Vol. 241 October 1, 2020 COVID-19 and Children

The only thing that has been consistent about school re-openings this month has been inconsistency; remote only, hybrid model, teaching/learning pods, ZOOM/Microsoft team/other platforms, and even full attendance in some places. We have been dealing with this pandemic long enough now that research on COVID-19 in children is beginning to be published. 

COVID-19 Symptoms in Children Are Usually Mild or Absent.
In a South Korean study of about 100 children seen in a hospital or other isolation facility (i.e. children who were suspected of having COVID-19).

  • 22% were asymptomatic
  • Most of the children (73%) who were seen by a hospital or clinic were symptomatic. About two-thirds had low grade fever (under 100.5 F). Half of all of them had negative chest X-ray.
  • Respiratory symptoms were present in 60%. GI symptoms or loss of taste and smell were present in less than 20%.
  •  Symptoms lasted a median of 11 days, but 10% of the children with symptoms had persistent symptoms at 21 days.
  • In asymptomatic children the virus was still detected a median of 14 days after the first positive virus test, but 20% of the symptomatic children were still shedding virus at day 21.
  • No child died and none had severe disease. Only two required supplemental oxygen (“moderate disease”).

“Though we don’t really know yet whether shedding the virus  means that the child is actually contagious, it does mean that a testing strategy restricting tests to only the symptomatic will have little impact on curtailing the pandemic.” (JAMA Pediatrics Aug 28, 2020)

Severe Illness Related to COVID-19 Is Rare In Children.
In May 2020 the CDC issued an advisory a about a severe inflammatory shock syndrome reported in children in England 2-4 weeks after acute COVID-19. By August 2020 the CDC had collected 565 U.S. cases of this Multi system Inflammatory Syndrome in Children ( MIS-C) after an acute COVID-19 illness. The MIS-C symptoms were similar to, but not identical with Kawasaki Disease (unknown cause) and Toxic Shock Syndrome (caused by staph.) Two-thirds of all patients had NO pre-existing condition putting them at risk. Two-thirds of all patients needed ICU care for a median of 6 days. Ten patients (2%) died. (MMWR Aug 14, 2020)

Children Rarely TransmIt COVID-19 To Household Contacts.
A detailed Swiss study of 40 patients in household clusters of COVID-19 showed that in 80% of cases at least one adult had COVID-19 symptoms before a child did. Adults who were positive for COVID-19 after exposure to an outside contact were more apt to have symptoms (85%) than the exposed and infected children (43%). (PediatricsMay 26, 2020)

COVID-19 Transmission To Younger Children Is Low.
Another South Korean study of 6000 confirmed cases of COVID-19 involving robust contact tracing showed that the only 5% of children under 9 y.o. that had a household contact with an under 9 y.o. COVID-19 patient developed the illness. In children aged from 10 to 19 y.o. about 20% developed COVID-19 after such a household contact. (Emerg. Inf. Dis July 16 2020)

Transmission Of COVID-19 Is Very Low In Day Care Centers.
A Rhode Island study of 19,000 children in 666 day care centers that reopened on June 1 revealed:

  • 52 cases were identified during the two months of June and July. 60% in children and 40% in adults (teachers and 2 parents).
  • 20 of the 29 of the 666 day care centers that had positive case had only a single case. Possible secondary contagiousness was detected in only 4 day care centers which lead to their closure and quarantine.

“Transmission of the COVID-19 from children remains an enigma.  . . . This study suggests that the CDC precautions can play a role in reducing outbreaks. . . . Without universal screening for asymptomatic carriage among young children and staff, it is not possible to fully understand transmission that may have occurred. . . . This study of robust contact tracing and adherence to infection control measures lends support for reopening schools in communities with declining prevalence of infections.” (MMWR, Aug. 21 2020)

Breast Milk Does Not Transmit the COVID-19 Virus.
Some viruses can be transmitted through breast feeding despite the presence of beneficial antibodies in breast milk. This study of 18 breast-feeding mothers infected with the COVID-19 virus (all asymptomatic) showed no COVID-19 capable of replication in the breast milk. Also, pasteurization of donated breast milk in breast milk banks eliminated all COVID-19 virus as well. (JAMA Aug 19, 2020)

COVID-19 Prevention Behavior Reduces Other Contagious Diseases.
Social distancing and other actions to prevent COVID-19 infection has markedly reduced (almost to zero!) the incidence of influenza, croup, and bronchiolitis in a Massachusetts study. Anecdotal information suggests that the “usual colds” in adults has been markedly reduced during the pandemic period. “We should remember the positive impact of behaviors learned during the pandemic, like hand hygiene, staying at home at the first sign of infection, and the importance of vaccines to reduce the spread among children.”  (Pediatrics Sep. 2, 2020)

COVID-19 Stress in Children Reflects Their Parent’s Stress Level.
A  study of 900 families with 2 to 14 y.o. children during the initial pandemic out break in Italy revealed that the primary stress on children was from quarantine. Not surprisingly, the amount of children’s stress was directly related to the degree of parental stress; i.e. the children of parents who were having more difficulty coping with quarantine restrictions demonstrated more stress symptoms themselves. (Frontiers of Psychology, July 3, 2020)  An unrelated study in Japan described the prominent symptoms of stress in children as “fear, clinging, inattention, and irritability”. (J.Peds March 3, 2020)

Political Stress and the Pandemic.
Of course, COVID-19 is not the only source of stress for our children. A 2016 presidential pre-election study of 14 to 24 year olds revealed that 86% reported issues of “anxiety, fear, or feelings that things were out of control”. 20% reported physical symptoms like “not being able to sleep and even nausea.” It was a non-partisan problem. “Even people who said that they didn’t follow politics, or were explicitly not interested in any of the candidates, were still having negative emotional responses to the election.” (Child and Adol. Psych and Mental Health, 2018)

“Pandemic or politics”, “drought or flood”, “fire storm or hurricane”, “work or no”, “office or home”, “school or remote” are all contentious issues that can increase our stress. We obviously can’t control all of the above, but at least we can lessen our stress by complying with the actions that help contain COVID-19 and rejecting the fake dichotomies of  “mask or no”, “alone or in a crowd”, and “hand wash or not”.

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