to be improved immediately by opening a door or window.

In stuffy rooms, or rooms that measure high for CO₂ (indicating the ventilation is poor), a longer-term plan to clean the air should be considered. What’s encouraging is that the technology already exists to address this.

Air cleaners, also known as air purifiers, scrubbers, or HEPA filters, can actually help to “clean” the air we breathe. Lots of schools around the world are now actively improving ventilation systems and air quality monitoring.

Improving the air quality in schools may also prevent some of the other colds and flus kids pick up at school, and reduce asthma and allergy symptoms.

3. Vaccination

At this stage in Australia the Pfizer vaccine is recommended for vulnerable children aged 12-15, including those registered on the National Disability Insurance Scheme.

Vaccinations for all children 12 and over are now under way in New Zealand.

New Zealand GP Dr Sarah Hortop shared this photo of her daughters who received their first dose of the Pfizer vaccine recently.
Sarah Hortop, Author provided

Many other countries have been giving vaccines to children for several months now. For example, in the United States, more than one-third of 12 to 15-year-olds are fully vaccinated and nearly 50% have had at least one dose.

We know the vaccines work well in this age group and just like in adults, there is very close monitoring of adverse events from these vaccines in children. It’s reassuring to see very few serious reactions, and even those that are (for example myocarditis — inflammation of the heart) are treatable.

Vaccine trials are under way in children under 12 in the US (for Pfizer and Moderna), and once we have the safety and efficacy data we can start making decisions around vaccinating them too.

Read more:
We should install air purifiers with HEPA filters in every classroom. It could help with COVID, bushfire smoke and asthma

The Conversation

Katrina McLean, Assistant Professor, Medicine, Bond University and Natasha Yates, Assistant Professor, General Practice, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Can’t get your kid to wear a mask? Here are 5 things you can try


Rebecca English, Queensland University of Technology and Karleen Gribble, Western Sydney UniversityLet’s face it, none of us actually enjoys wearing a mask. And it’s even harder when you’re a parent trying to get your kids masked up, as well as yourself.

Victoria, New South Wales and the Australian Capital Territory now require everyone over the age of 12 to wear a mask whenever they leave their home, unless they are exercising. This mandate includes in high schools in NSW and Victoria.

In parts of Queensland and South Australia, children 12 to 17 years also need to wear a face mask if they’re indoors and can’t socially distance.

Children should not wear masks while exercising. And children under two years old should also not wear masks, as they are a choking and suffocation risk.

Parents can decide if children between the ages of five and 12 should wear a mask. But, the World Health Organization says children under five years old should not be required to wear masks.

There is ample evidence showing masks help keep children and young people safe. Plus, unlike the earlier stages of the pandemic when kids weren’t contracting or transmitting the virus as much as adults, we are now seeing many cases in children of the Delta variant. Although, thankfully, serious disease among young people is still rare.

Read more:
Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?

Here are five things you can do to encourage your kids to wear a mask.

1. Model wearing one

One of the best things you can do to encourage your kids to mask up is to model mask wearing. Show your child it is OK to wear a mask; it is “normal”.

Mother and daughter listening to music and wearing a mask while waiting for train.
Show your child it’s normal, and not scary to wear a mask.

2. Empathise with their feelings

If your child is reluctant to wear a mask, you can empathise with their feelings. Nobody likes wearing masks. Children rely on facial gestures to communicate, and many have sensory issues that can make wearing masks uncomfortable. Reflecting back to your child that you know this is hard for them helps them feel understood.

Find out why they don’t want to wear a mask. It might be they get sore ears or a headache. If so, masks that tie behind the head can be helpful. If it’s fogged glasses, a better fitting mask, or a mask clip, may help.

The internet is full of mask hacks to help make masks more comfortable. Some are as simple as using hair clips in the loops to extend the length of the mask.

Read more:
13 insider tips on how to wear a mask without your glasses fogging up, getting short of breath or your ears hurting

3. Help them understand the science

Kids may be more willing to wear a mask if they understand why they need to. When children understand why a behaviour is important to their health, they are more likely to comply. Older children may be interested in the science of mask wearing.

There are many resources — including easy to understand YouTube videos — that can help.

You could get your kids to watch a video, like this one.

Remind your kids that doing things they want, like seeing their friends at school, relies on them wearing a mask.

