COMMENTARY

Medically Speaking, 2022 Was the Best Year Yet for Children

David M. Warmflash, MD

Disclosures

December 05, 2022

Headlines from earlier in the fall were grim: Thanks to the COVID-19 pandemic, life expectancy in the United States has fallen for 2 years running. Last year, according to health officials, the average American newborn could hope to reach 76.1 years, down from 79 years in 2019.

So far, so bad. But the headlines don't tell the full story, which is much less dire. In fact, 2022 is the best year in human history for a child to arrive on Earth.

For a child born this year, in a developed country, into a family with access to good healthcare, the odds of living into the 22nd century are almost 50%. One in 3 will live to be 100. Those estimates reflect only incremental progress in medicine and public health, with COVID-19 baked in. They don't account for biotechnologies beckoning to take control of the cell cycle and aging itself — which could make the outlook much brighter.

For some perspective, consider that a century ago, life expectancy for an American neonate was about 60 years. That 1922 figure was itself nothing short of miraculous, representing a 25% jump since 1901 — a leap that far outstrips the first two decades of the current century, during which life expectancy rose by just 2.5 years.

A gain of 2.5 years over two decades might not sound impressive, even without COVID-19 causing life expectancy in this country and abroad to sag. But during the pandemic, exciting new technologies that could drive gains in lifespan and healthspan, even bigger than those seen in the early 20th century, have moved closer to clinical reality. Think Star Trek-ish technologies like human hibernation, universal blood, mRNA therapy able to reprogram immune cells to hunt malignancies and fibrotic tissue, even head transplantation.

How long that last one will take to reach a clinic near you is hard to predict, but advances in the needed technology to anastomose cephalic and somatic portions of the spinal cord are mind-boggling. All this means that, from a medical standpoint, the future for babies born in the early 2020s looks dazzlingly bright.

Those sunny rays of optimism likely have failed to pierce the gloom of public discourse. Between "breakthrough infections," "long COVID," "Paxlovid rebound," vaccine-induced myopericarditis, the current respiratory syncytial virus (RSV) outbreak, school shootings, climate change, and the youth mental health crisis, news headlines are undoubtedly frightful.

RSV: What's Old Is New Again

For the youngest children, the RSV outbreak is currently the scariest story. With social interactions returning toward a pre-COVID state, RSV has rebounded with a vengeance. In many places, pediatric wards are close to, at, or even beyond capacity. With no antiviral treatment for RSV, no licensed vaccine quite yet, and passive immunization (intravenous palivizumab) reserved for children at greatest risk (those under age 6 months and born preterm 35 weeks or earlier), the situation does have the feel of the first year of COVID-19, when treatments were similarly limited.

But let's keep some perspective. RSV has always been a devastating infection. Prior to COVID-19, in the United States alone RSV killed 100-300 children below age 5 and 6000-10,000 adults above age 65. The toll has always been worse on the international level. In 2019, 3.6 million people around the world were hospitalized for RSV infections, mostly the very old and the very young. Among causes of death below the age of 5, RSV ranks second only to malaria.

Post-vaccine myopericarditis, a favorite concern of the vaccine-hesitant, is a real phenomenon in young males. But generally, the condition has a subclinical to mild manifestation and fully resolves within 2 weeks.

Vaccines on the Horizon

Monkeypox also was putting a damper on health news in recent months. Yet outreach efforts and selective vaccination and other precautions based on risk stratification appear to have calmed the outbreak. That's good news, as is the fact that the struggle against malaria may be about to change. After decades of trying, we now have a malaria vaccine with what appears to be 80% effective against the infection. The same goes for RSV; finally, not one but two RSV vaccines are showing promise in late-stage clinical trials.

To be sure, for many young people, the times don't seem so wonderful. The rate of teen suicide is alarming — yet it remains well below that seen in the 1990s. Are social media to blame, or is it something more complex?

If COVID-19 has taught us anything, it's that development of vaccines and treatments need not take a decade or more. Operation Warp Speed may have seemed like a marketing gimmick and political grandstanding, but you can't argue with the results.

Keep that perspective in mind to appreciate the moment — which I believe is coming soon — when the same type of intramuscular injection that we now use to trigger immunity against SARS-CoV-2 hits clinics, only this time as a way to cure cancer. Or when you read the stories of young victims of firearm violence who would have died but are rapidly cooled and kept hibernating for hours, so that their wounds can be repaired. And although you may not see that head transplant, one of these new babies might see it, or even might perform the procedure.

David M. Warmflash, MD, is a freelance health and science writer living in Portland, Oregon. His recent bookMoon: An Illustrated History: From Ancient Myths to the Colonies of Tomorrow, tells the story of the Moon's role in a plethora of historical events, from the origin of life to early calendar systems, the emergence of science and technology, and the dawn of the Space Age.

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