When is it okay for our elderly and kids to go out?

Published June 15, 2021, 12:14 AM

by Dr. Edsel Salvana

The promise of freedom with COVID-19 vaccination

Dr. Edsel Maurice T. Salvana

Among the most impacted segments of the population during this COVID-19 pandemic are the elderly and the children. After the first enhanced community quarantine from last year was lifted, the propensity of COVID-19 to give rise to super spreader events meant that the number of people allowed to go outside still had to be limited. The IATF decided that since workers needed to earn to support their families and the economy, the most logical groups who could stay at home were children and those above 65 years old.


COVID-19 in the elderly

Having the elderly stay at home in the face of an unknown virus is a no-brainer. The mortality rate from severe COVID-19 among older adults is much worse than for the rest of the population. Even though those above 60 years old only account for about 20 percent of the total COVID-19 cases, over 60 percent of COVID-19 deaths occurred in this population. The mortality increases as one gets older. In one study, the death rate from COVID-19 among those 60 to 69 years of age was 3.6 percent. For 70 to 79 years old, it was 8.0 percent; and for 80 years and older, it was 14.8 percent.

Understandably, the seniors themselves chafed at the stay-at-home requirement. Lack of outdoor exercise, lack of mobility, and physical isolation wore heavy on them. Some seniors risked visits with relatives and friends, with many paying the ultimate price. Whole households got infected, and the elderly had by far the highest number of deaths. As the pandemic wore on, families closed ranks and protected their elderly members, often to the chagrin of the seniors themselves.

When vaccines finally arrived, seniors were the second highest priority after healthcare workers. Paradoxically, the uptake has been less than ideal. Many seniors expressed reservations about the side effects of vaccines, were intimidated by the electronic registration process, or were too debilitated to leave home. As of this writing, less than 500,000 seniors are fully vaccinated with two doses of the available vaccines.


COVID-19 in children

In the scramble to protect the vulnerable populations from COVID-19, the kids have been somewhat lost in the shuffle. Understandably, seniors and those with comorbid conditions needed to be prioritized for life-saving vaccines. Mortality rates for these groups can be higher than 10 percent. Children, on the other hand, seem to do relatively okay if they get infected with COVID-19. Mortality rates are below 0.2 percent, and most children only get mild to moderate disease. The decision to stop face to face classes and confine the children at home was made in order to decrease transmission from the community in general. As a significant number of Filipinos live in multigenerational households, confining the kids at home decreases the risk of bringing home COVID-19 to the vulnerable seniors.

But children are far from being untouched by the pandemic. Lost school days, confinement to home, and limited personal interactions are taking their mental toll on both kids and their parents. For those fortunate enough to have access to computers and tablets, unsupervised surfing and media overload are exacerbating attention deficit disorders, and behavioral issues are getting in the way of learning.

While COVID-19 disease severity in children is generally mild, some children do develop severe disease. A unique syndrome has also been described, termed multisystem inflammatory syndrome in children (MIS-C). This ailment is very similar to an immune disease called Kawasaki’s syndrome where the body attacks its own blood vessels. MIS-C is rare, but it has already killed some children. Some children with severe COVID-19 also develop heart inflammation, known as myocarditis, which can lead to long-term cardiac problems. Similar to adults, children with severe lung involvement can develop long-term lung damage and may require oxygen for life.  

As the lowest priority group for vaccination, the prospects of letting the kids out soon do not look as good as those who are high up on the list. The initial clinical trials for the first-generation vaccines mostly only enrolled adults, the youngest participants were 16 years old. The recent approval of the Pfizer vaccine for 12-to-15-year-olds is with hope just the start of effective vaccinations for children. The Pfizer vaccine worked very well in this age group, 100 percent vaccine efficacy for symptomatic disease. Clinical trials for even younger children are already under way. Sinovac recently got a boost with the approval of its vaccine for children three to 17 years old in China. Astra, Moderna, and the other vaccines are also undergoing testing in children. Even if the vaccines are eventually locally approved for children, however, the kids will still have to wait their turn because of the prioritization framework and limited vaccine supplies.


The way forward

Despite these many challenges, there is light at the end of the tunnel. Vaccination among seniors is picking up as local governments, NGOs, and private societies intensify their efforts to improve access and motivate the elderly to get vaccinated. Recognizing that protecting the most vulnerable members of society is the best way to minimize fatalities, everyone is pitching in. House-to-house inoculation is being done to reach those who are homebound or bed-ridden. In Israel, cases and deaths dramatically dropped once they were able to fully vaccinate at least half of their seniors. This should be one of the immediate goals and will enable further opening of the economy and society at large.

As for the children, ideally the vaccine supply will improve to the point where we can begin to inoculate them in anticipation of face-to-face classes. Even before all the kids are vaccinated, however, restrictions might already be slowly eased on them as long as the most vulnerable have been fully vaccinated.  After all, the main consideration for keeping kids under wraps is because of the risk of transmitting COVID-19 to people who are at highest risk for dying. If this is no longer the case because the vulnerable are already protected by the vaccines, then letting them out cautiously even before achieving herd immunity may be reasonable. After all, children themselves are at low risk of dying.

As the government carefully begins to ease restrictions for fully vaccinated individuals, we must remember that there are still a lot of unknowns. The threat of the variants escaping our vaccines is still present, and so minimum public health standards need to be maintained for now. A little more patience will go a long way in ensuring that we do this right. The faster we get everyone vaccinated, the sooner the pandemic will be over.