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Why are young children contracting COVID-19 at such a high rate and what can parents do?

Why are young children contracting COVID-19 at such a high rate and what can parents do?

Children and families waiting for the COVID-19 vaccination at the Woodlands Galaxy Community Club vaccination centre. (Photo: MOE)

SINGAPORE: On Tuesday (Feb 8), Health Minister Ong Ye Kung revealed that among all age groups in Singapore, children are contracting COVID-19 at the highest rate.

The infection rate for children between the ages of five and 11 is about 67 per 100,000, followed by those aged 12 to 19, with an infection rate of about 55 per 100,000. 

The Omicron variant is more likely to infect children than the Delta variant, added Mr Ong. To this end, public and private hospitals are setting up more beds for children, he said, and COVID-19 treatment facilities are also converting more beds for children and their caregivers.

But admitting children to hospitals and facilities is often “precautionary” in nature, he added, with short stays of about two to three days. 

CNA spoke to health experts to find out why this age group has the highest infection rate and what parents should do.

Why is the infection rate so high for children aged five to 11?

The Omicron and Delta variants of the COVID-19 virus have “adapted” and become more effective in infecting children, said infectious disease specialist Leong Hoe Nam, who runs a private practice at Mount Elizabeth Novena Hospital.

He also cited behavioural traits - not wearing masks well and not keeping safe distances - as reasons for children in this age group being more susceptible to the disease, with a majority of them infected with the Omicron variant.

Echoing this view is Dr Nicholas Chew, who said that the high infection rate among children aged five to 11 is “not unexpected”.

The specialist in infectious diseases at Farrer Park Hospital said that these children may have close contact with one another in school, and may not be as “rigorous” with their safe distancing and mask-wearing efforts. 

He added that the two-dose primary vaccination regimen does not confer sufficiently robust immune protection against Omicron. A third booster dose has been shown to raise the level of protection to a reasonable level, he said.

Most children aged five to 11 are only just beginning their primary vaccination regimen and therefore are susceptible to Omicron infection, he said. 

Taking a slightly different view is Associate Professor Alex Cook, who said numbers might not tell the whole story.

"The chance of a case being diagnosed may well be different in different age groups, since we know that infections tend to be more severe in older individuals and the unvaccinated," said the vice dean of research at the National University of Singapore's Saw Swee Hock School of Public Health.

"I would therefore not over-interpret the rates being slightly higher in one age group than another." 

How effective is vaccination?

Given that Singapore is already in the midst of the Omicron wave, not all children would have completed their primary two-dose vaccination regimen - as well as a booster shot for those above 12 - to be sufficiently protected against the variant, said Dr Chew.

But he urged parents to vaccinate their children in preparation for the next wave, if and when it happens.

Dr Leong said that getting vaccinated does not prevent the disease, but its severity would be decreased, as would the risk of developing myocarditis and multi-system inflammatory syndrome if children are infected with COVID-19.

The Ministry of Health (MOH) has said that vaccination will reduce the risk of transmission in schools, and minimise disruptions to education and co-curricular activities.

Noting that only 60 per cent of children in the five to 11 age group have had a first vaccine dose, Assoc Prof Cook said that once the coverage among this group "reaches a plateau", the "burden of disease will likely shift further".

How can I protect my child?

Good hygiene measures should be observed at home, said Dr Isaac Liu, a specialist in paediatric medicine at Raffles Children’s Centre

This includes frequent hand washing before and after handling children with COVID-19, and having adult caregivers who are well wear masks, he added. 

Dr Leong stressed the need for education and training, recounting how parents have told him that there have been instances of the children reminding the adults to put on masks.

For Assoc Prof Cook, getting jabbed is paramount: "The main action to take to protect your child at minimal social cost is to get your child vaccinated and then boosted once they become eligible."

Dr Jenny Tang, senior paediatrician at SBCC Baby and Child Clinic, urged parents to discuss any concerns resulting in vaccine hesitancy with the child’s doctor. 

How worried should I be if my child gets COVID-19?

Parents should remember that the risk of severe disease in children is "extremely low", which is why adults were prioritised for vaccination, said Assoc Prof Cook.

“By and large, it is reassuring that in children, symptoms are generally mild, and they tend to recover well in three to five days,” said Dr Liu, who added that community paediatricians have, as a whole, been involved in caring for “thousands of children” with COVID-19 both in person and via the home recovery programme through teleconsultation.

Infection with the Omicron variant usually results in milder disease, with mainly upper respiratory tract infections compared with the Delta variant, which often results in more severe lower respiratory tract involvement like pneumonia or other lung diseases, Dr Tang said.

Dr Tang, who has a special interest in asthma, lung, sleep and allergies, also suggested completing all other vaccinations on the national immunisation schedule, including the influenza vaccine in a "timely manner".

"Other infections can also occur in the midst of the COVID-19 pandemic, so we should aim to prevent all other transmissible infectious diseases as well," she said.

Where these children go also matters.

"Minimise outings to crowded enclosed areas. Less crowded open spaces for activities is preferred," Dr Tang said.

Being prepared is also important, said Dr Chan Si Min, head of the Division of Paediatric Infectious Diseases at National University Hospital's Khoo Teck Puat – National University Children’s Medical Institute (KTP-NUCMI).

"Parents should prepare for their children to be infected and be unwell by having the necessary items like ART kits, thermometer and medications on standby at home," she said.

They can also plan ahead for how and where to isolate their child and other childcare needs should their child be infected, she said.

What should I do if my child tests positive?

According to MOH, the protocol for vaccinated people and children aged five to 12, even if they are unvaccinated, is the same.

Those with non-emergency conditions, including children, should avoid seeking treatment at hospitals and consult their primary care doctor instead, according to the website. 

Under Protocol 2, those who are assessed by a doctor to have a mild condition or are well should self-isolate at home for at least 72 hours. 

If well, they may exit self-isolation and resume normal activities upon a negative self-administered ART result. Those who continue to test ART positive need to continue to self-isolate and self-test daily until they obtain a negative ART result or until Day 7 for vaccinated individuals and children below 12 years old.

But children under 12 who test positive - and have other conditions such as a congenital condition or hypertension - should see a doctor even if they are well.

KK Women’s and Children’s Hospital said that the symptoms of COVID-19 infection are similar to that of an acute respiratory infection or pneumonia. These symptoms include fever above 38 degrees Celsius, sore throat, cough, runny nose and diarrhoea.

The treatment is mainly supportive, according to a home recovery guide issued by the hospital.

“If your child remains alert, active and continues to eat well, your child can recover at home," the hospital said.

However, further medical attention is needed if a fever above 38 degrees Celsius lasts for five days or more or if the child has a fever of 41 degrees Celsius and above. Parents should also seek medical help if the child experiences breathlessness or is unable to speak.

Other red flags include poor urine output of fewer than four times a day, severe headache and significant chest pain.

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Source: CNA/ja(ac)

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