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Children wait in line during picture day at St. Barnabas Catholic School in Scarborough, Ont., on Oct. 27, 2020.

Nathan Denette/The Canadian Press

COVID-19 hospitalizations and deaths among children remain rare – even with more infectious and deadly variants of the coronavirus, pediatric specialists say. But amid high rates of infection among the general population, the likelihood of severe disease in children increases.

On April 22, Emily Viegas, 13, of Brampton, Ont., became one of the youngest Canadians to die from COVID-19. Last week, B.C.’s Provincial Health Officer Bonnie Henry told reporters a child under the age of 2, who had underlying health issues, died of COVID-19. As of April 23, 955 people from 0 to 19 were hospitalized, 142 were in intensive care and eight had died since the start of the pandemic, according to national statistics.

We asked experts to explain the trends they’re seeing among children during this third wave of the pandemic.

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How is COVID-19 affecting children now?

At CHEO, a pediatric health and research centre in Ottawa, Nisha Thampi said more children are now testing positive for COVID-19, as the B.1.1.7 and B1351 variants of the coronavirus have become prevalent. However, the pediatric infectious-disease physician said she has not seen a rise in children being admitted to hospital for COVID-19.

While new variants of concern have been shown to be more transmissible, a recent British study in The Lancet Child and Adolescent Health journal found no difference in the proportion of severe disease among children with B.1.1.7 compared with those who had the original coronavirus, Dr. Thampi said.

However, if the overall number of people who are infected grows, so, too, would the number of children who become severely ill, she said.

“Kids are not expected to get severe COVID, but if we have relentless spread in our community … eventually, with more children being infected, then we can see these rare and devastating events,” she said.

Anna Banerji, a pediatric infectious-disease expert and associate professor at the University of Toronto’s faculty of medicine, said the number of deaths among children is still small compared with the nearly 24,000 total COVID-19 deaths in Canada. Even so, children can still catch COVID-19 and are still vulnerable to long-haul symptoms, Dr. Banerji said.

“They can also get COVID and spread it to other people, other classmates, teachers, [who] bring it home and that contributes to community spread,” she added. “So it is a concern.”

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How likely are children to spread the virus?

In a new study, published in CMAJ, Jared Bullard and his team studied 305 nasopharyngeal samples from children and adults in Manitoba who had tested positive for the coronavirus. They found the samples from children were about 50 per cent less likely to grow in a cell culture system than samples taken from adults.

The significance? These findings suggest children probably aren’t as good at transmitting the virus as adults, said Dr. Bullard, an associate professor in pediatrics and infectious diseases at the University of Manitoba.

“So in-person school is safer than we would anticipate. And likewise, extracurricular activities are probably also safer,” he said.

“That’s not to say that you can just go ahead and let kids run wild and do whatever they want. You still have to make sure that they’re trying to social distance as much as they can and washing their hands and using a mask and staying home if they’re sick,” he added, explaining it doesn’t mean children can’t spread it to other children and adults. “It just means they’re less likely to be able to do it.”

Dr. Bullard said his study included samples taken over about six months, and included different variants of the coronavirus that were circulating in Manitoba during that time. But the researchers did not look specifically at the variants of concern, such as B.1.1.7 and B1351, because these variants were not yet found in the province.

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However, while other countries hard-hit by these variants have seen a rise in cases among children, Dr. Bullard said it isn’t evident that children are spreading the virus more effectively now than in previous waves.

“I haven’t seen very convincing data in that regard,” he said.

When can we expect to see children receiving COVID-19 vaccines?

Trials are now under way to make sure COVID-19 vaccines are safe and effective in children. The Pfizer-BioNTech vaccine is approved in Canada for those 16 and older. And the other vaccines, Moderna, AstraZeneca and Johnson & Johnson, are approved for those 18 and older.

Dr. Banerji in Toronto said the trials among children are likely to produce results in the coming months. It’s important to first vaccinate adults and high-risk groups, including those in COVID-19 hot spots and essential workers, she said. But she said she hoped that if vaccines are shown to be safe and effective in children, children would be vaccinated over the summer to ensure a safer return to school in September.

“For the safety of kids and their families and teachers, in an ideal world, it would be good if the kids could be vaccinated before they go back to school,” she said. “And then you don’t have the opening and closing and opening and closing of schools, all the inconsistencies, et cetera.”

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How can parents tell whether their children need medical attention?

At The Hospital For Sick Children in Toronto, associate pediatrician-in-chief Jeremy Friedman said parents needn’t have any reservations about bringing their children to the hospital, if needed. Even though more children are coming to his hospital with COVID-19 than during previous waves, the numbers are still “very tiny” – about four or five children at any given time, he said. “It hasn’t impacted in any way on our capacity to look after any children that need hospitalization.”

While the majority of children with COVID-19 have just mild cold-like symptoms, Dr. Friedman said there are three key signs children need medical attention: They’re struggling to breathe; they refuse to eat or drink, to the point where parents worry they’re becoming dehydrated; or they’re not responding normally to interaction and appear lethargic. “That’s an absolute indication to seek immediate medical attention.”

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