There is a renewed focus on how children and pregnant women, groups that until recently were considered relatively safe from severe forms of the coronavirus, fare with the disease. That assumption has changed, leaving physicians with a wealth of theories but not enough clear answers.
The number of children and pregnant women with severe COVID-19 is still low, albeit higher than in the first months of the pandemic. But add to this the need to protect these groups and the possibility (not yet supported by data) that mutations could make the virus more dangerous to children, and you get a disturbing picture, particularly in light of the fact that the vaccines have not been approved for children under the age of 16.
Dr. Uri Pollak, director of the pediatric intensive care unit at Jerusalem’s Hadassah University Hospital at Ein Karem, said the hospital is seeing a steep rise in the number of children under 9 years old who tested positive for the coronavirus and developed symptoms. He believes recent mutations, and especially the British variant of the virus, which is thought to be more transmissible, is one of the reasons. “We are seeing more children who are very ill, which led us to open a coronavirus-specific pediatric ICU at Hadassah. We are seeing an unusual number of patients,” Pollak said.
Four babies ranging in age from 14 days to two years are being cared for in the new unit. Two have been sedated and intubated, and three of the four had existing conditions. “We are also seeing children with severe post-COVID-19 illness, including post-coronavirus Kawasaki-like inflammatory syndrome,” said Pollak.
Pollak said the new variants are more highly transmissible and symptoms appear sooner than with the “regular” coronavirus. He added that while the data on the variants hasn’t yet been published in scientific journals, anecdotal data is mounting from conversations with research groups in Europe and the United States.
Severe COVID-19 in children is quite rare. Until the current wave, fewer than 1 percent of young coronavirus patients were hospitalized, and most of them were not seriously ill. A few dozen children have become severely ill since the pandemic began over a year ago, most of them with multisystem inflammatory syndrome – a syndrome resembling Kawasaki disease that was first seen in April and has been associated with what some people are calling “long COVID” in children and teens.
According to Health Ministry figures, more than 51,000 children under 17 in Israel tested positive for the coronavirus in the first three weeks of January alone. In September, at the height of the second wave of the pandemic in Israel, about 34,000 children under 17 tested positive, while for all of December, some 24,000 children tested positive. Many public health experts say the rise is connected to the overall rise in infection rates, attributed to the recent variants.
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“We are seeing a slight rise in positivity in children in the past two or three weeks, but not in children with COVID-19, and we aren’t feeling an extreme change,” said Dr. Efrat Bron-Harlev, the CEO of Schneider Children’s Medical Center of Israel in Petah Tikva. She added that the virus is spreading more quickly than before, including among children, and that since most older adults and people who are high-risk have already been vaccinated, the proportion of children being infected has risen. “More than one-third of Israel is under 16,” Bron-Harlev said. “That has enormous significance. We at Schneider, and at other hospitals, are not seeing excess severe illness in children.
Ten pregnant or postpartum women are currently hospitalized in Israeli medical centers in severe or critical condition with the coronavirus. Since the start of the pandemic, more than 6,500 pregnant women have tested positive for the virus – over 1,700 during the first three weeks of January, compared to about 1,200 in all of December and 850 in September, the peak of the second wave. Late last week, the Health Ministry reported that the British variant of the virus had been identified in six of the seven pregnant women hospitalized with the coronavirus whose samples were sequenced.
Public health officials say it’s difficult to determine from these findings whether the genetic mutations in the British variant contributed to the decline of these women’s condition.
Pregnant and breastfeeding women were not enrolled in the clinical trials of the coronavirus vaccines developed by Pfizer, AstraZeneca and Moderna, and the original guidance was to exclude this group from receiving the vaccines until additional information could be collected. However, a few days ago, the Health Ministry recommended that pregnant women get the vaccine, citing support from the National Council for Gynecology, Genetics and Neonatology, and even instructed Israel’s health maintenance organizations to give them priority. “In this wave of the pandemic we are seeing more and more cases of young people with severe illness, to the point of endangering their lives. It’s no longer a disease of old people with existing conditions,” said Dr. Yael Haviv Hadid, director of the coronavirus critical care ward at Sheba Medical Center at Tel Hashomer.