COVID-19 And Children: What Have We Learned Six Months Into The Pandemic?

Op-Ed by Dr. Chuck Williams

It’s been six months since the coronavirus pandemic was recognized as a public health emergency in the United States.  While there is still much we don’t know about the virus that has caused so much disruption to the lives of our citizens, our economy and our schools there are some things we have learned.  Compared to six months ago we have a better understanding about the how the virus spreads, who gets the most sick from it, and what measures we can take to control it.

One of the crucial questions asked since the beginning of the pandemic is how the virus affects children.  Children are known vectors of influenza spread every season so scientists have been interested in the role they might play in the transmission of the coronavirus as well.   The answer to this question has significant implications for the way in which we have opened up our economy and our schools.  A few things to consider when examining this issue:

Children generally have a less severe form of COVID-19 illness than adults.   While the true incidence of the virus among children is not known due to the lack of widespread testing in these age groups, just this week the American Academy of Pediatrics released data that showed more than 513,000 children across the country have been diagnosed with COVID-19 since the pandemic began.  Thankfully, children account for just 7% of all COVID-19 cases and only 0.3% of all COVID-19 deaths.

Children also seem to have a much milder form of the illness when infected, and many show no symptoms at all.  While this is good news for the children affected it can make tracking the virus more difficult given the possible number of asymptomatic cases among kids.

Multi-system inflammatory syndrome in children (MIS-C) is a rare but serious complication arising from COVID-19.  Fortunately few children develop this syndrome and our understanding of its diagnosis and treatment is improving.

The hospitalization rate among children with COVID-19 remains low.  A retrospective study released this past week from the Children’s National Hospital in Washington, DC found no statistical difference in the rates of hospitalization, admission to the ICU, or ventilator use between children with coronavirus and influenza.

This is good news in the sense that children seem to suffer no worse from when hospitalized for influenza but bad news when you consider that every year in the United States we hospitalize around 20,000 children under the age of five for flu complications.  Flu deaths in children are tragic but are rare and range anywhere from around 30 to 200 annually in the U.S.

Children do carry high viral loads of the virus but it’s unclear what role they play in transmissibility.  The CDC recently shared that “it is unclear whether children are as susceptible to infection by SARS-CoV-2 compared with adults and whether they can transmit the virus as effectively as adults” (cdc.gov).  A study published in JAMA Pediatrics in late July suggests that children have the same or higher viral loads in their nasopharynx when compared to adults.  We don’t know whether this higher viral load leads to increased viral transmission.

We must prioritize ongoing pediatric wellness care.  We’ve seen declines in pediatric immunization rates early on in the pandemic as many families sheltered in place and delayed their usual medical care.  Routine childhood immunizations for diseases like measles and polio remain very important, along with immunizations for the seasonal flu.

What does this all mean for returning to school safely?  This of course is the million-dollar question that every school system across the country continues to grapple with.  Everyone recognizes the inadequacy of remote learning and importance of getting students back to the classroom. When children do return to in person instruction we would expect to see an uptick in the number of cases and we should be prepared for quarantines of some students and staff when outbreaks occur.

While the threat to most of our students from COVID-19 remains low we also must acknowledge that some teachers and school staff will be more prone to serious illness and complications if they contract the virus.  Older teachers, those with chronic medical conditions, and those with vulnerable family members in the home might understandably choose to continue remote instruction for now.

How do we respond to this data?  One thing we should all be able to agree on is the need to be supportive of our superintendent, board of education, administrators and teachers.  School leaders everywhere are faced with incredibly difficult decisions as they plan for the reopening of our schools and in person instruction.   As we continue to learn more about the virus and its effects we must remain unified to do all we can to control it, and get our children and teachers back to their classrooms safely.

Chuck Williams, MD is a family physician with Horizon Family Medicine of Clayton and father of two high school students in the Johnston County Schools and a college freshman.  Dr. Williams is the co-founder of Project Access, a medical non-profit dedicated to providing healthcare for the uninsured of Johnston County.  He is a candidate for the Johnston County Board of Education this fall.