4. Make it a game

Younger children may be helped by making the mask wearing a bit of a game, which can include making up silly poems about wearing masks. Or you could encourage your child to see themselves as a superhero protecting others by wearing a mask.

Younger children can imagine they’re a superhero helping others.

You could also give your child the chance to choose a mask or decorate their own, turning it into a craft activity. This will make the child comfortable with the mask and give them a sense of ownership over it.

Read more:
Tinker Bell, Batman, Ben 10… if your kids are in character, they’re more likely to help around the house

5. Ask others for help

Children require good fine motor skills to put on, and keep on, a mask. If you want your child to be wearing a mask at school, you could talk to the teacher, teacher aide or guidance officer to see if they can help.

Teachers can make sure the mask is on properly, and help your child to adjust the mask as needed.

For children with a disability

If your child has a learning disability, developmental delay or is on the autism spectrum, asking them to wear a mask, and keep it on, may be harder.

Making it a game or making it fun may also work for these children. And there’s evidence that tolerance training, where you gradually expose your child to mask wearing providing praise when the child is able to complete a step, can help.

But it may be impossible to force compliance and it may be dangerous in some circumstances. There are exemptions for people who have any medical condition that makes wearing masks unsuitable.

Students in class wearing masks.
You could ask a teacher to help your child wear their mask properly at school.

Lastly, ask yourself these questions

If your child isn’t legally required to wear a mask, but you’re still wondering, ask yourself these questions:

  • are there high levels of virus in my community?
  • is my child going to be indoors with poor ventilation and lots of people?
  • does my child have a medical condition that might make COVID-19 more risky for them or are they going to be around people who have a medical condition that makes them more susceptible to COVID-19?

If the answers to any of these questions are “yes”, that would lend weight to encouraging mask wearing.

If the answers to any of these questions are “no”, this would lend weight towards not requiring mask wearing.

Read more:
Children need playgrounds now, more than ever. We can reduce COVID risk and keep them open

But if your child is under 12, or has a developmental or another kind of disability, it’s also important to consider whether they can put the mask on and take it off safely by themselves, and whether you or someone else can supervise them while they are wearing a mask. If not, it may be better they don’t wear one.The Conversation

Rebecca English, Senior Lecturer in Education, Queensland University of Technology and Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Do kids get long COVID? And how often? A paediatrician looks at the data

Oded Balilty/AP/AAP

Philip Britton, University of SydneySince the rise of the more infectious Delta variant, we’ve seen reports of more cases in children than with previous strains of the virus.

Many parents are becoming more concerned about COVID in kids. One question many are asking is whether kids can get “long COVID”, too, where symptoms persist for months after the initial phase of the illness.

I’m a paediatrician and infectious diseases expert, who cares for children with COVID-19, and have been following the research in this area.

Children can get long COVID, but it seems to be less common than in adults. And they tend to recover quicker. Let’s go through the data.

What is long COVID?

There’s still no standard definition of long COVID, and the syndrome itself is quite variable.

Even though there’s no one form of it, three broad types of symptoms frequently occur:

  • cognitive effects, such as slowed thinking or “brain fog”
  • physical symptoms, including fatigue, breathlessness and pain
  • mental health symptoms, such as altered mood and anxiety.

Having symptoms that persist for more than 28-30 days following the onset of COVID is increasingly being labelled as long COVID in the medical literature.

The cumulative effect of long COVID symptoms can have a profound impact on sufferers’ ability to function in their daily life, work or schooling.

Read more:
The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far

Does it occur in children?

Long COVID probably does occur in children but it is likely less common than in adults.

Two Australian studies are useful here. In one study of adults and children, researchers found 20% of over 2,000 COVID cases in New South Wales had persistent symptoms at 30 days. By 90 days, this had reduced to 5%. The youngest age group (0-29 years) were more likely to recover quicker than older age groups.

In a study from Victoria that looked at children only, 8% of 151 children with mostly mild infections had some persistent symptoms for up to eight weeks. However, all had fully recovered by 3-6 months.

The most comprehensive study to date was a large study in children aged 5-17 years with mild COVID from the United Kingdom. Of 1,734 children, 4.4% reported persistent symptoms 28 days after the start of their illness.

In these children, the number of symptoms at 28 days was fewer compared to that in the first week of their illness.

