Kids and COVID-19: What experts do (and do not) know about how the virus affects children
As the debate about reopening schools rages at the local, state and national levels, infectious disease and engineering experts are trying to keep up with the ever-evolving situation with the coronavirus pandemic so they can advise administrators considering — and reconsidering — whether and when to open facilities for the year.
On Friday, Denver Public Schools rolled back its plan to host in-person classes five days a week this fall, opting instead to start the year online on Aug. 24, a week later than originally planned. The decision came after consultation with local public health experts, Superintendent Susana Cordova said. The district will consider gradually reopening schools and welcoming students back after Labor Day.
Colorado is experiencing an upward trend in COVID cases with more than 2,900 new ones reported the second week of July, the highest increase the state has seen since May. Still, the circumstances are not as alarming as many other places in the United States.
So far, most districts plan to welcome students back for full-time, in-person instruction this fall while implementing safety protocols such as mask requirements, student cohorting and modified schedules to mitigate the risk of a potential outbreak. But school and public health leaders caution that plans could change — again.
In May, districts floated the idea of a hybrid approach that would have kids in school for in-person instruction part-time and have them supplement with online work remotely. That’s still a contingency plan for many should the circumstances around COVID-19 escalate.
“What happens in schools is going to be reflective of the broader community no matter how good a job we do in implementing the mitigation measures,” said Dr. Sean O’Leary, professor and pediatric infectious disease specialist at the University of Colorado’s School of Medicine in Aurora. “If we see that in mid-August we are seeing similar levels of disease to what we’re seeing in Texas and Arizona, I don’t know that it’s safe to open schools at that point because there’s so much virus circulating.”
Much of the guidance around reopenings suggests the benefits of sending kids back to school outweigh the risks, as children appear to be less susceptible to the virus. We spoke with pediatric doctors, as well as public health and engineering experts to parse what’s known — and unknown — about kids and their COVID-associated risks.
What we know
Dr. Glen Mays, professor and chair of the Department of Health Systems, Management and Policy in the University of Colorado’s School of Public Health, says medical experts have been looking at observational data from reported cases nationally and internationally to deduce how the novel coronavirus affects children. Mays called the data “imperfect,” but said it’s helpful in identifying patterns and trends among sectors of the population.
For example, kids appear to be at lower risk of contracting COVID-19 and those who do are at a substantially lower risk of developing health complications, he said. Fewer children have been hospitalized with the disease and very few deaths have been reported compared to adults, said Dr. Sam Dominguez, an infectious disease specialist at Children’s Hospital Colorado.
“Overall, kids are doing much better with this virus,” he said.
Data also suggests the rate of transmission among children is lower, meaning they don’t spread the disease between one another as easily as adults do, doctors said. But if they catch it, COVID-19 symptoms are typically different for youths.
Dominguez said children can experience a runny nose and cough similar to a mild cold, as well as vomiting and diarrhea. While about 80% of infected adults get a fever, Dominguez said, only about 50% of children do. And evidence shows that many kids who catch COVID-19 are asymptomatic — possibly as many as 30% to 40% of them, O’Leary estimated.
Complicating matters further, COVID symptoms and severity can also vary between teenagers and younger kids.
“As we approach the fall and the winter, we assume influenza will come back, SARS-V will come back. We’ll have those regular seasons, but it will be in the context of this virus also circulating,” Dominguez said. “It’s going to be a huge challenge to differentiate this virus from other viruses or other causes of respiratory and gastrointestinal symptoms.”
Another important fact to consider when discussing reopenings, the doctors said, is that children suffer academically, emotionally and oftentimes physically when they are not in school. A recent survey of U.S. school social workers conducted by searchers at The University of California Los Angeles, Loyola University Chicago, Cal State Fullerton and Hebrew University found that many students and families are struggling to have their basic needs met during the pandemic.
Of the 1,275 social workers who responded, about 62% said their students had needs related to food insufficiency, about 62% cited needs for individualized tutoring, and more then 75% said their students needed access to mental health services — all services typically provided by schools.
“Increases in obesity, increases in mental health issues, anxiety, depression, suicidality,” said O’Leary. “Many, many things have already come to light in the short time that kids were out.”
What we don’t know
For as many indicators experts have about kids and the novel coronavirus, there are as many questions. The biggest one?
“I think the big research question is, why is that the case?” said Dominguez. “We don’t really fully understand why kids are doing better than adults and maybe why they don’t spread it as efficiently.”
There are theories, of course. Doctors suspect biological differences could play a role. For example, children have fewer of the receptors that the coronavirus uses to gain entry into cells, O’Leary said.
Kids also have different immune system responses to disease, Dominguez said. Some have developed a multisystem inflammatory syndrome, known as MIS-C, after becoming infected. Doctors don’t fully understand what causes it or how common it is, he said, but it’s believed to be a rare condition.
Factors driving youth trends could also be circumstantial, doctors said. Perhaps because the nation shut down schools in March, children had fewer opportunities to be exposed to the virus, Dominguez said. It’s also worth considering how kids in different age groups interact with one another and how that could cause variances in transmission rates among teens versus young children, he added.
Despite not having answers to those questions, Dominguez, O’Leary and Mays were in favor of reopening schools. That’s not to say they don’t have concerns.
“Even if we take kids out of the equation, there’s still a large number of adults in an indoor setting for a long period of time. That’s a higher-risk activity,” Mays said.
“The overall risk to kids, at least as of today, it does appear to be similar to other respiratory viruses that we accept regularly,” O’Leary said, adding that he and his wife caught COVID-19 earlier this year while their kids, ages 16 and 12, did not.
“It’s much more severe in adults and people with chronic medical conditions than influenza,” he said. “But for children, the risk from COVID-19 seems to be in line with influenza, roughly. That’s how I’ve been thinking of it as a parent.”
What experts say we should do about it
Shelly Miller, a professor of mechanical engineering at the University of Colorado Boulder, was one of more than 200 scientists who implored the World Health Organization to consider COVID-19 an airborne illness. That distinction is important, she said, because it informs which precautions schools should take to create a safe environment.
Engineers have been rapidly studying how COVID-19 spreads based on factors such as ventilation, how many sick people are in a room, how long they’re in a space, and different measures of social distancing. Miller has conducted studies on how singing and playing wind instruments could propagate the virus, as well as the rate of transmission in a nursing home where a ward of 30 rooms were converted to negative pressure ventilation.
She believes the three most effective ways to mitigate the spread of the virus in schools are to require masks, to circulate outdoor air inside school buildings, and to minimize the time students and faculty spend indoors.
“You need outside air into the space to dilute the virus concentration,” Miller said. “If you can’t get virus concentration down by adding air, you can by filtering it with an air purifier.”
Even if many kids won’t show a fever, it’s important that schools still conduct health screenings as one measure to find potential cases, doctors said. Additionally, O’Leary said, there’s never been a more important time to make sure kids are up to date on their vaccines.
“The last thing we can handle is a vaccine preventable disease outbreak in our school in addition to COVID-19,” he said.
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