Kids are suffering from COVID in ways we never expected

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In the biblical verse Matthew 19:14, Jesus tells his disciples to not take children for granted; that, in their vulnerability, they have much to teach us as adults: “Suffer little children, and forbid them not to come unto me.”

This is sage advice, especially at a time when our pediatric system health system is living in a crisis of near biblical proportions.

Pediatricians, family physicians and emergency rooms are being slammed by a tri-demic: simultaneous outbreaks of respiratory syncytial virus (RSV), influenza and COVID-19, with cases of rhinovirus and enterovirus thrown in for good measure.

To make matters worse, there is a grave shortage of children’s pain medication in pharmacies. Even antibiotics such as amoxicillin, used to treat the complications of these minor ailments, are in short supply.

A winter surge of respiratory illness in children is to be expected, but this year it has come early and hit hard. The number of infants and toddlers needing hospitalization is unusually high.

Because there are a limited number of beds (since the number of physicians, nurses and other health professionals who care for children are in limited supply) this has led to the postponement of surgeries. And, in year three of the pandemic, the backlog of surgeries for children is already significant.

There is every indication that this troubling situation is going to get worse before it gets better. After all, winter cold and flu (and potentially COVID) season is only just beginning.

Where will all the sick kids go?

That is a question that should send chills down the spine of every parent.

Since COVID-19 started wreaking havoc in early 2020, we have made the mistake, time and time again, of taking children for granted.

We have consistently portrayed COVID-19 as a threat only to older people. Early on in the pandemic, some went as far as to say that children couldn’t get or transmit COVID. Then, we settled into the mild view that if kids do get COVID, it’s just the sniffles.

At the height of COVID, when adult hospitals were overwhelmed, pediatric hospitals were eerily quiet. Now they are seeing double and triple their normal rates of ER visits and admissions.

When provinces imposed mitigation measures such as lockdowns, crowd limits, mandatory vaccination and masking, the rules tended to be a little more lax for children. (Vaccines approved for young people were also developed and approved much later than those for adults.)

In most jurisdictions, schools and daycares were always the last to close, and the first to reopen, which is not an unreasonable approach. But we never took masking or better ventilation as seriously as we could have in congregate settings for children.

In Canada, COVID-19 pediatric deaths have been mercifully rare – to date, 66 deaths in those under age 19. (In the U.S., COVID remains one of the leading causes of death in young people.) But there are likely few children who have not been infected with SARS-CoV2, and we may now be seeing the insidious effects of that reality.

Take RSV, a common respiratory virus that usually affects infants. Case numbers are not up dramatically, but we’re seeing more toddlers infected. They are also getting much sicker, degenerating to pneumonia and even requiring ventilators.

There are those arguing that this spike is due to an “immunity deficit” – that children are getting sick now because they were deprived of infections during lockdowns and school closings.

Let’s be clear: that theory is made-up nonsense, perpetuated by the same people who opposed COVID mitigation measures.

As epidemiologist Dr. Colin Furness explained eloquently on Twitter last week, the immune system is not a muscle. You don’t have to “use it or lose it.”

What we are likely seeing, he says, is “immunity robbery,” where COVID infection stealthily hobbles the immune system, even in those who don’t suffer severe illness, like many children.

We know the coronavirus has evolved to become better at evading the body’s immune response. That’s why vaccines and drug treatments have become less effective.

In the process, the virus has also improved immune suppression, making children less able to fight off other illnesses. (There is long-standing evidence of this occurring with other viral infections, such as measles.)

The potential consequences of widespread immune suppression are frightening. It’s a reminder that the harms of SARS-CoV2 can be long-lasting, just as we’re seeing with long COVID.

A reminder, too, that we may have declared victory over the pandemic, and given up on mitigation, a little too early.

But moving forward, our primary goal should be to minimize the suffering of children.