An exponential rise in Covid-19 cases among children in the US, the alarm has sounded alarm among experts as the new school year begins.
A recently released study by the American Academy of Pediatrics and the Children’s Hospital Association found that nearly 339,000 cases of coronavirus among children have been reported nationwide since the start of the pandemic, with 97,000 cases reported in just the last two weeks of July.
The findings add concern to difficult reports emerging from places that relocated to schools early. The day after school returned to one Georgia district for school, a second-grader tested positive for coronavirus, sent his teacher and classmates home for a two-week quarantine. That same week, the Georgia Department of Health confirmed the death of a seven-year-old boy, the youngest in the state, to die from the virus. He had no underlying health conditions.
Linda Rosenstock, a professor of health policy and dean-emeritus at UCLA’s Fielding School of Public Health, said the rise in cases among young people was a reflection of the widespread toll the virus has taken in the country.
“A fair interpretation of this data is that as cases increase, more children become infected. In the same way, the lockdown helped slow the rise, when restrictions were lifted, we generally saw more cases, ‘Rosenstock said.
“It reflects the state of the pandemic that is currently unabated in the US,” she added. “If you try to reopen in places where the disease is rooting, we see a rise in cases among children.”
Rosenstock said the fact that fewer children were previously tested in the pandemic may have fueled a ‘myth’ that children were not at risk for infection. While research suggests that children have leaner than milder symptoms than adults, she said the new data attest to the fact that children can still infect adults, whose symptoms may be more severe.
The findings underscore assumptions that children are unlikely to catch and spread coronavirus to adults and other children – a claim that Donald Trump decided to make a case that schools should reopen this fall for personal instruction.
What we know about children and coronavirus in the US
The nation’s understanding of how coronavirus affects children has evolved during the pandemic. Experts say the new study further confirms that children can play an important role in spreading the virus and that in rare cases, infections can lead to serious illness or death among the youth.
Nationally, children represent 447 positive cases out of 100,000 and 8.8% of all Covid infections, according to the American Academy of Pediatrics report. About 70% of the new cases reported among children in July came from states in the south and west, where coronavirus has been ripped by the population.
California, which saw its first death of a child because of Covid late last month, has reported more cases than any other state. But the proportion of infected children relative to the entire population puts it in the middle of the pack, just above the national average. Wyoming, Tennessee and New Mexico top the rates of infection per child for children; in all three states, children represent more than 15% of all cases.
Children represent less than 4% of hospitalizations from the virus and account for less than 1% of Covid-related deaths in states that report results. Twenty states reported zero child deaths.
Katherine Williamson, a pediatrician in Orange County, Southern California and a spokeswoman for the American Academy of Pediatrics, said the findings also indicated that the virus affects children differently in age groups.
Children under five are the least symptomatic, Williamson said, and outbreaks among children and teachers at care centers and kindergartens remain low. The risk goes up for children ages five to 10, and children over 12 appear to have more adult-like symptoms, she said.
“The hard part is that because young children are less symptomatic, we can miss and ignore the symptoms to test them,” Williamson said.
What it means for reopening schools
The report comes as states and regions across the country are struggling with how these schools can safely reopen for personal instruction this fall, a decision with both academic implications for children and economic consequences for parents hoping to find and return childcare to work.
But cautious stories have emerged. In late May, days after Israel opened schools, infections bound to a Jerusalem high school balloon fat in a devastating outbreak.
In Georgia, a summer camp that opened in late June caused an outbreak that infected more than 75% of the 344 campers and staff tested. In that case, staff members wore face masks, but children did not wear them.
That response to the coronavirus is determined by state and local decision-makers complicating a uniform response to the fight against the virus.
In July, on the same day that principals in Los Angeles and San Diego announced that they would begin the school year online, the Orange County Board of Education reopened their schools without the use of masks or social distance. Officials cited as part of their argument a report that appeared supported by a cadre of medical experts.
In the days after the report, however, several experts distanced themselves from the work, saying they had never been consulted for the final report.
The American Academy of Pediatrics was not consulted for the report, nor does it support the recommendations to return to school without safety measures, Williamson said.
“We have a pretty good idea of how you can reduce the risk of the virus spreading to schools through social distance, masking, handwashing and screening for systems before students enter school,” Williamson said. Equally important, she added, was consistent enforcement of security measures.
“That last piece is where places got into trouble. “They started to get lax about the rules and then things went up,” Williamson said.
John Swartzberg, a clinical professor emeritus of infectious diseases and vaccinology at the UC Berkeley School of Public Health, said the timing of the death marked by the report did not bode well for a return to personal instruction in the near future.
“The very significant increase in cases happened when children were out of school, suggesting that if we put children back in school, the problem will increase,” Swartzberg said.
“Bringing people together – whether it’s children or older adults – is the worst thing you can do in the face of the pandemic,” he added.
Swartzberg said that even schools in regions where cases remained low could not completely eliminate the risk of infections, but they could limit that risk by using masks, hand washing and social distance.
However, mitigation efforts will cost extra money: additional classes would have to be used to distance students, which would require more teachers.
“For the most part, public schools in the U.S., which have been terribly underfunded for so long, where will those resources come from? At schools I know in the Bay Area, teachers buy paper and crayons for the kids because the school district can’t afford it. And that was before the pandemic, “said Swartzberg.
“Bringing children back to school, sending students back to universities is a great experiment,” he said. “We have no idea what will happen.”
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