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 Several large studies have shown that the vast majority of children
who contract COVID-19, the disease caused by the virus, have milder
illness than adults. And early reports did not find strong evidence
of children as major contributors to the deadly virus that has
killed more than 780,000 people globally.
But more recent studies are starting to show how contagious infected
children, even those with no symptoms, might be.
"Contrary to what we believed, based on the epidemiological data,
kids are not spared from this pandemic," said Dr. Alessio Fasano,
director of the Mucosal Immunology and Biology Research Center at
Massachusetts General Hospital and author of a new study.
Schools across the United States and elsewhere are trying out a wide
range of strategies to reopen, from all online classes to all in
person. They are asking whether reopening schools with stringent
mitigation measures is worth the risk to students, families and
educators, given that keeping schools closed will likely harm
academic progress, social and emotional development, mental health
and food security.
“We can't just sit back and assume that there'll be no problems with
schools… I think we have to reopen schools, but we have to reopen
them cautiously,” said Dr. Matthew Snape, Associate Professor in
General Paediatrics and Vaccinology at University of Oxford.
Dr. Fasano and colleagues at Boston's Massachusetts General and
MassGeneral Hospital for Children found that infected children have
a significantly higher level of virus in their airways than adults
hospitalized in intensive care units for COVID-19 treatment. The
high viral levels were found in infants through young adults.
The study, published on Thursday in the Journal of Pediatrics,
involved 192 participants ages 0-22 who were seen at urgent care
clinics for suspected COVID-19. Forty-nine of them - a quarter of
the total - tested positive for the virus. Another 18 were included
after being diagnosed with multisystem inflammatory syndrome, a
serious COVID-related illness than can develop several weeks after
an infection.
The research suggests that children can carry a high viral load,
meaning they can be very contagious, regardless of their
susceptibility to developing a COVID-19 illness.
"There has been some conflicting data out there about the degree to
which children can be contagious," said Dr. Marybeth Sexton,
assistant professor of infectious diseases at Emory University
School of Medicine in Atlanta, who was not involved in the study.
"This is further evidence that we may see children as sources of
infection."
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She added more extensive research is needed.
"NOBODY IS SPARED"
A separate study published last month in JAMA Pediatrics found that older
children hospitalized with COVID-19 had similar levels of the virus in their
upper respiratory tract as adults, but children younger than five carried
significantly greater amounts.
However, other medical groups show differing information over children's
potential to spread the virus. The American Academy of Pediatrics on Wednesday
updated its guidelines to reflect "that children under 10 years may be less
likely to become infected and spread infection, while those 10 years and older
may spread it as efficiently as adults."
A recent South Korean study found that people were most likely to contract the
new coronavirus from members of their own households, with children aged nine
and under least likely to be the first identified case.
Since most children infected with the coronavirus have very mild symptoms, they
were largely overlooked as a demographic in the earlier stages of the pandemic,
Dr. Fasano said.
The U.S. Centers for Disease Control and Prevention reported a pediatric
COVID-19 hospitalization rate of 8 per 100,000 for March 1 to July 25, compared
with a rate of 164.5 per 100,000 for adults.
Experts say the incidence of a related disease, which can develop after COVID-19
infection, multisystem inflammatory syndrome, is concerning. "The number of
these patients is growing," Dr. Fasano added.
Concerns have also been raised about cases of type 1 diabetes among children
diagnosed with COVID-19. A small UK study found that the rate of diabetes almost
doubled during the peak of Britain’s COVID-19 epidemic, suggesting a possible
link between the two diseases that needs more investigation.
"The more we understand, the more it boils down to nobody is spared in this
pandemic," Dr. Fasano said.
(Additional reporting by Alistair Smout in London; Editing by Peter Henderson
and Aurora Ellis)
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