First wave of COVID 19 gripped elderly population, second wave gripped youths, now it is anticipated that next wave will effect pediatric population i.e. kids below age of 18 years. Why corona spared young population earlier and why it is attacking them now? Are kids less susceptible to corona infection? Is COVID less serious in children? What is the truth and what may be the reason?
There are many theories/hypothesis related to Covid 19 in kids:
- Novel Corona virus (nCoV) enters through binding to ACE2 receptor present on the cells of nasopharynx, lungs, intestine, heart, kidney. The expression of ACE2 in nasopharynx and lung epithelium increases with age, furthermore the affinity of ACE2 receptor to nCoV also increases with age, hence lower age group population has less chance of getting infection. Animal studies show that ACE2 protects against nCoV associated lung injury. After nCoV gains entry into cells through ACE2 receptor, the expression of ACE2 decreases and its protective effect reduces leading to severe disease.
- The endothelium (the innermost layer of blood vessels) and coagulation system of children is different from adults hence less chances of thrombotic complications like heart attacks and strokes.
- Most individuals develop antibodies to commonly circulating human corona viruses during early childhood. These preexisting antibodies facilitate entry of novel (new strain) corona virus into cells and increases susceptibility to severe infection in adults, a mechanism called antibody dependent enhancement (ADE). Children with COVID 19 have lower ADE than adults.
- Ageing is associated with immunosenescence; a gradual decline in innate and adaptive immunity, which contributes to reduced virus clearance. Moreover, children have stronger innate and adaptive immunity that makes them less susceptible.
- Children have lower prevalence of comorbidities such as diabetes, hypertension, heart disease, COPD etc. that have been associated with severe COVID 19 in adults.
- Deficiency of vitamin D, which is known to have anti-inflammatory and anti-oxidative property, is more in adults as compared to children.
- Pediatric respiratory and gastrointestinal tract are more heavily colonized with microbes (like bacteria, viruses) as compared to adults, which increases competition for novel corona virus to invade the cells.
- Hormone Melatonin, known to have anti-inflammatory and anti-oxidative property, has high level in infants and decrease with age might contribute to milder symptoms in this age group.
- As compare to adults, the pediatric population receives vaccine like BCG and other live vaccines more recently, might contribute to milder disease.
- Children have less intense workplace, travelling, shopping, nosocomial exposure to nCoV as compared to adults. More going out, more exposure. (Most Acceptable Reason in my view)
How can we protect our kids from nCoV infection?
Exactly the same way we protect ourselves. Physical distancing, wearing clean mask completely covering nose and mouth, hand hygiene, avoid going in close overcrowded places and vaccination. More youth and elderly population gets vaccinated less will be the chance for pediatric population to get infected. Moreover, we might get vaccine for two years and above age group population as well.
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