Why Are So Many Children in Brazil Dying From Covid-19?

In the modern history of catastrophic infectious diseases in Brazil, children often suffer the most in terms of deaths and disability. When dengue epidemics emerged in Brazil in 2007 and 2008, children accounted for more than half of the fatalities. When pregnant women became infected with the Zika virus during an epidemic that began in 2015, more than 1,600 newborn Brazilian infants were born with devastating microcephaly birth defects, far more than in any other nation. Respiratory viruses continue to disproportionately affect Brazil’s children, while hookworms and other intestinal parasites stunt childhood growth and development, especially in poor rural areas.

Now Covid-19 is causing severe illness in young Brazilian children at levels not seen in other parts of the world. Research by Dr. Fatima Marinho of Vital Strategies, a nongovernmental organization, has found that more than 2,200 children under the age of 10 have died from Covid-19. While this number represents less than 0.5 percent of Brazil’s 467,000 Covid-19 deaths, more than 900 of the fatalities occurred in children under the age of 5. The United States has recorded nearly 600,000 deaths from Covid-19, but only 113 of those have been of children under the age of 5.

We studied Covid-19 infection rates for adolescents and children in the state of São Paulo, home to more than 20 percent of Brazil’s population. Our analysis found a surge in the numbers of both reported cases and hospitalizations among adolescents and children since the end of 2020. Approximately half of those hospitalizations, more than 900, were among children younger than 5, including many infants.

Why Are So Many Children in Brazil Dying From Covid-19?When the pandemic began last year, the coronavirus appeared to affect children far less frequently, and less severely, than adults. So why are so many young children in Brazil being hospitalized with and dying from Covid-19? Identifying the answer is critical not just to the health of children in South America; it’s also vital to understanding what path the coronavirus pandemic may take in the future.

One possible explanation lies in Brazil’s emerging variants of concern. The predominant strain of the coronavirus circulating in Brazil is the P.1 variant — now called Gamma, according to an announcement from the World Health Organization this week. Like Beta (the new name for the B.1.351 variant, which was first identified in South Africa), the Gamma variant is more transmissible compared to earlier virus lineages, and it may be able to partially escape the antibodies produced by a Covid-19 infection or vaccine. It is possible that the same mutations that make Gamma more transmissible also contribute to higher rates of infections, hospitalizations and deaths among children.

Of course, it’s equally likely that the rise in Covid-19 cases among children is part of an uncontrolled spread of Gamma across all age groups. Pregnant women who get Covid-19 are at a higher risk for severe illness and preterm births, and women who are infected may pass the coronavirus to their newborns.

Given the presence of the Gamma variant in the United States — about 7 percent of Covid-19 cases in the United States can be attributed to this variant — it’s possible that pediatric and newborn Covid-19 cases could soon become more prevalent. This is cause for serious concern.

While the B.1.1.7 variant, now called Alpha, is now responsible for more than two-thirds of all coronavirus cases in the United States, Gamma appears to be spreading quickly in some areas. In Illinois Gamma is now responsible for 22.4 percent of cases for which the coronavirus strains have been genetically sequenced; in Massachusetts, 13.6 percent of sequenced Covid cases were caused by the Gamma variant.

If the Gamma variant continues to spread and outpaces vaccination efforts in the United States, officials may need to reinstate virus mitigation measures or identify new ones. Booster shots that are tailored to variants may be critical. And the United States needs to continue its efforts to vaccinate adolescents and to approve vaccines for younger children and infants. Public health officials must also continue to educate parents about the very real threat that Covid-19 poses to their children and the importance of vaccination. Otherwise, pediatric and infant Covid-19 may become a tragic new reality.

The Covid-19 crisis in Brazil is the result of the government’s failure to take adequate public health measures to limit the transmission of the coronavirus, as well as inadequate supplies of vaccines. As more transmissible variants spread, similar crises are unfolding in South America, as well as in India and the Democratic Republic of Congo. Brazil’s experience illustrates how children will suffer unless governments and the global community take bold action.

Peter Hotez a professor of pediatrics and molecular virology and microbiology as well as the dean of the National School of Tropical Medicine at Baylor College of Medicine. He is the author of Preventing the Next Pandemic. Albert I. Ko is professor of epidemiology and medicine and chair of the department of epidemiology of microbial diseases at the Yale School of Public Health. He has worked for 30 years in Brazil on infectious diseases such as Zika, dengue and COVID-19.

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