The study found 1.8% of children has symptoms at day 56. Headache, fatigue and loss of smell were the main issues.

Three-quarters of the children with persistent symptoms went on to report a full recovery. However, a quarter were not followed up, so it was unclear how many among this small group may have had longer-term problems.

The same study observed children who had other viral illnesses, not COVID. It found 0.9% showed persistent symptoms at 28 days. This suggests a “background rate” of non-specific symptoms like headache and fatigue occurs in children, which is important to consider — although the rate in children following COVID was considerably greater.

Read more:
COVID: long-lasting symptoms rarer in children than in adults – new research

Some studies of COVID in children, for example, from Italy and Russia, have found persistent symptoms to be more common.

But these studies looked at variable populations, such as only those who were hospitalised or had moderate to severe illness, or collected data retrospectively.

Also, the children were infected during the first wave of COVID in Europe and the overall societal impacts may have contributed to some of the ongoing problems reported in children, like fatigue and insomnia.

This variability between studies makes it hard to compare them to work out the real rate of long COVID in children. Taken together, there seems to be a relative increase of persistent symptoms in teenagers compared with younger children.

What about Delta?

These studies were done before the effects of new variants of concern, most notably Delta, which has shown an increase in the number of COVID infections in children.

Delta might be leading to increased severity of COVID in adults. But there’s no compelling evidence yet that Delta is more severe in children.

Current admission rates in the 2021 Delta outbreak in NSW are no greater than those in children across Australia during 2020.

Read more:
Under-12s are increasingly catching COVID-19. How sick are they getting and when will we be able to vaccinate them?

Both adults and potentially children who get more severe COVID in the initial (“acute”) stage of their illness seem to be at increased risk of long COVID. But if Delta isn’t causing more severe illness in kids, it’s reasonable to expect Delta won’t increase the risk of long COVID in children either.

Scientists need to agree on a consensus definition of long COVID, and a standardised way to measure it.

Given the non-specific nature of many long COVID symptoms, research also needs to include a control group of kids who haven’t had COVID to really determine the COVID effect.

Do persistent symptoms occur following other viral infections?

Yes. Common examples include the glandular fever virus, also known as Epstein Barr virus, and Ross River fever virus.

Studies report up to 10-15% of children and adults with these infections report chronic symptoms including fatigue, pain, slowed thinking and altered mood.

What actually causes persistent symptoms following viral infections, including COVID, remains a major focus of researchers. Persisting infection itself is not likely.

Major theories include chronic inflammation, blood flow disturbances or nervous system damage.

What should I do if my child has had COVID?

Some children do have persisting cough and fatigue around the four-week mark.

Parents are understandably concerned, but should be reassured most children will fully recover. If there’s a pattern of improvement, that’s a reassuring sign.

If symptoms continue beyond four weeks, it’s sensible to stay in touch with your GP or paediatrician.

In terms of persistent symptoms following other infections, we do know what helps to promote recovery. Things to consider are:

  • ensuring good sleep
  • aiming to have your child gradually return to normal activities
  • where fatigue is an issue, use rest well, in short periods and after doing activities.

Returning to normal activities may require planning, including liaising with teachers around school return, which is especially important in the context of online learning.

Aim for incremental gains, remain optimistic about recovery, and always seek help if you’re not sure what to do.The Conversation

Philip Britton, Senior lecturer, Child and Adolescent Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

High priority: why we must vaccinate children aged 12 and over now


Emma McBryde, James Cook UniversityPeople aged 16 and above will soon be able to get a COVID vaccine in Australia, but this begs the question: what about children in younger age groups?

Currently, only 12-15 year olds with underlying medical conditions, Aboriginal and Torres Strait Islander children, and those living in remote communities are eligible.

Modelling by the Doherty Institute has suggested vaccinating 12-15 year olds would not make a material difference to the COVID epidemic.

However, as a researcher with expertise on modelling infectious diseases, it’s my view children aged 12 and over must be vaccinated with high priority.

Read more:
We may need to vaccinate children as young as 5 to reach herd immunity with Delta, our modelling shows

Children and transmission

A key concept you might have heard about is the reproduction number — the number of new cases per infectious case. For the Delta strain, this number could be as high as nine. In other words, if there were no lockdowns or other controls in place, each Delta infection could theoretically lead to as many as nine new infections.

