COVID-19 in children in NSW, Australia, during the 2021 Delta outbreak: Severity and Disease spectrum

Abstract

Objective(s): To describe the severity and clinical spectrum of SARS-CoV-2 infection in Australian children during the 2021 Delta outbreak. Design, Setting & Participants: A prospective cohort study of children <16 years with a positive SARS-CoV-2 nucleic acid test cared for by the Sydney Children's Hospital Network (SCHN) virtual and inpatient medical teams between 1 June-31 October 2021. Main outcome measures: Demographic and clinical data from all admitted patients and a random sample of outpatients managed under the SCHN virtual care team were analysed to identify risk factors for admission to hospital. Results: There were 17,474 SARS-CoV-2 infections in children <16 years in NSW during the study period, of whom 11,985 (68.6%) received care coordinated by SCHN. Twenty one percent of children infected with SARS-CoV-2 were asymptomatic. For every 100 SARS-CoV-2 infections in children <16 years, 1.26 (95% CI 1.06 to 1.46) required hospital admission for medical care; while 2.46 (95% CI 2.18 to 2.73) required admission for social reasons only. Risk factors for hospitalisation for medical care included age <6 months, a history of prematurity, age 12 to <16 years, and a history of medical comorbidities (aOR 7.23 [95% CI 2.92 to 19.4]). Of 17,474 infections, 15 children (median age 12.8years) required ICU admission; and 294 children required hospital admission due to social or welfare reasons. Conclusion: The majority of children with SARS-CoV-2 infection (Delta variant) had asymptomatic or mild disease. Hospitalisation was uncommon and occurred most frequently in young infants and adolescents with comorbidities. More children were hospitalised for social reasons than for medical care.

Demographic Predictors of Mothers' Willingness to Vaccinate Young Children Against COVID-19, Get Tested and Isolate: A Cross-Sectional Survey Before and During the Greater Sydney Lockdown 2021, Australia

“…The adverse impacts of COVID-19 infection on morbidity and mortality are higher in socially disadvantaged population groups ( 16 ). Although severe symptoms and consequences from COVID-19 in children are rare ( 7 ), there are concerns about uncertain impacts on children from the new variants. At the time of writing, Australia has already opened up the COVID-19 vaccination services to children aged 5 years and above.…”

“…Currently, COVID-19 vaccinations for children aged 0–5 years are not approved. To date, generally speaking, children and adolescents have a low probability of experiencing severe health outcomes and have low mortality rates ( 7 ). However, if transmission increases in children, the number of adverse cases will inevitably increase.…”

Key lessons from the COVID-19 public health response in Australia

“…Children and young people experienced a relatively low risk of severe disease, with a dramatic increase in the disease risk and burden among older individuals. 34 , 35 As highlighted by the recent Royal Commission into Aged Care Quality and Safety, 36 the pandemic exposed major system weaknesses in the Australian residential aged-care sector. Delays in vaccination, poor infection control practices, inadequate planning for staffing disruptions and failure to meet the social and emotional needs of residents and families during times of loneliness and end of life care were particularly distressing.…”

“…Fortunately children and young people experienced a low incidence of severe disease, 35 , 44 but messages from paediatric health care professionals to reduce unwarranted fear and emotional distress in children and their parents/carers were not heard. At times, children were mainly viewed as potential ‘vectors of transmission’ (using an inappropriate influenza paradigm) without adequately considering the detrimental impacts of school or playground closures on their education, emotional and physical development, and mental health, as well as the unequal effect of these measures on children from disadvantaged backgrounds.…”

Transmission of SARS-CoV-2 in a primary school setting with and without public health measures using real-world contact data: A modelling study

“…Delta, however, does present an increased risk of severe disease and hospitalisation for both adults and children with co-morbidities when compared to Omicron and previous variants [ 18 , 56 , 57 , 60 ]. Our results demonstrate a significantly increased risk of teacher-to-student (T-S), and teacher-to-teacher (T-T) transmission.…”