With over 64% of the Australian population fully vaccinated the lockdown restrictions from COVID-19 relaxed, the attention now shifts to children. Will, our children, get infected with COVID, how severe is the effect of infection on children, and is it safe for them to get the vaccine?

Mobinah Ahmad from AMUST conducted an exclusive interview with Dr Habib Bhurawala, Head of Department in Paediatrics at the Nepean Blue Mountains Local Health District. 

As schools are reopening, there is a serious level of concern regarding children getting COVID. According to Dr Bhurawala, “we need to be mindful of children being more likely to contract COVID infection if an infection is spreading around in the community. Children are particularly vulnerable and not as well protected as vaccinated adults and other individuals.”

Mobinah: If children do get COVID, how severely are they affected?

Dr Habib: Up to half of the children don’t get any symptoms of COVID infection. That’s a good thing. So they do get COVID, but most of them do not suffer from serious illnesses as the adult population may suffer, which is good. The effects of the COVID infection persist in young children. They can have fever, cough, runny nose and other respiratory symptoms. They also may have diarrhoea and vomiting, and also abdominal pain. They may start to feel unwell, not eating and drinking as well and maybe at risk of dehydration.

All of this may sound like other viral infections or illnesses. Still, we need to be mindful that it can affect some children. A small number of children can also need hospital admission and hospitalisation. We also have had incidents of children requiring intensive care, which is, for severe illnesses condition due to COVID.

This is more common in children who have already pre-existing medical conditions. So they may have other health conditions which may make them predisposed to more severe illness because of COVID. For example, having conditions such as cancer, or having some other chronic disease treatment, may have diabetes, obesity, other health conditions, genetic conditions, delayed development, autism, all of these children are particularly more at risk of developing severe complications COVID.

Mobinah: Wow, that’s so hard to hear. Initially, the health advice said that children couldn’t get COVID, but now things have changed. Can you advise if that’s the case like that switch?

Dr Habib: Yeah, so I think children do get COVID. It’s all evolving situation, and indeed while any person of any age can get COVID. We saw more severe complications and infections in the older population than children, but they get COVID.

We have had many cases of children getting infected with the COVID, especially in the recent outbreak in New South Wales and has been seen in Victoria. So they do get COVID, and indeed, we need to be mindful of that.

Mobinah: Absolutely. Should children get the vaccine? Does the vaccine cause any harm, and does it have any side effects on children?

Dr Habib: So I think children do get side effects of COVID vaccine like many other vaccines, and the side effects are again very similar to the other vaccines, and the commonest one which we know of is injection side pain, pain the way the vaccine has been given. And can occur in up to half of the children. Up to 50% of children can get that or one in five children. So up to 20% of children can get a fever, usually within 48 hours after receiving the vaccine, and generally responds well to the pain relief or fever medications, which they can get from the pharmacy or get their local doctors to advise and administer that. It’s no different to many other vaccines, and then they do have those complications.

Serious complications are rare, very uncommon. And for example, there are some rare side effects been regularly reported, such as inflammation or the swelling of the muscle of the heart, which we call myocarditis and inflammation of the membrane or covering surrounding the heart, which we call pericarditis. These effects are much, much rare. There is ongoing monitoring of those effects in children worldwide, wherever it’s been given in children. It’s more commonly seen in male, young adults between 16 and 30 years of age, not as common in younger children under 16. So that’s reassuring, but it is something recommended that we keep an eye on, but it’s much rarer.

Just coming back to your question around, should they get the vaccine? The health advice in Australia is that children above the age of 12 years should get the COVID vaccine. It has been recommended by the ATAGI, which is National Advisory Body on Immunisation for the Australian population and has also been approved by TGA. The Therapeutic Goods Administration, the regulatory body, approves any vaccine used in Australia as other medicines or devices and antibiotics. So it is recommended.

Mobinah: Okay, thank you very much. What can we do to protect young children under the age of 12 as there’s no approved vaccine for children younger than 12 in Australia?

Dr Habib: That’s a very good question. And a lot of parents do worry about this, especially when they’re starting to send the children to the school since the primary schools have also opened, especially in New South Wales. What I would like to describe in a word we call cocooning. So it is around, , protecting them by a kind of, , by vaccinating, helping those vulnerable children for which we do not have the vaccine. All adults are surrounding them, and if they are vaccinated, we are protecting them indirectly. So all the adults in the household, all adults in the school setting, if they are going to the school or if they’re going to the daycare or going to the early childhood centres or whatever they are. If all of those people are vaccinated, the less risk of them contracting COVID from those adults. Because children, majority of the children when they get an infection, it is not from other children. They get it from other adults.

So there was a study done in New South Wales by National Centre for Immunisation Research very recently, and it was in the media. It has recently been published, I think, a few weeks ago. They’ve looked in this year’s COVID outbreak in New South Wales, all the school transmission cases they’ve investigated, and they’ve looked at that.