The “effective reproduction number” is how many new cases you get per infectious case after public health measures such as lockdowns have been applied.

The Doherty modelling used a baseline effective reproduction number of 3.6 but acknowledges the effective reproduction number will be different from state to state. It can also change over time.

The effective reproduction numbers in NSW and Victoria are currently under two — but this figure could rise when lockdowns lift.

Modelling by colleagues and I shows that once the value of the effective reproduction number creeps up above four, all else being equal, children including those younger than 16 start to feature highly in transmission.

In other words, we need to vaccinate children aged 12 and above now, in preparation for a scenario when the effective reproduction number is much higher than it has been under lockdowns.

A reality check

In a scenario where children aged 12 and above are returning to school and moving around the community unvaccinated, could masks and social distancing be enough?

Well, perhaps in an ideal world. But many simply assume children will be able to socially distance and wear masks just like adults do. Parents may wish to reflect on that.

We also need to compare old assumptions about COVID and children with what we are now seeing in reality.

The original strain of COVID-19 appeared to spare children; they were less likely than older people to be infected in the first place. The Delta strain seems to have changed all that.

According to NSW Health’s factsheet on coronavirus disease in NSW, only one person under 20 has died due to COVID. However, people in this age group are showing up significantly in overall case numbers.

Since NSW began its current lockdown, about one third of new COVID cases in NSW (around 3,000) have been in under 20 year olds.

According to NSW Health, only one person under 20 has died due to COVID but people in this age group are showing up significantly in overall case numbers.
NSW Health

Victoria’s chief health officer has also noted childcare centres and schools feature heavily among the hotspots in that state.

If Delta does end up infecting children more than the original strain did, children may become the super-spreaders of the Delta variant — just as they are key transmitters of influenza, pertussis, measles, chicken pox and just about every respiratory virus.

Now, some expert groups — including modellers — are starting to call for younger children to be vaccinated with high priority.

Read more:
Should we vaccinate children against COVID-19? We asked 5 experts

Which vaccine? While Pfizer is scarce, we should direct it to younger people

While Pfizer is scarce, we should be providing Pfizer to the younger population (who are more likely to transmit COVID-19), while giving AstraZeneca to older people.

While both vaccines are over 90% effective at reducing death and severe outcomes from COVID (including Delta), Pfizer is better than AstraZeneca at reducing transmission of the virus.

In Australia, children 12-17 are approved to receive Pfizer but not AstraZeneca.

What are the consequences of not vaccinating younger children?

The risks of not vaccinating children in the 12+ age group include:

  • more children becoming sick with COVID
  • denying children potential freedoms that may come with vaccination, such as returning to school, travel or avoiding strict lockdowns
  • not vaccinating children means living with the knowledge we haven’t done everything possible to ensure they don’t transmit COVID to more vulnerable people.

It’s unlikely Australia will achieve herd immunity to COVID this year.

But even without herd immunity, every little bit helps — and the growing number of cases in younger children suggests we need to vaccinate this group sooner, rather than later.The Conversation

Emma McBryde, Professor of Infectious Disease and Epidemiology, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How to prepare your child for a COVID test


Therese O’Sullivan, Edith Cowan University and Mandy Richardson, Edith Cowan UniversityWe’ve been urged to get COVID tested even if we have mild symptoms. Or perhaps we don’t have symptoms but are a close or casual contact of a known case. This includes children.

So what can you do to make COVID testing as simple and stress-free as possible for your child?

With a bit of preparation, role play and modelling the type of behaviour you’d like to see, the process can be plain sailing.

Read more:
The symptoms of the Delta variant appear to differ from traditional COVID symptoms. Here’s what to look out for

Start the conversation now

Ideally, you want to start the conversation about COVID testing before your child actually needs a swab. Reflect together on the pandemic so far and envision what might happen in the future.

Child's drawing of how 'Covid-19 sucks'
Here’s what 10-year-old Roisin from Ireland thinks of lockdown.
Our COVID-19 Artwork/Children’s Artwork Project, CC BY-NC-ND

Let your child know COVID tests ensure sick people are cared for and stop them spreading the virus to others.

Point out COVID testing sites when you drive past.

Read more:
8 tips on what to tell your kids about coronavirus

Preparation is the key

Knowledge of what is going to happen is important for children to feel in control and empowered in situations like COVID testing.

