Children do not get sick with COVID-19 as often as adults do, but they appear to spread the coronavirus easily. Experts assess the risks in and out of school.
As students start to head back to school across the United States, adults are legitimately concerned about the COVID-19 risk this may pose, both to children and to the community at large.
Although our knowledge about the novel coronavirus keeps evolving, available information shows that children are less likely than adults to develop COVID-19 and less likely to get very sick when they do become infected. The American Academy of Pediatrics (AAP) estimates that as of August 6, children represented about 9.1 percent of all COVID-19 cases in states reporting cases by age.
That number appears to be on the rise. The AAP reported that almost 100,000 kids tested positive for COVID-19 in the last two weeks of July — a 40 percent increase in all child cases. For the month of July, nearly one in three coronavirus tests of children in Florida came back positive, according to South Florida Sun Sentinel.
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A Small Percentage Get Very Sick
The Mayo Clinic says that children with COVID-19 tend to develop mild cold-like symptoms such as fever, runny nose, cough, fatigue, muscle aches, vomiting, and diarrhea; many have no symptoms at all. The latest figures from the Centers for Disease Control and Prevention (CDC) suggest that 40 percent of all coronavirus patients are asymptomatic.
While severe COVID-19 among kids is very rare, some infected children can get seriously sick and even die. As of August 6, the CDC has received reports of 570 confirmed cases of a potentially fatal illness associated with COVID-19 called multisystem inflammatory syndrome in children (MIS-C). More than 70 percent of these cases involved children who are Hispanic or Latino or non-Hispanic Black.
In addition to fever, children with MIS-C may experience abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or extreme fatigue.
According to the CDC, 10 children have died from the illness.
Thomas McDonagh, MD, a pediatrician with Northwell Health’s Huntington Hospital in Long Island, New York, stresses that although MIS-C is rare, parents have genuine cause for alarm about their child’s health if he or she gets COVID-19.
“Some healthy children who don’t have any particular underlying risk factors can become severely ill,” he warns.
Dr. McDonagh has treated several children with COVID-19 and a couple who developed MIS-C, but says “Luckily, none of them have had significant long-term consequences to their health.”
Why are most children able to do so well? McDonagh suggests there may be a physiological explanation. “The receptors on their cells may not accept viral infection from this particular novel virus quite so easily,” he says. “There is also a hypothesis that children may be less susceptible because they have some innate cell protection against coronavirus related to being infected more recently and more frequently with the normal cold virus.”
For now, these remain theories, and more study is needed to understand how the virus affects kids.
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How Easily Do Children Spread the Virus?
Although children have made up a lower proportion of those who test positive for COVID-19, evidence increasingly suggests they may be effective transmitters who not only pass the virus along to each other but to adults as well.
A large study first published on July 16 in the CDC journal Emerging Infectious Diseases found that young people between the ages of 10 and 19 can spread the virus at least as well as adults do, although children under the age of 10 appear to transmit the virus much less frequently compared with adults.
A paper presented in JAMA Pediatrics at the end of July, however, suggested that very young children could be absolutely brimming with the virus. Researchers discovered that children under age 5 may host as much as 100 times the amount of the virus carried by adults.
“Certainly, one could be tempted to correlate a high amount of viral load to an ability to spread the virus rather efficiently,” says McDonagh. “But I don’t think that there’s enough data yet to say that children are ‘superspreaders.’”
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Do Summer Camps Portend Problems in Schools?
While kids may not be deemed superspreaders, they seem to be doing a good job of transmitting the coronavirus — at least judging from recent outbreaks at overnight camps this summer.
A CDC report published on August 7 that looked at 597 children and young adults at an overnight camp in Georgia found that 260 tested positive for the novel coronavirus. The virus was detected in 51 percent of those ages 6 to 10, 44 percent of those ages 11 to 17, and 33 percent of those ages 18 to 21. Among staff members, 56 percent tested positive.
“These findings demonstrate that SARS-CoV-2 [the virus that causes COVID-19] spreads efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission,” the authors wrote.
The camp mandated that attendees provide a negative COVID-19 test result before arriving, and that counselors wear masks. But, the study notes, campers were not required to wear face coverings, and windows and doors were not opened for increased ventilation in buildings.
Other camps have also run into trouble. Central Michigan District Health Department officials have traced dozens of recent coronavirus cases to a Gladwin-area summer camp, according to the Detroit Free Press. KGW8 in Oregon reported that 11 campers and 14 staff members, all age 20 or younger, tested positive at a Bible camp in Multnomah County.
Some schools that have already opened their doors show how quickly the coronavirus can spread in that setting. In Mississippi, the Corinth School District quarantined at least 116 students for 14 days because they were thought to be in close contact with an infected individual. North Paulding High School in Dallas, Georgia, which has a mask-optional policy, temporarily switched to remote learning after six students and three staff members tested positive for COVID-19.
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Trying to Tame Bad Habits
Yvonne Maldonado, MD, a professor of pediatrics at Stanford Medicine in California who specializes in infectious diseases and health research and policy, points out that schoolchildren have been notorious spreaders of the common cold and flu, so it makes sense that they could do the same for COVID-19.
“We know that they don’t handle their secretions very well — they’re more likely to spread them around because they handle their nose and their mouth and they smear things,” she says. Plus, little kids can forget to cover their mouth when coughing and sneezing.
With colds and flu, children will have symptoms, but one of the great difficulties with the coronavirus is that it seems to be carried by those who have no symptoms. It may be challenging to get kids to follow habits related to COVID-19 prevention, like mask wearing and social distancing, when they feel perfectly fine.
The educational news site Chalkbeat points out that mask policies vary from school to school. Some states mandate face coverings for all students and school employees (as urged by the CDC), while other states require masks only for staff members and older students. Just as with some adults, though, some teenagers may be reluctant to don a face covering for social or political reasons.
“We need to stress the fundamentals with children,” says Dr. Maldonado. “Should we be masking? Yes. Should we be distancing? Yes, as much as possible. Should we be practicing hand hygiene? Absolutely. So if kids are not doing all of those things, don’t be surprised if you see infections.”
The CDC offers a checklist for parents on how to help prevent the spread of COVID-19 in schools. For instance, the agency recommends that parents buy multiple masks for their kids that fit snugly but comfortably over the nose and mouth, and that they help children practice putting on and taking off the mask by the straps rather than by touching the cloth. Parents should also check in with children every morning to watch for signs of illness, such as a temperature over 100.4 degrees or a sore throat, and keep kids home if they are unwell.