There is no evidence that “immunity debt” is real, however, the end of COVID-19 mitigation efforts means a higher risk for viral infections

Hospitals are reporting never-before-seen surges in children with severe viral infections, causing historically long wait times and pushing critical care beyond capacity.  One new phrase that is being widely used (especially by critics of public health measures such as masking and social distancing) is the concept of “immunity debt”. An opinion piece in the publication The Hill attempts to explain this phenomenon. The idea is that the current rise of pediatric RSV cases suggests children’s immune systems are “catching up” to the typical childhood viruses and so young children, as well as older children who may not have been exposed the past few years, are at risk for infection.

Is there any credence to this theory?

The phrase “immunity debt” comes from a French position paper published in 2021. No evidence was cited to back up this claim.

Some people believe that public health measures against COVID-19, including masking and social distancing, have resulted in children getting more sick now because of a weakened immune system. Experts disagree about whether “immunity debt” is a real phenomenon or convenient pseudoscience.

It’s not that children’s immune systems are weaker, but rather that they are all being exposed to viruses from which they were shielded when public health measures were in place, and they are now falling ill at the same time. 

William (Billy) Lennarz, MD, System Chair of Pediatrics, Associate Medical Director, Ochsner Health has this to say…

The surge of sick children we are seeing is a result of our COVID mitigation.  Children have been kept fairly cloistered from all communicable diseases that spread through the respiratory tract throughout the pandemic due to mitigation efforts, social distancing and school closures. Now with schools fully open and other mitigation tactics largely eliminated, the ability for viral infections to transmit through the child population has been restored. A cohort of children who have not seen viral infections for several years are now being exposed. The good news is, children are only nominally affected by these viral infections and hospitalizations from any of them is extremely rare.