How will the new strain of COVID-19 affect children and young people?
A guide to the new strain, what it means for children’s services, the vaccination programme and the advice nurses should give parents
- The new strain of the coronavirus that emerged in September 2020 has been shown to be more transmissible and has led to soaring infection rates
- Experts have stressed the variant appeared to affect all ages and, as yet, clinicians are not seeing any greater severity in children and young people
- Parents should always be encouraged to seek medical help for their children when needed
In late 2020, the government announced that a new strain of the SARS-CoV-2 virus had been identified in England.
Health and social care secretary Matt Hancock told the House of Commons on 14 December that scientists had identified a new variant which could be associated with the faster spread of the disease that was occurring in south east England.
By this point the strain, officially named VUI 202012/01, had already been identified in more than 1,000 cases across 60 local authorities.
14 December 2020
Health and social care secretary Matt Hancock informed parliament that scientists had identified a new COVID-19 variant in south east England
But how infectious is this new strain, and how does it affect children and young people?
Here, we look at what is known about the new strain.
When did the new strain emerge?
Scientists believe it probably emerged in September, circulating at low levels until mid-November.
Public Health England (PHE) uncovered the variant when looking into why infection rates in Kent were not falling despite the second national lockdown. It was then linked to rapidly spreading cases in London and Essex.
Why does the new strain matter?
All viruses mutate and new strains emerge regularly. More than 4,000 strains of the coronavirus have already been identified in the UK.
But this particular strain is causing concern because it appears to spread among people more quickly than the original virus. The evidence shows that infection rates in areas where this variant has been circulating have increased faster than expected, and that this variant has a higher transmission rate.
Rates this winter have risen rapidly in many areas, leading to the third national lockdown, and these increases are believed to be fuelled by the new strain.
There have been suggestions it could be up to 70% more transmissible, but the latest PHE briefing says it is more likely to be 30 to 50%.
On 22 January, prime minister Boris Johnson announced that there was some evidence that the new strain may carry a higher risk of death, but government scientists downplayed this as the data is limited and more research will be needed before this can be concluded.
Why is it more transmissible?
Mutations in the spike protein, the part of the virus that makes it infectious, can change how the virus interacts with human cells. But not enough is known yet about how this leads to an increase in transmission for this strain.
Is this the only strain causing concern?
No. Strains from South Africa and Brazil are also causing concern and have led to the introduction of new travel restrictions to the UK.
On 2 February, a door-to-door testing programme of 80,000 people in England was announced in a bid to find ‘every single case’ of the South Africa variant in a bid to stop the spread of the more infectious strain.
Does the new strain affect children differently?
2 January 2021
The Royal College of Paediatrics and Child Health (RCPCH) stressed that the new COVID variant appeared to affect all ages and, as yet, clinicians were not seeing any greater severity in children and young people (Source: RCPCH)
So far COVID-19 has affected children less than the rest of the population. While the disease has been reported in children and young people of all ages, including shortly after birth, there have been far fewer confirmed cases of COVID-19 disease in children than adults.
Children consistently make up 1 to 5% of total case numbers in reports, according to the Royal College of Paediatric and Child Health (RCPCH).
When children do get it, it is generally mild or asymptomatic, with few children becoming seriously ill.
But there have been concerns that this strain could be affecting children differently, after reports in the media suggesting that children’s wards are particularly busy.
What is happening to COVID-19 case numbers among children?
The number of cases of COVID-19 has risen across many parts of the UK as the current wave has taken hold, and this is also being seen in children. The RCPCH says that as cases in the community rise, there has been a corresponding increase in the number of children affected.
6 January 2021
England’s third national lockdown began
A major surveillance study by Imperial College London shows infections among children aged five to 17 years were increasing through October, November and into early December.
Prevalence has increased in school-aged children during the second wave, particularly among secondary school-aged children, experts have advised the government.
But a lot remains unknown about the new strain and its affect on children and there are no published studies of the new variant relating to transmission and prevalence in children, according to the RCPCH.
Fortunately, there is no evidence or signs that children are becoming more seriously ill as the new strain spreads.
Are children’s intensive care units busier than normal?
The RCPCH says that hospitals are not seeing large numbers of children with COVID-19 in need of hospital care, nor of any increase in paediatric inflammatory multisystem syndrome (PIMS-TS) – a hyperinflammatory response syndrome which could be related to COVID-19 in children.
RCPCH president Russell Viner says this is usually a busy time of year for children’s units, and not related to COVID-19.
‘We are not seeing significant pressure from COVID-19 in paediatrics across the UK.
‘As cases in the community rise there will be a small increase in the number of children we see with COVID-19, but the overwhelming majority of children and young people have no symptoms or mild illness only. The new variant appears to affect all ages and, as yet, we are not seeing any greater severity among children and young people.’
Association of British Paediatric Nurses chair Katrina McNamara-Goodger, says that rates among children are edging up as rates increase across all age groups.
‘We are hearing that children’s intensive care units are busy, but also that they are taking in a broader age range than normal by accepting adults,’ she says. ‘We are not hearing from colleagues in acute hospitals of higher numbers of children being admitted with severe cases of COVID-19.’
The effect of this strain on children is more through the knock-on effect on the services they normally use, Ms McNamara-Goodger says. The transfer of children’s nurses to support adult services struggling with large numbers of seriously ill patients is affecting services usually used by children, such as vaccination programmes.
In late January, University Hospitals of Leicester NHS Trust made the ‘difficult’ decision to transfer children with complex medical needs to Birmingham Children’s Hospital, in order to free up the paediatric intensive care unit at Glenfield Hospital to treat adult COVID-19 patients.
Will the new strain affect COVID-19 vaccination?
There is no evidence to suggest that the approved vaccines will not be effective against the new strain.
In the future, as new strains emerge, vaccines may need to be tweaked and adapted, much like the flu jab which is updated annually.
But few children are likely to get the vaccine, with the focus on adults, health and social care staff and those at high clinical risk.
The Joint Committee on Vaccination and Immunisation says there is limited data on COVID-19 vaccinations in adolescents, with no data on vaccination in younger children at this time.
The committee advises that only those children at very high risk of exposure and serious outcomes, such as children over 12 with severe neuro-disabilities that require residential care, should be offered the vaccine.
What advice should be given to parents about the best way to control the virus?
The way to control this virus is the same, whatever the variant. The government says it will not spread if people avoid close contact with others and carry out handwashing, wear a face covering, keep their distance from others and reduce their social contacts.
England’s chief medical officer Chris Whitty says that due to the new strain ‘it is now more vital than ever that the public continue to take action in their area to reduce transmission’.
Parents should always be encouraged to seek medical help when needed for their children.
Further information
- UK Government (2020) COVID-19 (SARS-CoV-2): Information About the New Virus Variant
- UK Government (2020) Investigation of Novel SARS-CoV-2 Variant: Variant of Concern 202012/01
- Royal College of Paediatrics and Child Health (2021) RCPCH Response to Media Reports of Increased Admissions of Children and Young People with COVID-19