Coronavirus pandemic updates
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The writer is a science commentator
Back in July, as rich countries were completing their adult vaccination rollouts, the science journal Nature posed a provocative question: will Covid-19 become a disease of the young?
This is now happening in some countries — by design, rather than by accident. Schools in England are reopening just as more than 28,000 new cases were recorded on Thursday. Term time is likely to spell germ time: in Scotland, where schools opened in mid-August, more under-18s are infected now than at any time in the pandemic. While lateral flow testing is continuing in England’s secondary schools, mitigations such as masking and bubbles are no longer prescribed. Isolation requirements when pupils or family members test positive, are loosening.
After education unions aired concerns about poor ventilation, the UK government belatedly promised carbon dioxide monitors to schools. But it is yet to give the green light to vaccinating all 12 to 15-year-olds, despite the Pfizer and now Moderna vaccines having been approved in that age group. A generation of young people is being thrust back into the viral trenches with minimal protection, a situation that verges on the incomprehensible given the availability of safe, effective vaccines and continuing bad news about the risks of natural infection.
Last week brought more chilling dispatches. First, neurologists warned that Covid-19 could fuel a pandemic of dementia, because of long-term brain damage wrought in some patients. Second, a paper in the Journal of the American Society of Nephrology noted that “long Covid” sufferers are at increased risk of kidney damage. Millions may need dialysis for years to come, a costly tragedy for patients and creaking healthcare systems.
Third, scientists reported that one in seven children in England who tested positive were still suffering three or more symptoms, including headache, fatigue and breathlessness, 15 weeks after infection. The landmark study suggests “long Covid” affects between 4,000 and 32,000 children aged between 11 and 17 in England; the larger number equates to nine afflicted pupils in every state secondary school.
Some US states are also dropping mitigations, such as masking, in schools, but the country is vaccinating over-12s. The UK seems an international outlier in restoring in-person learning largely without mitigations during high transmission while not vaccinating all 12 to 15-year-olds (except the clinically vulnerable or those with family members at risk).
The Joint Committee on Vaccination and Immunisation, which advises ministers, is right to say that the decision to immunise under-16s is finely balanced. But it is hard to understand its continued reluctance to recommend what many other high-income countries, such as the US, Israel and others in Europe, are already undertaking. The committee has previously taken a slower course to the same destination: it recently advocated vaccinating all 16 and 17-year-olds, after months of querying the benefits.
True, it is incredibly rare for children to die of Covid-19. The same could be said of seasonal flu. There were 25 Covid deaths among under-18s in England between March 2020 and February 2021. For comparison, 30 people aged 19 or under died of seasonal flu in England and Wales during 2019. Seasonal flu is the subject of a schools-based vaccination programme that recognises children as spreaders — but Covid-19 is not, despite being the most disruptive global health emergency for a century.
The primary known risks from the mRNA vaccines (BioNTech/Pfizer and Moderna) are myocarditis and pericarditis, two types of heart inflammation, that have been mostly seen in younger male adolescents and adults after the second dose. As of 25 August 2021 the US Centres for Disease Control has confirmed 798 incidents among a total of 369m doses of all vaccines given.
One might expect heart specialists to harbour flutters of doubt but the American College of Cardiology is firmly pro-vaccination for all over-12s, stating that “unvaccinated (adolescents) are at risk of not only myocarditis, but also more serious complications that can lead to hospitalisation and death”.
There may be good reasons why the JCVI demurs. Perhaps it is privy to safety information that experts in other countries have either missed or judged less concerning. Still, it would boost public confidence if it showed its working. Delaying child vaccination is not risk-free, particularly with the super-transmissible Delta variant. Unchecked spread will eventually reach the vulnerable, including those with waning immunity from early vaccination.
It also feels dissonant to see vaccines now championed as essential for 16-year-olds but too risky for 14- and 15-year-olds, particularly if, as a recent Lancet paper implies, they offer some protection against long Covid as well as hospitalisation and death.
As Sage adviser Jeremy Farrar argues in our co-authored book Spike: The Virus Vs The People, a decision not to do something is still a decision. The UK’s current strategy is to deny younger adolescents any opportunity to be vaccinated, even with a single dose, while expecting them to return, en masse and unmasked, to poorly ventilated buildings for seven hours a day, five days a week. How transmission will play out is unpredictable but this looks like the officially sanctioned mass infection of schoolchildren with a vaccine-preventable disease.
If Covid-19 does indeed become a disease of the young, conjuring up new variants that put them and others at future risk, it will be a sorry twist of our own making.