They found that the majority of the transmission in school settings has occurred between adult to adult, between two adults, or from adult to children. And then a very small number of transmission has occurred from child to child. So all I’m trying to say is, the message is, if you immunise or if you have all , people, adults surrounding those children immunised, them transmitting or contracting COVID infection is much, much less. So that’s the best we can do while we do not have an approved vaccine for children under the age of 12. That’s the best we can do.

I might want to add for the viewers is that just recently in the last two, three days in America, so in last week of October, I just heard the news that the FDA in America has approved the Pfizer vaccine for children between the age of 5 and 11. That’s for use in America. They still plan to roll it out in the US, and we need to watch for that to happen before we understand what the will be the situation here.

What also we’ve heard is, and it was in the media in Australia as well in last week. So the TGA is currently reviewing that submission. We may not have an answer for a few weeks, but they may be a vaccine available for that younger age group. Regardless of that, what we can do now and what is a piece of advice is that protecting those children is important by vaccinating adults and having some other strategies that can help us.

Mobinah: Absolutely. That’s some great tips. I appreciate that. It was interesting to note that COVID–children are not mainly getting it from each other. They’re getting it from adults. And one of the ways to protect children it’s for all adults to get vaccinated. Absolutely. Just as a new question, so we can isolate it. Dr Habib Bhurawala, can babies get vaccinated?

Dr Habib: Not at the moment. It’s a very good question. We do not have a vaccine approved for the babies. Babies can get COVID. And in fact, one of the groups of, , the vulnerable population is a very young infant. So the infants can get COVID as well. And some of those infants do require hospitalisation because they are very young, do not have very strong immunity against fighting infections, and may get more sick.

So again, the best, , way how we can protect them is especially for the pregnant woman, the woman who just had the baby or the breastfed, they all can and all of those groups are also high priority groups and should get vaccinated. And that’s one of the other ways they can protect the babies from getting contracting COVID infection. But there are some studies in progress also looking at more younger children, but it might be some time before we have some results or any vaccines available for that group.

Mobinah: With over a decade of experience as the head of a department in paediatrics, what are some things that you’ve seen , in the past two years regarding COVID and the vaccine, some common questions asked or the health of the children or the issues that children go through? What are some things that you’ve seen?

Dr Habib: Look, I think we have seen that pregnant women tend to get much worse COVID. Also, the infants in the delivery period can get affected. So when they’re born, there might be premature deliveries, they may need to have intensive care stay. And so, having COVID vaccination during pregnancy, during childbirth or soon afterwards, at any stage is highly recommended. We’ve certainly seen cases of  them having more significant complications.

We’ve also seen children getting admitted with COVID infection. They have had complications of COVID. It’s not an entirely mild illness, just not like the flu. We also know that the children can get a rare but significant infection of complication of COVID. It’s called multisystem inflammatory syndrome. It’s particularly seen only in children, and there have been more than 4000 cases of multisystem inflammatory syndrome in America.

And more than half of the required stay in the Intensive Care Unit occurs only in children. That is another reason we should consider them getting vaccinated because it can occur after some time, after the COVID infection, and that can affect them, as the name suggests, multisystem. And that would mean that it can affect the heart, affect the lungs, and affect other parts of the body. So we need to be mindful of that.

We’ve certainly seen cases, , not as many in Australia compared to say in the US, but that multisystem inflammatory syndrome has been seen here in New South Wales as well. So I certainly would say to all the parents that it’s important that we get the children up to the age of 12 vaccinated. It is available. It is available for all the children, and it’s quiet, , follow the advice. If you have specific concerns, you talk to your local health, trusted health professional, your GP.

I would also suggest a website with really good information available for the frequently asked questions, particularly around children and COVID and vaccination, and it’s called ncirs.org.au. So National Center for Immunization Research. It is based at the Children’s Hospital at Westmead. And it has a really good page advising all the simple questions and answers for all the parents who wish to seek more information on this area.

Mobinah: Dr Habib, what have we found from news around the world about children and the vaccine?

Dr Habib: Children in America and the UK; have started vaccinating children much earlier than we have. Especially in America, the last count of vaccines had around 9 million children. And certainly, it’s quite a large number. We have not seen many side effects or others that people are scared or worried about with the vaccine. It’s also found to be quite safe. We also know that children who have had vaccinations in some school districts in America where the children had vaccinations and some other more vaccination coverage than other school districts. And what they found is, the COVID transmission is definitely less in those school districts where there is a more number of children who have had the vaccine.