Encourage them to watch videos showing kids having a COVID test, like this one.

Encourage questions and be open to answering them honestly. Acknowledge it feels uncomfortable to have something pushed up your nose. But the discomfort will be only temporary.

This Canadian video shows the swab going right up a child’s nose. The video says this feels a bit like what happens when you get water up your nose, or the tingly feeling you get in your nose after a fizzy drink.

The swab goes up your nose, but only for about five seconds. Count them.

Children report feeling deceived if they are told a procedure won’t hurt when it does. This can lead them to distrust future medical procedures.

Depending on the age of the child, you could also help prepare with some role play, known as therapeutic play. This type of preparation helps children feel more comfortable and less anxious before medical procedures.

For COVID testing, this can include asking your child to try wearing a mask. Then your child can use a couple of cotton buds taped together to make a long swab, to “test” their teddy or doll.

Read more:
Why children and teens with symptoms should get a COVID-19 test, even if you think it’s ‘just a cough’

Before you go

To help your child feel in control of what is happening to them, think about how they can participate in the process. Give them choices where possible.

Which testing centre would they like to go to? What toy would they like to take with them to hold during the test? There may be a long wait for the test. What fun things could they take with them or do to help pass the time? What snack would they like to take?

During the test

Children are good at picking up on cues from their parents, so stay calm and confident when taking your child for testing. If you are also being tested, they may like to see you go first.

Ask the tester to talk through what they are doing. Avoid distractions and bribes. Offering a bribe can give the child the impression there is something to be worried about, and distractions can leave the child suspicious of why they were distracted.

As with vaccinations, some children may like to watch so they know what is happening, rather than shutting their eyes. Give your child the option.

Be fully present with your child during the procedure and put your phone away.

Humour can help keep things light hearted and it reduces stress levels. What do COVID-19 jokes have in common? They’re catchy!

Read more:
Needles are nothing to fear: 5 steps to make vaccinations easier on your kids

After the test

You need to go home until you receive a result so brainstorm with your child about some fun things to do while you wait.

Explain their result will come back either positive or negative. Positive means you have COVID-19, negative means you don’t.

Consider how best to help your child deal with a positive result. Some children may have some anxiety around this, even if they have very mild symptoms.

Read more:
Kids at home because of coronavirus? Here are 4 ways to keep them happy (without resorting to Netflix)

In a nutshell

Overall, this respectful approach to child-centred health care focuses on developing a cooperative relationship with the child, rather than using authority or incentives.

We have used this approach successfully in our child research projects involving invasive assessments. It helps the child feel in control, helps reduce anxiety around medical procedures and helps them feel empowered by their experiences.

Look at COVID testing as an opportunity for your child to learn more about how health care works. An empowering COVID testing experience can help set up your child for future interactions with the health system.The Conversation

Therese O’Sullivan, Associate Professor, Edith Cowan University and Mandy Richardson, PhD candidate, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We may need to vaccinate children as young as 5 to reach herd immunity with Delta, our modelling shows


Emma McBryde, James Cook UniversityRecently released modelling from the Doherty Institute, which the federal government used to back its roadmap out of the pandemic, misses one critical point — the importance of vaccinating children.

The Doherty modelling instead focuses on vaccinating 70-80% of the adult population as thresholds for easing various restrictions, such as lockdowns. It says vaccinating younger adults, in particular, is important to reach these thresholds.

However, our modelling shows vaccinating children is vital if we are to reach herd immunity, which would allow us to ease restrictions and safely open up.

This would mean potentially vaccinating children as young as 5 years old.

However, we are still waiting to see if this is safe and effective, with trials under way in the United States. So we need a plan that assumes we may never achieve herd immunity.

Here’s what our modelling shows and how it differs from the modelling used to advise the federal government.

Read more:
We need to start vaccinating people in their 20s and 30s, according to the Doherty modelling. An epidemiologist explains why

Here’s what we did

Our modelling, which we’ve uploaded as a pre-print and has yet to be peer-reviewed, considers different vaccine strategies for Australia to achieve herd immunity. That’s when we can expect no sustained transmission of the virus in the community.

We take into account the Delta variant, which is twice as infectious as the original Wuhan strain of the virus, and has a reproduction number estimated between 5 and 10. In other words, this is when one person infected with Delta is estimated to infect 5-10 others.

