The outbreak of COVID-19 has been stressful and confusing. Information and recommendations change as more people contract the illness and as researchers conduct additional studies. To clarify what is known now about the pandemic and kids, we connected with Dr. Jeffrey Kahn, chief of infectious diseases at Children’s Health as well as chief of the division of pediatric infectious disease and professor of pediatrics at UT Southwestern.
When the pandemic started, the thought seemed to be that kids were largely insulated from COVID. But children are getting the illness. Can you shed some light on that situation? Clearly, we know that children can get infected and can get disease. As you mentioned, early in the pandemic, there were very few children getting infected, probably because those were the most sheltered individuals in society as we began to shut down. You can imagine that in a family, the kids would probably stay home when the parents would go out to the grocery store—the kids weren’t really exposed to the population at large.
So that may explain why, early on in the epidemic, we weren’t seeing that many cases in children—that, and that children tend to get very mild or asymptomatic disease, so they weren’t being tested as much. Looking back, we now recognize that there may be some reasons for the apparent lack of disease in children earlier this year. That is no longer true.
Data came out showing 97,000 U.S. children tested positive for COVID in the last two weeks of July, a 40% increase over the previous two weeks. And in mid-August, stats showed a 90% increase in cases in children over the past four weeks. Can you give some context for those numbers? Those are coming from a study that was published by the American Academy of Pediatrics along with the Children’s Hospital Association. The increases you’re citing reflect a number of things. One is the fact that there may be more testing; another is that we know that the virus is spreading throughout the country—not only in the cities, but in the rural areas as well, so there’s more exposure. I think those are two big driving factors to potentially explain these statistics.
And there is the fact that—as I mentioned—earlier in the pandemic, children were isolated to a very large extent, and now, perhaps they are not as isolated as they were.
Has the relaxation of social distancing contributed to the increases? In May and after Memorial Day weekend, we saw a large increase in virus circulation in Dallas after social distancing measures began to relax. But what’s important to point out is that the age group that had the largest increase in positive cases was in the 18-to-40-year-old age group. If you look at 18- to 40-year-old individuals, what do they have in common? This age group has young children at home. As adults with kids at home went out in the community, they got infected and brought the virus back to their house. Certainly, there’s still a lot of virus circulating out there, we should not be letting down our guard for sure.
There was another study that showed children with COVID often have a higher viral load than adults. Does that say anything about the susceptibility of children to the illness or their ability to pass it on to others? I think it has several implications. One, it shows that young children can acquire the virus and they can have a lot of virus in their respiratory secretions; that is clear right now. And sometimes they have more virus than adults.
But as far as spreading the virus, if children are not symptomatic, they can be less likely to transmit the virus than if they are symptomatic. And this is true for adults too; you can imagine that if an adult is coughing and sneezing, they’re creating a lot of aerosolized respiratory particles that harbor virus.
If your child happens to have the virus, they may even have a lot of virus in their nose—but if they’re not coughing or sneezing, then they’re going to be transmitting less virus. And of course, even if they are coughing and sneezing or yelling or crying, their capacity to move air around the room is far less than an adult just based on size and lung capacity. The bottom line is children get infected and they can spread the virus to close contacts.
We’ve also heard that children seem to be at lower risk before age 10. What is it about age 10 that triggers susceptibility to COVID and more severe infections? There’s nothing magical about age 10. Look at the experience here in Dallas County; this is data that’s available on the Dallas County website. They define the pediatric population as individuals less than 18 years of age. They don’t break it down any finer than that.
What we do know is that for individuals who are less than 18 years of age, they represent 10% of the positive cases. But only 2% of hospitalized individuals are less than 18 years of age, suggesting, and there are plenty of data out there that support this, that children tend to be less susceptible to severe disease. The real driving force in infection and disease in children, much like that with adults, is underlying medical problems.
People generally understand the risks associated with underlying conditions, but there have been cases of people who are reported not to have underlying conditions and still become very ill or even die. What’s the best medical explanation for something like that? Every year, we have children die of influenza—fortunately, a very small number—but every year we have children die of influenza, and some of them have no risk factors. And why do these children die of influenza, or why are some children particularly prone to severe flu or now severe COVID? We really don’t know.
It’s very difficult to come to conclusions based on individual cases. You have to go back to this large wealth of data that we have and that we discussed from the American Academy of Pediatrics and other data that supports the notion that for the most part, children are less prone to severe COVID as compared to adults and, in particular, compared to adults with underlying risk factors.
Children are either back on campus or their schools are preparing for an expected return to the classroom. What precautions do you consider very important for schools to take? The American Academy of Pediatrics and the CDC issued guidelines that families and the community should follow.
Mask wearing is extremely important in reducing spread of the virus. Remember, you’re wearing a mask for two reasons: one is to protect yourself, and the other is if you happen to have the COVID virus, you won’t spread it to other individuals. Parents should get children used to wearing a mask and send them to school with a number of replacement masks.
Kids will be kids, and their mask may fall off, get soiled or get wet. Make sure they have a backup mask or several backup masks because the last thing you want to do as a parent is drop your kid at school and have to go back 10 minutes later and pick him or her up because they don’t have a mask.
Hygiene is another issue. And that may be somewhat challenging in school, particularly for the younger kids who like to go around and touch each other and touch things. Hand hygiene is critical. Of course, social distancing—we know these measurements work.
These measures were not just discovered during COVID. There’s a long history of these measures preventing the spread of influenza and other respiratory viruses.
Do you expect that schools will have cyclical closures due to exposures? That’s certainly possible. There is a high chance that the virus is going to find its way into schools based on examples not only in this country, but elsewhere. That’s why we need to follow guidelines and procedures to mitigate the spread of the virus in the community.
If a child has mild symptoms of something—maybe Mom and Dad aren’t sure if it’s just a cold or if it could be COVID—do you recommend a child get tested? Or would that be only in the case of severe symptoms? I would certainly promote testing for mildly symptomatic children, and the reason is because of who the child may come in contact with. If there is somebody else at home who may fall in one of the high-risk groups, it would be important to know whether the child has the virus. Or if the grandparents want to visit, it would not be the best idea to have them over if you know that your child is infected.
We’ve talked about advice for parents. Is there anything you want to add in terms of a message for moms and dads as far as COVID infections in kids? This is obviously a very dynamic situation, and it could shift from community to community, county to county. There are a lot of resources out there that are readily available to assess the amount of spread of virus in the community, so keep an eye on that.
In North Texas and in Dallas County, it looks like the trend (as far as circulation) is that it’s decreasing or at least heading in the right direction. There’s still a lot of virus out there, but hopefully, we’ll get to the point where the virus level is so low that we can actually start relaxing social distancing restrictions and that may be a sign for parents that they may be more comfortable sending their child to schools.
Another thing, of course, is that when your kid comes back from school, make sure whatever mask they had been wearing gets thrown in the laundry. Clean it up. And pay particular attention to hand sanitation when the child comes home. These measures will have a great impact in reducing the spread of virus.
Image courtesy of iStock.