So what is telling us is that COVID does help in reducing the transmission of infection between each other. And so when we try to think about why we should vaccinate the children, we have to think about a couple of those points. One is to help them to protect themselves. So they themselves are protected from a serious illness. They’re also less likely to have less disruption in the school because of the fewer school closures because of the outbreaks because there are more vaccinated children. And they’ve already missed out on a lot of schooling. So we want to make sure that they actually get an important time back. And also, there will be less risk of them having to quarantine everyone every time when they get exposed to the COVID if they are vaccinated. Certainly, these are the advantages for them.

The other one I would like to mention is why we should vaccinate children. And what we’ve seen worldwide as well is that when you vaccinate children, they’re also part of, , in the chain of transmission, so they may be unknowingly a vector. They may not get a serious illness. They may not even know often that they have had an infection when they are unvaccinated, and they get a COVID infection. But what they can do is they can come home and transmit to an elderly member of the family, your grandparents. So somebody who even if they had two doses, because of the age, because of other medical comorbidities, other conditions they have, they’re still more at risk. So you do not want them to contract COVID because of some other members of the family. So I think all of that is important that at a community level, the vaccine works best when there is a high vaccine coverage in the whole community.

And the third reason I’ve already mentioned previously is that in children, there are rare but significant risks of long COVID and, more importantly, inflammatory syndrome. Now, the multisystem inflammatory syndrome is another reason why we should be worried about it. That is very uncommon in children, which is good, it’s reassuring, but I must say that in America, based on the Center for Disease Control Data which was the last week, 700 children have died because of COVID.

So it may sound like very small numbers compared to a large number of adult death. But we must remember that every day is, , it’s still important, it counts, it’s somebody’s son, daughter, someone’s brother, sister, someone’s grandchild. So I think all of those children’s lives matter. And we must really not take it very lightly that well, it’s okay, and it doesn’t cause anything. A lot of those children did have other medical conditions, and that’s another reason. If you have any other, it’s actually much better to really protect and vaccinate them as well.

Mobinah: Dr Habib, in your expertise and experience, do you see more Muslims in the hospitals in paediatrics?

Dr Habib: We’ve not seen any, I mean, I wouldn’t be able to comment on specifics of how many different religions and communities have had an affected population. But what we do know in general, especially in Sydney, , western southwest Sydney, the population there is a quite a significant proportion of culturally and linguistically diverse communities. And that’s certainly has been represented because that’s the population who live in the area. And I think it’s quite reflective of the demographic of that area in the hospital admissions in general. There were some reports from Melbourne, which I’ve also seen that there have been some increased numbers of Muslims in intensive care units in Victoria, which I’ve heard, , through the media sources as well. So it’s probably certainly there is, , there is a bit more proportion of that population.

What we do know, though, what I would like to mention is that in the UK, there are the BAEM communities, so British Asian Ethnic Minorities, so British Asian Ethnic Minorities communities, so black Asians and minorities were significantly over-represented in hospital admissions, in ICU, and in death in the UK and in the COVID way. So we do know that some of those communities definitely are getting more affected. And that’s been the trend, I think at other places as well. So I do think that it is a concern that if those communities have a low vaccination rate, and there is more proportion of them representing in the hospitals, it’s important that , we really need to advocate for more coverage.

Mobinah: Absolutely. Absolutely. Is there anything else that you’d want to share in your role that you’ve sort of seen and come across that you would like to share with the multicultural community?

Dr Habib: I would like to give a message that COVID is there to say. We need to learn to live with COVID. It is still pandemic. It’s not completely over. We still have to be cautious and follow all the measures. We need to follow all the measures, and we need to also follow the health advice. Certainly, the community members and health professionals have been trying at multiple platforms and multiple ways to try and improve some of the myths and misconceptions and also help with some of the information to try and get the right information.

I would like to give a message to all the community members that especially around the vaccination of COVID, that that’s the biggest group of  in the community who is currently vulnerable and not vaccinated and get the right advice. Look at the resources such as National Center for Immunization Research, look at the frequently asked questions. And if you’re unsure, talk to your local GP or your trusted health professional and get advice. Thank you.

Dr Habib: So one of the advantages of vaccination in children is that you would be able to do certain activities, which otherwise would be considered or being too high risk, such as travel internationally with children. And why I say that it because especially in Australia for the last 18 months, many of us haven’t really had an opportunity to travel anywhere, be domestic or international, particularly and many parents with young children would like to travel as soon as the restrictions are lifted. And having vaccinated children do give you and offer you extra protection. So that certainly is an important consideration when we reopen.

There may also be some requirements in certain overseas countries to have vaccination status. We’re unsure about it how and what it would look like. But it would certainly give you an advantage. And also other activities for children, which they have always enjoyed and we took it for granted in the past. But now, we would really have to revisit before we start to do that. And that includes attending the indoor gathering, mixed gathering, such as wedding, such as, , movies, dining into the restaurants, and the some of the other children’s activities or sports. So I think overall, there’s certainly some advantages of children have been vaccinated because of these reasons. Thank you.