Covid cases in the UK have fallen sharply in the past few weeks, and hospital admissions appeared to have turned a corner. But now, it seems, the situation has stalled, with cases bobbing around 90,000 a day.
The reason for the change is that while case rates are falling among adults, they are rising among children – where vaccination rates remain sluggish.
According to data for England, the rate of new cases for every 100,000 people fell from 1,430.4 among 60- to 64-year-olds in the rolling seven-day period to 1 January, to 529.3 in the rolling seven-day period to 19 January. However, they rose from 941.6 to 2,384.1 for children aged five to nine during the same period, and from 1,230 to 1,909.7 for children aged 10 to 14.
The Department for Education’s latest attendance figures show that 374,000 children were absent from school with confirmed or suspected infections of coronavirus. In the last week before Christmas, the figure was 199,000. However, these DfE figures do not include children who were off after having a positive PCR test, who are counted separately as being off ill.
One intervention available for some children is vaccination. However, according to the latest data from the UK Health Security Agency, uptake of first doses has been slowing, with 52% of children aged 12-15 having received at least one Covid jab.
While vulnerable five- to 11-year-olds are now eligible for Covid vaccinations, with a national rollout expected by the end of January, some GPs are already giving jabs – although a lack of paediatric doses means at present this tends to be where there is capacity to use fractionated adult doses off-label.
Prof Christina Pagel, the director of University College London’s clinical operational research unit, said one reason for the slow uptake of jabs among adolescents is a lack of clear messaging from bodies including the Joint Committee on Vaccination and Immunisation (JCVI), the cabinet and the chief medical officers that they should be vaccinated against Covid.
Pagel added that long Covid and the rare paediatric multisystem inflammatory syndrome (PIMS-TS) are serious concerns, while the proportion of young children hospitalised with Covid has risen – although others have noted most cases are “mild” and may reflect the lower threshold for bringing infants into hospital.
“[It’s] almost like there’s this understandable desire to reassure, and that ends up kind of minimising [the importance of vaccination],” said Pagel, adding that all children aged five and above should be offered the jabs.
But others, such as Prof Russell Viner of UCL, suggest the slow uptake of jabs is down to a host of factors from logistical challenges to initially only offering jabs through the school vaccination programme, and that while evolving messaging may have led to some uncertainty among parents and children, it was the right approach to take – not least because of early concerns about myocarditis.
Prof Adam Finn, the head of the Bristol Children’s Vaccine Centre and a member of the JCVI, said Covid is a mild disease in childhood, while evidence suggests long Covid is rarer, milder and less long-lasting than in adults.
Finn added that it is not surprising vaccination rates are lower in adolescents than adults, noting vaccines are “not that good” at preventing onward transmission and adolescents have lower risks from Covid. While vaccination of healthy five- to 11-year-olds is under discussion that, too, is a difficult decision, he said.
Such disagreements look set to continue. But one thing is clear: when it comes to children, there are many lessons yet to be learned around how best to manage a pandemic.