It seems the rate of coronavirus infections during this current omicron wave in Germany has finally passed its peak. As the recent all-time high incidence rate reached nearly 1,500 cases per 100,000 for the entire population, that same incidence for children was more than 3,000, according to Germany's Robert Koch Institute. In this wave, children were affected by COVID-19 more than ever before.

In terms of how the pandemic affects children and teens — since the beginning of the coronavirus pandemic, this has been special a focus in particular for two researchers: Jakob Armann, a senior physician with pediatric intensive care at the Technical University Hospital in Dresden; and Jörg Dötsch, director of pediatric and adolescent medicine at the University Hospital Cologne.

Their current focus is on the omicron variant, which has caused a sharp rise in numbers of infections; at the same time, the variant has not had the impact on hospitalizations that was feared.

But kids are still not in the clear.

Delta vs. omicron variants

In December 2021, German pediatric associations issued a joint statement pointing out what seemed to be a significantly lower severity of illness with omicron than with the delta variant, across all age groups.

Another sigh of relief can be heard with regard to hospitalization rates: Data from a University of Cambridge study shows that the number of hospitalizations for children has not differed greatly between delta or omicron infections. Other studies, including a preprint from Denmark not specific to children, have confirmed these findings.

"In the meantime, it is clear that omicron is more contagious, but results in milder courses," said Armann. Daily registrations in children's hospitals seem to prove him right — on average, only about one admission with a proven COVID-19 infection is registered per facility per day.

When children are admitted to hospital, particular attention is paid to respiratory syncytial virus (RSV), a widespread respiratory virus that can cause simple cold-like symptoms or in some cases, severe illness.

"Cases of people hospitalized with RSV from October to December 2021 were about six to eight times higher" than those with COVID-19, according to Armann.

Anyone can fall ill with RSV, but young children are particularly affected. The virus is highly contagious and spreads when an infected person sneezes or coughs; similar to how COVID-19 is transmitted. This makes it a useful comparison to the coronavirus.

Fears of inflammatory syndrome

However, parents are not only concerned about the immediate impact of COVID-19 infections; they also worry about long-term effects, including long COVID or pediatric inflammatory multisystem syndrome (PIMS).

"Initial data from England and Denmark suggest that there is no evidence that PIMS incidence increases with omicron," Armann said.

The delta variant triggered fewer PIMS cases than alpha and the original variant, although this development didn't receive much attention due to the focus on delta's overall higher case numbers, Armann believes. Germany does not yet have data on PIMS in connection with omicron.

This winter saw about the same number of PIMS cases as the same period last year, yet against the background of higher COVID-19 case numbers, said Armann, who hopes to get data for more recent trends in Germany in four to six weeks.

In its statement, the German pediatric associations noted the difficulty of inferring based on data from other countries, including the UK, for Germany, saying, "Conclusions should be drawn with particular caution." They recommend continued coronavirus protection measures, including in schools, to protect children and adolescents from contracting COVID-19.

Most often, PIMS occurs three to six weeks after a COVID-19 infection. Possible symptoms include sudden high fever, fatigue and joint pains.

Children who have such symptoms, perhaps after a possibly asymptomatic or even undetected COVID-19 infection, should see a doctor immediately, says Dötsch. "Treated in time, PIMS is not a problem, and the risk of a severe course is low."

Vaccinations protect children

Data from the Centers for Disease Control and Prevention in the United States shows that double immunization with the BioNTech-Pfizer vaccine achieves efficacy of about 91% against PIMS syndrome in 12- to 18-year-olds.

"I advise all children and teens older than 12 to be vaccinated," Dötsch said, which is in line with recommendations by Germany's standing committee on vaccination (StiKo), which recommends COVID-19 inoculation for children over the age of 12.

For children aged 5 to 11, the committee allows coronavirus immunization should the families wish it, but only recommends this if the children are particularly at risk.

"In Germany, the StiKo is our expert body for vaccination recommendations, it makes well-informed decisions," said Dötsch, who is in favor of the commission giving parents the opportunity to decide whether to vaccinate their children or not.

Regarding COVID-19 vaccinations for children under the age of 5, studies are ongoing. The US Food and Drug Administration has postponed testing the BioNTech-Pfizer vaccine for children under 5 after data suggested it was less effective against omicron than delta, according to the Reuters news agency.

"Anyone can get vaccinated or have their child vaccinated; 5- to 11-year-olds even tolerate the vaccines better than adolescents, so there's no need to worry," Armann said.

He added that there is no reason to restrict or limit children in their rights or social participation, or in their education or development otherwise, due to vaccination status. "We massively restricted children, often for not very good reasons." Armann said.

Children should have top priority

Last year in December, German Chancellor Olaf Scholz appointed members of a new expert group to combat the COVID-19 pandemic in Germany. This included virologists, epidemiologists, sociologists and psychologists.

This group has urged policy-makers to give top priority to the interests of children. "The pandemic places a particularly high burden on children and adolescents for a variety of reasons," the experts said in a statement. They pointed out how this includes not only the infection itself, along with possibly PIMS and long COVID, but also potential burdens from the indirect effects of the pandemic such as lockdowns; family issues including stress, fear, illness, death or loss of livelihood; the loss of social interaction; and general uncertainty.

"A careful combination of infection control and social participation, adapted to the specific situation, is urgently needed in combination with psychosocial stabilizing measures," the experts wrote.

Dötsch, who is part of the group, is relieved that the German government specifically requested the report, which he takes as a sign that the recommendations have reached the highest levels of government. He sees the next step as being up to the politicians.

Though not part of the expert panel, Armann agrees children should be an absolute priority. "More than anything, we should guarantee children normal lives again."

This article was originally written in German.