To what extent are children and adolescents at risk from a COVID-19 infection?

Children and adolescents can also become infected with COVID-19. If they display no symptoms at all, the infection often goes unnoticed. This makes it all the more important to test regularly – also to prevent the infection spreading. In contrast to especially vulnerable high risk groups and very elderly people, however, only a very small number of infected children and young people are hospitalised. Even fewer need intensive care.

But there are high risk patients among children and young people too. This applies, for instance, to those with chronic lung disease, an impaired immune system, or other chronic conditions. In very rare cases, a particularly insidious secondary disease has been observed following infection with COVID-19. Paediatric Inflammatory Multisystem Syndrome or PIMS can result in organs or blood vessels becoming inflamed.

Do children and adolescents become infected particularly often?

During this third wave of the pandemic the number of infected children and adolescents is rising particularly fast. The Robert Koch Institute pointed to this recently. Over the last weeks the incidence among children under the age of 14 has more than doubled. Young children are now affected more and more frequently. Increasingly, COVID-19 outbreaks are being seen in nursery and children’s daycare.

According to Franziska Giffey, the Federal Minister for Family Affairs, the percentage of infections accounted for by children aged 5 or less has quadrupled since mid-February. At the end of March, some 6,300 cases were reported within one week in this age group. The more easily transmissible variant of the virus is also playing a part in the higher numbers of infections among children and adolescents.

What is the situation in nurseries and children’s daycare?

The number of cases of COVID-19 infections in Germany’s 56,000 nurseries and children’s daycare facilities is rising. We are now seeing almost as many children as staff affected. Overall, however, it is still not clear to what extent children transmit the infection. Initial observations appear to indicate that they pass on the infection to their contacts slightly less frequently than adults. This makes it all the more important to find out more about the role of children and the current situation in nurseries and children’s daycare.

The Corona-Kita-Studie (COVID-19 study in nurseries and children’s daycare) is to provide the information we need. It is examining the role of these facilities and of children in spreading COVID-19 from a medical and social science stance. And it is looking at the consequences for nurseries, children’s daycare, children and parents. 15,000 nurseries have already registered for the study, which is being conducted by the German Youth Institute (DJI) and the Robert Koch Institute. The Federal Ministry for Family Affairs and the Federal Ministry of Health are financing the study.

How exactly is more information being gathered in nurseries?

The COALA Study is an important module of the ongoing investigations under the Corona-Kita-Studie. COALA investigates in detail all aspects of infections among staff, children and families following a COVID-19 outbreak in nurseries. An RKI team interviews the management team of the nursery and visits families affected in an effort to answer the following questions:

• What role do children and nurseries play in spreading the virus?
• How often do infected nursery children transmit the virus inside nursery groups and in the household?
• What symptoms are seen among infected children over what time scale?
• How frequently do children who are infected with COVID-19 display no symptoms?

What impact does the infection situation have on school opening?

Most Länder currently have Easter holidays, but it must be carefully weighed up whether or not schools can offer in-person teaching. The situation at the moment is that the Länder can decide whether schools should offer distance learning or in-person teaching. In many cases we have recently seen a hybrid model, with in-person teaching alternating with remote learning.

Basically, Federal and Länder Governments aim to keep schools open wherever possible. For children and young people it is important to have in-person contact to teachers, friends and peers at school. On the other hand, however, we need to closely monitor infection trends.    

How can nurseries and schools be kept open for as long as possible?

In view of rising infection numbers, in particular, it is important to ensure that appropriate protective strategies are in place, if the facilities are to remain open. This includes hygiene measures and in the case of schools organising alternating in-person and remote learning.

Another component is to vaccinate nursery staff and teachers in primary and special schools as a priority group.

The Federal and Länder Governments have also decided to offer regular testing in schools, nurseries and children’s daycare. The aim is to test teachers and students in schools, as well as nursery staff, twice a week as soon as possible. Federal Government will provide support for test procurement. The Länder are responsible for distributing tests as swiftly as possible to all facilities in their area of responsibility.

The tests will provide better protection against infection in the facilities. Infection chains will be better identified and broken, and these also affect the wider community of nurseries and schools.      

When will COVID-19 vaccines be authorised for children and adolescents?   

There are currently no vaccines authorised for use in children and adolescents up to the age of 16. For young people aged 16 or more the BioNTech/Pfizer vaccine is authorised. Authorising vaccine for use in children is an extremely sensitive matter. It must first, for instance, be sufficiently clear that the vaccines are safe for use in adults. Studies of their use in children can only begin when this has been demonstrated.

Studies are underway at the moment, but it is not yet clear when they will be completed and when a vaccine will become available for children.