We are three pediatric infectious disease specialists who live and work in West Virginia. The University of West Virginia health system serves 400,000 children and, according to our internal data, to date, 2,520 children ages 17 and under have been screened for the coronavirus. Sixty-seven of them tested positive and one became ill enough to be admitted to the hospital.
Almost daily they ask us about children and COVID-19: Do they receive COVID-19? Should they attend daycare or school, play sports, meet friends, and attend summer camps? What are the risks for them and for others?
Based on current research and our own experiences, it appears that children 17 and under are at little risk of contracting the coronavirus. Almost all children have asymptomatic disease, very mild or mild, but a small percentage of children become seriously ill. Furthermore, there is evidence that children can transmit the virus to others, and with the large outbreaks occurring across the United States, these realities raise serious concerns about the reopening of schools and how children should navigate the world of the pandemic. .
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Children at risk
When considering the role of children in this pandemic, the first question is whether they can become infected, and if so, how often.
Of the 149,082 reported cases of COVID-19 in the United States at the end of April, only 2,572 – 1.7% – were children, despite the fact that children represent 22% of the United States population.
But current research shows that children are physiologically as likely to become infected with SARS-CoV-2 as adults. This discrepancy between case numbers and biological susceptibility may be due to the fact that children generally have minimal to mild symptoms when infected with the coronavirus, and are therefore less likely to be tested. It may also be that children in general have had less exposure to the virus compared to adults. Children don’t go to work, they probably go out to stores less than adults, and in states that had relaxed quarantine measures, they don’t go to bars or gyms.
Although children are less likely to get sick from the coronavirus, they are definitely not immune. The data shows that children under the age of one and those with underlying conditions are more likely to be hospitalized. These children generally experience the respiratory distress commonly associated with COVID-19 and often need oxygen and intensive care support. As of July 11, 36 children ages 14 and under had died from the virus.
In addition to the typical cases of COVID-19, there have recently been some terrifying reports that children’s immune systems go haywire after being exposed to SARS-CoV-2.
Reports of Kawasaki disease are notable. Kawasaki disease typically affects young children and preschool-age children, causing prolonged high fever, rash, red eyes, swelling of the mouth, and swelling of the arteries of the heart. The vast majority of children who contract Kawasaki disease survive when they receive treatments that reduce inflammation, but sadly, some children have died from exposure to the coronavirus that caused the disease. Doctors don’t know what causes Kawasaki disease normally, or why a coronavirus infection could trigger it.
[[[[You are too busy to read everything. We understand. That is why we have a weekly newsletter. Sign up for a good Sunday read. ]In recent months, there have also been reports of some children, after becoming infected with the coronavirus, experiencing a fever and a rash along with a life-threatening drop in blood pressure and sudden severe heart failure. Children and adolescents with this COVID-19-related shock syndrome, now called Children’s Multi-Systemic Inflammatory Syndrome, or MIS-C, are older than doctors often see with Kawasaki disease. Experts think that these two diseases are not the same, despite having similar characteristics and treatments.
AP Photo / Ted S. Warren
Children as dividers
So if children can contract the coronavirus, the next important question is: how easily can they transmit it? Since children have milder symptoms, some experts believe that children are probably not the drivers of the COVID-19 pandemic. Additionally, recent research has shown that most children who get the coronavirus get it from their parents, not from other children.
Young children may have a weaker cough and therefore would release fewer infectious virus particles in their environment. A recent study from South Korea found that while young children appear less able to transmit the disease compared to adults, children ages 10 to 19 transmit the virus at least as well as adults. The lack of evidence that children are the main sources of transmission may simply be because the route of infection was interrupted due to the closure of schools across the country in the spring. As children resume their normal daily activities, such as school, sports, and daycare, we may find the answer to how easily children transmit this dangerous virus.
AP Photo / LM Otero, File
And now that?
The evidence clearly shows that all people, regardless of age, can become infected with SARS-CoV-2. While research shows that children are more resistant to serious coronavirus diseases, they are still at risk and can transmit the virus even if they are not sick themselves.
Given all this information, a question naturally arises: Should schools reopen in the coming weeks? In places where transmission rates are low, reopening schools could be a viable option. But today, in the United States, new case numbers are increasing in most states. This requires a more nuanced approach than a large-scale reopening of schools.
Because young children face a low risk of becoming seriously ill, less likely to spread the disease, and greatly benefit from in-person interactions, we believe that learning at school should be considered. Opening schools for elementary children and creating more and more online options for older grades could be one way to tackle this thorny problem.
