With many children scheduled to return to their campuses soon, there are questions around what will happen amid COVID-19.
Dr. Michael Chang, an infectious disease pediatrician with UT Physicians and McGovern Medical School at UTHealth who is also affiliated with Children’s Memorial Hermann, shared some findings and advice.
He said looking at COVID-19 trends in countries across the globe, pediatric cases (in people 0 to 17 years or 19 years, depending on the area) represent a smaller percentage of cases as compared to adults 18 to 50 years old. He emphasized that those results are not because there are fewer children and teens and gave an example that they may make up 25 percent of a population, but instead of having 25 percent of the cases, they may have only 10 percent of the cases.
“So proportionally, kids seem to have tested positive less, and they make up less of the cases of confirmed COVID-19 that we know of, and that’s been true across multiple countries,” Chang said. “The numbers differ from country to country. But generally speaking, kids seem to make up a smaller proportion of the total cases.”
The greater Houston area’s pediatric COVID-19 numbers are a little higher than other parts of the United States, Chang said: about 12 percent of total cases are found in people 0 to 19 years, compared with about 8 percent nationally. He said part of the difference could be that Houston counts differently, including those 0 to 19 years, so there are more people, compared with other parts of the country that just count people 0 to 17 years.
He explained that children 0 to 4 years (or 0 to 9 years in Houston-area counting) have had fewer reported cases nationally than children that are older.
“It does appear that as you get older, you are more likely to get the infection or more likely to be symptomatic,” said Chang, noting also that older children tend to be hospitalized more for the disease.
Chang said another important trend is that COVID-19 death rates in pediatric patients are very rare and that fewer than 100 children in the United States have died from the disease. He also mentioned when children do get sick, they often have fewer, more mild symptoms.
Children tend to spread respiratory viruses like the flu a lot, but Chang said data with contact tracing has not indicated that’s the case with COVID-19. He said more of the spread has come from adults to children but said an important factor is that schools and activities for children closed early in the pandemic. Since children have primarily been at home while adults have been out working and running errands, etc., he said data right now in the United States falls in the context of children not being around each other.
He brought up a few studies with some interesting data. Contact tracing in Israel showed that 12 of 13 family clusters that were studied were cases where an adult spread COVID-19 to the family, not children. When testing was done there, the children had fewer positive tests, Chang said.
A study of 15 families in Chicago showed that child-to-child spread accounted for about 13 percent of the cases and that child-to-adult spread also accounted for about 13 percent of the cases, Chang said.
“So most of the cases were due to adults spreading to each other or to the children,” he said.
Another study from South Korea suggested that people 10 to 19 years old could spread the virus as easily as adults. Chang said a further review was warranted. “But if you look at kind of the whole dynamics of the pandemic, if there’s many fewer pediatric cases, even if they spread into, you know, like two adults, and each adult spreads it to two adults, if there’s one child but 10 adults, then it’s still adult-to-adult spread that’s really driving kind of the widespread community disease,” Chang explained.
He said a study in Ireland had three children ages 10 to 15 years and three adults. Two of the three children and all three adults showed symptoms but went to school. The study contact traced around 1,000 people around them for two weeks and showed no secondary exposures from the children at the school.
However, Chang said that school study and similar ones from Australia and Israel were conducted near the start of the pandemic where once cases were identified, schools closed, followed by whole countries. So he said this situation is different because there is community spread now and schools will be reopening.
Chang said there are certain things parents can do to help ease their children back to school during a pandemic. He recommends having them wear a mask for most of a day sometime before in-person instruction begins.
“No matter the age of the child, it’s worthwhile explaining to them why you’re doing that and why you’re practicing and whatnot,” Chang said. “I think many parents would be surprised at how well their children can tolerate wearing a mask.”
He suggested using good hand hygiene habits at home because they will need to continue them at school, as well as practicing what six feet for social distancing actually looks like. And as students return to school each morning and come home each afternoon, parents should discuss with them whether any new COVID-19 symptoms are happening, Chang said. A cough, trouble breathing and a loss of smell or taste are the main ones he noted. Other COVID-19 symptoms that could also be indicative of other illnesses include fever, runny nose, congestion and gastrointestinal issues like vomiting or diarrhea.
He urged parents to avoid sending children with COVID-19 symptoms to school because they could potentially expose other students or school staff members.