The infuriating viral videos of young Americans on Spring Break – “I’m not going to let it stop me from partying”, drunkenly slurs one in an interview posted to Twitter — contrast sharply with Mark Stubb’s experiences. The 28-year-old told Good Morning Britain of his Covid-19 infection: “The aches and pains, it’s not an exaggeration to say you feel like you’ve been in a car crash.”
Young people are less likely than older people to die from this pandemic, but they are not immune to Covid-19. The disease caused by the novel coronavirus claimed its youngest victim in the UK over the weekend with the death of an 18-year-old, while 36-year-old nurse Areema Nasreen is on a ventilator. “I want everyone to know how dangerous this is. My sister is only 36 and is normally fit and healthy,” her sister told local Birmingham media. “People are not taking this seriously enough. She is young – it is not just the elderly who are at risk.”
It may be a failure of media reporting and government communications that young people initially took this pandemic as a threat to older generations, but WHO director-general Tedros Adhanom Ghebreyesus set the record straight at a press conference last week. “I have a message for young people: You are not invincible, this virus could put you in hospital for weeks or even kill you. Even if you don’t get sick the choices you make about where you go could be the difference between life and death for someone else.”
It is true that older people are more likely to succumb to the disease: the average age of those who have died from Covid-19 in Italy has hovered around 78 years. But younger patients do still get seriously sick, with 20 per cent of hospitalisations in the US aged between 20 and 44, with that same cohort making up 12 per cent of intensive care admissions, according to one Centers for Disease Control and Prevention (CDC) study of American cases between February 12 and March 16.
While those in the younger cohort are likely to survive, with the 20-44 bracket making up two per cent of deaths in the US to date – which is, to be clear, still a high number of deaths – spending ten days in the intensive care unit on a ventilator not only contributes to hospital shortages, but it’s incredibly physically painful even if you need not be hospitalised. Twenty-nine-year-old Daryl Doblados of Littleport in Cambridgeshire only had a mild case of Covid-19, but told a local news website: “I felt like I was drowning.” Plus, regardless of age, health could be impacted in the longer run, with Prabhjot Singh of the Icahn School of Medicine telling The Hill: “Yes, maybe you don’t die, but living with a damaged lung or damaged organ is not a good outcome.”
Why are older people at more risk than younger adults? “Part of it is the illnesses we get as we get older,” says Paul Hunter, a professor in medicine at the University of East Anglia, adding that this is exacerbated by bad habits such as smoking. “Any additional damage to the lungs means we don’t have much in reserve to cope with a viral infection.” That’s borne out in reports that suggest many of the older people dying in Italy had comorbidities such as high-blood pressure, cancer and diabetes.
As we age, our immune systems weaken, Hunter adds. “Older people take longer to produce good antibodies to viral infections than younger people,” he says, explaining that cells will try different configurations to fight a viral infection, before selecting and producing the one that works. “This process doesn’t happen as quickly in older people, and to a large extent, whether you live or die from Covid-19 depends on how quickly your body produces antibodies compared to how quickly the virus grows.” That’s why front-line health workers are at such risk, as they’re exposed to more of the virus, giving their bodies more to fight against, he adds.
Children are a different story, even compared to young adults. There’s only one child recorded to have died from Covid-19 so far, a 14-year-old in China. According to the CDC study, fewer than one per cent of hospitalisations in the US were in people under the age of 19. That’s similar to what happened with Sars and Mers, neither of which killed any children.
The disease appears to be milder in most – but not all – children compared to older adults, but they still need protection: some children have become severely ill, in particular those with lung conditions. “We do know that children tend to have more mild infection, have more mild disease but we have seen children die from this infection so we can’t say universally that it’s mild in children so it’s important that we protect children as a vulnerable population,” said Maria Van Kerkhove, technical lead on Covid-19 at the World Health Organisation (WHO), last week at a press conference.
At this point in the pandemic, there’s much we don’t know, and the limited impact of the disease on children will be an area of study when the crisis abates, but there has been some work already published. Research in the scientific journal Pediatrics last week looked at 2,143 children in China of which a third were confirmed by labs to have Covid-19 and the rest suspected via symptoms. The majority of the children, some 55 per cent, had either no or mild symptoms, while 39 per cent had moderate symptoms. Only one of the patients in the study died – one of only two children to die from Covid-19 to date – and only six per cent had severe or critical symptoms, versus 18.5 per cent in adult cases. And even that six per cent figure may be high, as the section of the cohort that had not been lab confirmed to have Covid-19 had a higher rate of severity, which the researchers said could suggest the children were ill with a different respiratory disease.
That doesn’t necessarily mean schools should stay open. While children and young people are not getting as severely sick with Covid-19 as their grandparents, they’re still getting infected – and that means they can spread this coronavirus. Children are less likely to carry the disease, according to CDC figures, but that’s possibly a side effect of limited testing. Children don’t show severe symptoms, and are less likely to be hospitalised, so they aren’t tested. In South Korea, 30 per cent of its confirmed cases were among people aged 20 to 29, while Italy saw only 3.7 per cent of its Covid-19 patients in that same bracket. That could be down to testing or demographic differences between the two countries, with South Korea skewing younger and Italy older.
“If the severity of the disease in 20-year-olds was what it was like for everyone else, we wouldn’t be doing anything like what we are at the moment,” Hunter says, in terms of prevention measures like social distancing and government lockdowns. “But the problem for young adults is not that they’re going to be the ones dying, it’ll be their grandparents dying because of their stupidity.”
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