There is a visible increase in children testing positive for Covid-19, although their rate of admission to hospitals and fatality remains substantially lower in relation to adults.
Children’s admissions to hospital are about 13 times lower than those of adults, says Heather Zar, a public sector paediatrician at Cape Town’s Red Cross Children’s Hospital.
The National Institute of Communicable Diseases’ (NICD) surveillance report on children with Covid-19, published on Monday, says children make up 4.2% of all Covid-19 associated admissions to hospital.
“There has been no increase in the proportion of children dying. Among those who died, most had underlying conditions, and infants or adolescents [aged] 15 to 19 years constitute the major groups. About 6% of children hospitalised go to the intensive care unit. The in-hospital death rate is about 3.5% of those who are hospitalised,” Zar said.
Mignon McCulloch, the president of the South African Paediatric Association, says that since the beginning of the pandemic in March last year to May this year, 401 children have died, compared with 60 000 adults who succumbed to Covid-19 complications. That translates to 99.97% as against 0.03%.
But the third wave of the pandemic has seen an increase in the number of infections in children, compared with the first and second waves.
“This has occurred especially in adolescents aged 15 to 19 years as well as in children under five years,” says Zar, ascribing the increase to a larger number of tests conducted and the highly transmissible nature of the Delta variant.
“However, there are still much lower numbers of infected children compared to adults, with children comprising about 10% of all positive tests, despite being about 30% of the population,” she adds.
Regarding younger children being carriers of the virus and introducing it to their families, Zar says children can transmit it, but are less likely to do so than are adults.
But adolescents can be a greater source of transmission, especially among their peer group, says Zar.
Jo Barnes, an epidemiologist at Stellenbosch University, agrees, noting that “teenagers the world over show scant regard for the sensible but irritating precautions that help to cut down on transmission rates”.
Barnes describes teenagers who might be asymptomatic as a “weak link” in stopping the chain of infections reaching adults at home.
Wolfgang Preiser, the head of medical virology at Stellenbosch University, says if a small child is infected there is little chance for the parents or caregivers to remain uninfected.
“Adolescents have been involved in several rather momentous outbreaks around schools and establishments. Due to young age and less common comorbidities, they tend to do better than older people but they do become infected and infectious,” Preiser says.
Zar warns that compared with the previous waves, more infections and household transmission can be expected during the third wave because of the highly transmissible nature of the Delta variant.
“This makes it crucial to urgently upscale vaccination in the adult population and to use all the nonpharmacologic interventions — social distancing, mask wearing, good ventilation — to prevent transmission in children and adults,” she says.