How are the kids doing after the pandemic?

Dr Martin Karsten takes a look back at the time of COVID measures and explains why he is disappointed and even angry about child health today.

Health damage to children as a result of the Corona pandemic

Children have been harmed in two ways by the pandemic. They bear the consequences of the lockdown, the school closures, the mask wearing. I see various forms of damage that have increased significantly. Children suffer more from depression and behavioural problems, they are more overweight, and their media consumption has increased. All these have triggered consequences in their school performance.

At present, I see significantly more mental and psychiatric illnesses in my medical practice, as well as a spike in infectious diseases. And of course, because of the high numbers, you also see significantly more complications and severe courses of disease. These two go together.

Some of the damage to children's health as a result of the pandemic measures is irreparable. And the lost years of these adolescents will still evolve into unfortunate consequences. This experience will affect puberty, relationships, personality development; a lot has been lost. This is not something to be taken lightly. I have my doubts over whether it is possible to make up for it at all. Two years are very relevant periods for children and adolescent development. This is sad and negative. We don't enough psychotherapists and paediatricians as needed for care and rehabilitation. They are completely overburdened and cannot provide the necessary help. This is going to fall on us.

To state it clearly: In hindsight, you are always smarter. And looking back, there was no experience to fall back on to face the pandemic.

Children should have been excluded from the measures

Nevertheless, it is now clear: children should have been left out of the prescribed measures. But the fear back then was that COVID-19 would behave in the same way as influenza, for example. As the pandemic evolved, the argument was that children were the drivers of infection. We paediatricians knew better from our own experience, and also from studies. It was found that children can have corona viruses in their throats just as quickly as adults, but they do not excrete viral loads as much. And that the child's immune system reacts very quickly and fights off the viruses immediately. After two months of the pandemic, I contacted the RKI (the German virology institute) and the public health service and shared my analysis on this. I was told that my impressions were not a study.

Therefore, decisions were based on results from the laboratory and not from medical day-to-day practice. In addition, experiences with other viral diseases were extrapolated; while studies based on models predicted how contagions would unfold. This is also true for flu epidemics. Children always get it two months before adults. The greatest fear was that such contagion models would also happen for SARS-CoV. But it quickly became clear that this would be different. There was no adequate reaction, and so the wrong decisions were made.

The media also played a major role

Paediatricians know what it's like: when a child has an infection, it spreads to the other child very quickly and over a wide area. We have never seen this with COVID-19, not from the beginning. We have never seen entire kindergartens fall ill with Corona - in contrast to streptococcus infections or influenza. That was a completely different occurrence. Every one of us could see that. So we should have dealt with the children quite differently in the pandemic event. It was completely absurd to close sports clubs. Playing football outside is the best thing children could do!

The media also played a role. Every serious case of Paediatric Inflammatory Multisystem Syndrome (PIMS) was highlighted - but these were rarities. As a comparison, I just had a child who developed kidney infection due to strep throat and then developed a hypertensive crisis - with changes in the MRI of the head. The child was comatose and was in intensive care for a fortnight. But apart from family and friends, hardly anyone is interested in a case like this. If something like this had happened in connection with Corona, the papers would have been full of the story.

Children were never the problem during pandemic

I am angry and disappointed that my colleagues and I were not heard. Our expertise was not of interest. The sentence made during the pandemic was that children were the pandemic drivers. This was wrong! Three months into the pandemic I gave a lecture on this. In preparation to it, of course, I reviewed the literature. I found the first paper on COVID-19 in the New England Journal of Medicine. In the 30 or so pages of the paper, there were 5 lines about children! At that time, 60,000 people were studied in Wuhan, about 150 of them children. That was because children simply had no significance in that context. I was surprised myself at first. But nobody wanted to hear this, not even once the perceptions on the matter were become fixed. Children were never the problem of the pandemic. By comparison, when I do smears during influenza season, 80 percent of these are positive. With COVID-19, we only found very, very isolated positive tests.

Current waves of infections are due to weak immune system

Now our children are affected for a second time, because other infections are spreading. Children were healthy for two years, had no infections, but their normal immune system development was missing. Now a wave of infections has increased significantly, and the number of respiratory infections is much higher than before the pandemic. During the autumn of 2022 came the RSV wave, then influenza at the turn of the year, and now we are dealing with streptococci, scarlet fever, and skin infections.

In any case, there is hardly any time to look back. But the fact remains: pediatricians' voices were not heard for a long time. No thought was given to the effects that lockdowns, or school closures would have on children. It was not known, and a few didn't even want to know. And plus, there was a lack of experience.

I want to look forward now. We have to be prepared in case something like this happens again. This was certainly not the last wave of infections to hit us. We need to have a clear procedure in place for the next time. Which strategy is of benefit, and which one solves nothing at all? And what does more harm than good? And then, what strategy is actually related and relevant to children?