Read more:
Scientific modelling is steering our response to coronavirus. But what is scientific modelling?

We also consider different contact patterns across various age groups. This is because some age groups are more mobile and have many contacts. If infected, these people are more likely to infect many others, particularly of similar age, which can lead to reservoirs of transmission.

We combine this information with possible vaccine effects. These include the possibility of having the vaccine then becoming infected, having symptoms, and if infected, how serious the illness is and how infectious people are.

This allows us to model what’s likely, given we’re focused on the Delta variant for now, and allows us to assess the impact of strategies across different age groups, types of vaccines and percentage vaccinated.

Our interactive tool also allows rapid response to changing information, such as new variants, or new evidence about vaccine impact.

Delta is more infectious

The Wuhan strain had a basic reproduction number of 2.5. This means, at the start of the pandemic, one person infected with it was expected to infect 2.5 others.

If the Delta variant is twice as infectious, this means its basic reproduction number may be over 5 (at the lower range of international estimates). So this changes the number (and type) of people we need to vaccinate to reach herd immunity considerably.

The simplest form of the herd immunity equation would suggest we needed to fully immunise 60% of the population to achieve herd immunity for the Wuhan strain but as much as 80% for the Delta variant.

If we take into account how different age groups mingle or are in contact with others, the situation is worse.

Read more:
Is it more infectious? Is it spreading in schools? This is what we know about the Delta variant and kids

For the Wuhan strain, children were not as infectious or susceptible to infection and we predict that if we vaccinate 65% of the adults, transmission would not continue among children.

However, with the Delta variant, we predict children will continue to infect other children, even when most adults are vaccinated.

We also know both the AstraZeneca and Pfizer vaccines are less able to protect against the Delta variant, with a reduced efficacy after one dose and slightly reduced efficacy after two doses.

All this makes achieving herd immunity a great challenge.

Read more:
When will we reach herd immunity? Here are 3 reasons that’s a hard question to answer

We estimate if the reproduction number is 5, then vaccinating 85% of the population, including children down to age 5, will be necessary to achieve herd immunity.

If the reproduction number is as low as 3, then vaccinating children will not be necessary to achieve herd immunity and we will only need to vaccinate 60% of the population.

The Doherty modelling uses an effective reproduction number of 3.6. This explains why its modelling does not see vaccinating children as critical to reaching herd immunity. This is the major difference between our model and theirs.

What happens next?

Of course, new variants may arise pushing Delta aside, and the world post-COVID is unpredictable.

The lesson from Delta is if we don’t vaccinate children, we may need to continue some form of public health action to prevent large-scale circulation of the virus.

This would not require stringent lockdown, but may require ongoing mask use and physical distancing, including in children. The alternative is to reduce the focus on case numbers, expect transmission and focus on protecting the most vulnerable.

Read more:
Should we vaccinate children against COVID-19? We asked 5 experts

Do we need to reach herd immunity?

Herd immunity is not the only possible target. Even if we don’t reach full herd immunity, we may achieve “herd protection”. This provides some reduced risk to people who can’t or won’t be vaccinated, and it will make outbreaks smaller and easier to control.

And without full herd immunity, individuals still benefit from vaccination as they are dramatically less likely to die from COVID.

Read more:
How well do COVID vaccines work in the real world?

Do we need to change our vaccination strategy?

We predict Australia’s strategy of vaccinating the elderly and vulnerable first is the best strategy for reducing deaths under most circumstances, particularly when there is insufficient vaccine available.

But once the most vulnerable groups have been covered, we should turn our attention to the highest transmitters to achieve herd protection. In Australia, this group is the late teens and young adults.

Whether we next focus on vaccinating children is controversial and many people have voiced their concerns about going down this path. This is because COVID is generally a very mild illness for most children — although long COVID and life-threatening complications can arise.

So we need to balance the risks with benefits. But included in the benefits should be the potential benefit of herd protection and the freedoms that may bring.

Read more:
National Cabinet’s plan out of COVID aims too low on vaccinations and leaves crucial questions unanswered

The Conversation

Emma McBryde, Professor of Infectious Disease and Epidemiology, James Cook University

This article is republished from The Conversation under a Creative Commons license. Read the original article.