The Delta variant of Covid-19 has forced governments around the world to rethink the way they tackle public health.
The good news has been rare – with one notable exception. Children have been spared the worst of the virus.
New research from the Murdoch Children's Research Institute in partnership with the Royal Children's Hospital and the University of Melbourne evaluates what risk children face from the Delta strain.
It found "most children and adolescents with Covid-19 have no, or only mild, symptoms".
"Typical symptoms include fever, cough, a sore throat, blocked or runny nose, sneezing, muscle aches, and fatigue," the research read.
"Changes in smell or taste, diarrhoea and vomiting are less common. Severe disease typically manifests as pneumonia with respiratory distress, and may require admission to hospital or intensive care.
"Severe Covid-19 disease in children and adolescents is very uncommon, and only very rarely causes death."
The researchers found that Delta "does not appear to cause more serious disease than previous variants" even though it is thought to spread more easily among younger people.
The institute's findings are supported by statistics.
The institute found that as of September 5, 22 per cent of all Covid-19 cases in Australia have been among adolescents under 19. There have been 5374 cases among children under 9 and 7223 cases among children aged between 10 and 19.
In 2020, about 50 children were hospitalised with Covid-19 in Australia; one adolescent who had Covid-19 and another serious infection died.
Researchers ran the numbers on the recent NSW outbreak. They found that between June 16 and August 19, there were 810 Covid-19 cases among children aged 0-5, 945 cases among children aged 6-12, and 1109 cases among children aged 13-18.
Of the total 2864 cases, 2.4 per cent were admitted to hospital – 43 of those were for medical reasons.
Just five ended up in intensive care.
In the United Kingdom between February 2020 and March 2021 (pre-Delta), there were 470,000 infections in children aged 17 and under. That age group had 25 deaths.
During the Delta surge, between March and September this year, there were 52 deaths among those aged 0-19, but the death rate remained the same for both variants.
Death is not the only measuring stick for Covid-19's impact on children. In extremely rare cases, multi system inflammatory syndrome (MIS-C) has been associated with Sars-CoV-2.
It usually occurs a month after exposure to Covid-19 and can cause inflammation in different parts of the body, researchers said.
"Severe MIS-C may cause inflammation of the heart muscle, and this may result in low blood pressure. Some MIS-C patients do not require treatment, but patients with more severe disease often need admission to an intensive care unit.
"MIS-C has caused deaths among a small proportion of children overseas, mainly early in the pandemic. However, increased awareness of MIS-C has allowed for earlier diagnosis, more appropriate treatments and improved outcomes.
"In 2021, almost all children with MIS-C have recovered fully, and the long-term outcomes appear good, with resolution of the inflammation of the heart."
In Australia, there have only been four confirmed cases and two possible cases of MIS-C since the start of the pandemic.
There is also the issue of "long Covid".
Long Covid, which is loosely defined as a set of symptoms that persist for months after the initial diagnosis, needs to be researched further.
But researchers did say that reported symptoms include "fatigue, headache, anosmia, and sore throat".
"Some studies have found that children who tested negative for Covid-19 have had similar symptoms, which are common after other viral infections, and could also be due to the experience of lockdown and other social restrictions," researchers wrote.
"A study in Melbourne in 2020 (pre-Delta) observed no cases of long Covid among 136 children who presented to the Royal Children's Hospital, noting they were a young cohort (median age three years)."
What researchers did find was that the pandemic has affected children in other ways.
Lockdowns have been particularly hard on the younger generation where schools have been closed and social interaction has been hampered.
"Prolonged school closures and lockdowns exacerbate these impacts, differentially affecting those living with disadvantage, diminishing social mobility and impacting economic productivity.
"There have been substantial increases in admissions to paediatric hospitals for mental health, substance use, self-harm and suicide attempts. Studies are continuing to emerge that highlight the negative effects of the pandemic on the mental health of children and adolescents."
While the research fills in many gaps, some remain.
"At this stage, long Covid does not appear to be common in children and adolescents, but existing studies are generally of poor quality with no consistent definition used," researchers said.
"The Delta variant is more transmissible than other variants, and makes the control of outbreaks more challenging, even when public health measures are in place.
"More data [is] needed to describe the burden of Covid-19 that children and adolescents will carry as the pandemic evolves, given the emergence of the Delta variant and as older populations achieve high rates of vaccination.
"More information is needed as to how the changing number of infections will impact children's medical services.
"More evidence is needed regarding the vaccination of children and adolescents, including those with underlying special risk conditions."
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
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