As schools contemplate reopening amid rising COVID-19 cases, an awkward truth is emerging: Adults are the problem, not our kids.
For months, we’ve kept children carefully isolated, pleading with them to behave, wear masks, wipe their boogers and not hug Gram and Grandpa. We’ve assumed this new virus acts just like the flu and common cold — so classrooms full of kids would create one giant cootie colony.
But a growing body of research suggests young children aren’t responsible for most viral transmission.
Based on these findings, school-based transmission could be a manageable problem, particularly for elementary school aged-children who appear to be at the lowest risk of infection, according to a recent commentary in the journal Pediatrics.
“The evidence suggests that children are less likely to become infected, less likely to develop severe disease and less likely to transmit the virus to other children and adults,” said co-author and pediatrician Dr. William Raszka Jr. of the University of Vermont School of Medicine. “It is wildly different from flu.”
If confirmed, this is good news for teachers, whose classrooms can feel like big Petri dishes. It’s a relief for parents, weary of juggling work and childcare. Best of all, it’s good for kids, who aren’t learning or playing with friends.
At the same time, more work must be done to prove that kids are truly harmless, experts cautioned. Dr. Anthony S. Fauci, director of the National Institutes of Allergy and Infectious Diseases at a Thursday briefing. Federal researchers are now closely tracking 6,000 people in 2,000 families to determine who gets infected with the virus, whether they transmit it to other family members, and who gets sick.
Transmission in elementary school seems lower than in high schools, according to Dr. Naomi Bardach, associate professor of UCSF’s Department of Pediatrics. There’s limited data on middle-school and preschool children, she said.
Based on her analysis of research, “staff and teachers, as adults, are more likely to transmit it to each other,” she said.
As the country enters a worrisome phase of the pandemic, with new daily cases surpassing 57,000. On Friday, the Centers for Disease Control and Prevention recommended that schools take measures that include spacing students’ desks six feet apart, staggering class times and teaching kids basic hygiene measures. CDC director Dr. Robert Redfield said the agency will issue additional guidance next week.
The American Academy of Pediatrics, a traditionally cautious group of smiling, Band-Aid-bearing, Patch Adams types of doctors — says that kids belong in school. While COVID-19 risk can never be eliminated, students should be “physically present in school” as much as possible, because there are known emotional, social and educational risks to keeping children at home, it recommends.
As evidence that children are not the agents of spread, pediatricians point to large “contact tracing” data sets from around the world. They show that a household’s COVID-19 infection rarely starts with children; on the contrary, grownups bring it into the home. And children rarely share it with others.
A 9-year-old British boy contracted the virus at a chalet while skiing in the French Alps. But he did not pass on the virus, despite coming into contact with more than 170 other people, including his siblings and over 112 pals at three separate ski schools, according to a study by England’s Centre for Evidence-Based Medicine.
Of 68 sick Chinese children admitted to a children’s hospital, 96% were found to have been sickened at home by adults, researchers reported in July’s issue of the journal Pediatrics. In an Australian high school, 863 pupils and teachers had close contact with 18 sick students and staffers — but just two, or 0.23%, became infected.
Swiss researchers analyzed data on 39 children younger than 16 and found that in nearly 80% of cases, the illness came from an adult in the house, according to a May study in the journal Pediatrics. Research from the Netherlands also found that the virus is mainly spread from adult family members to children.
To be sure, the emergence of a rare but dangerous complication called “multisystem inflammatory syndrome in children” — with symptoms such as fever, abdominal pain, vomiting and diarrhea — shows that youth are not completely spared. A recent CDC review of 186 cases found that it tends to be concentrated in places that had outbreaks relatively early on, such as New York, New Jersey, and Michigan.
On Thursday, the British medical journal Lancet estimated that 1.5% of children infected with the COVID-19 virus developed the syndrome and required Intensive Care Unit admission. Of the 78 children needing ICU care, only 22% had pre-existing medical conditions that put them at risk. Two died.
It’s possible that we simply haven’t seen transmission among U.S. children because they’ve been stuck at home. In California, children represent a small fraction of confirmed COVID-19 cases. About 1.8% of cases are in children younger than 5 and 6.5% of cases are in people aged 5 to 17. In contrast, 33% of cases are among people between the ages of 18 and 34 years. But if children are driving the spread of the virus, we would have seen big spikes in countries where they’ve already returned to school, such as Germany and Denmark, experts said.
Nationally, YMCA emergency child care centers have cared for 40,000 children between the ages of 1 and 14 at 1,100 separate sites and seen no clusters. Israel suffered a school outbreak, forcing closure, but it occurred in a high school. Hong Kong suspended schools on Friday, but it was largely pre-emptive because the city is experiencing a resurgence in cases.
So why aren’t young kids super-spreaders? It’s a mystery. Surely, we thought, their dripping noses and sticky little hands are loaded with germs. A new study found that younger children have less of a receptor called angiotensin-converting enzyme 2 (ACE2), which the virus needs to enter cells. Expression of the gene for this receptor is lowest in 4- to 9-year-olds. It is higher in 10- to 17-year-olds, although still lower than in adults.
With milder symptoms, children cough and sneeze less. And their smaller lungs eject fewer infectious particles into the air.
So is it better to wait before visiting that precious new grandchild?
“A one-month-old infant is unbelievably unlikely to transmit COVID-19,” said Vermont’s Raszka. “But I’d wear a mask and physically distance and ask the parents very carefully what their exposure has been. The risk is from the other adults, not the infant.”
