SOUTHEASTERN, N.C. — Research is producing mixed results regarding how Covid-19 affects and spreads among young children and teenagers, just as adults make the decision to bring them back together for in-person instruction in large quantities.
Studies are still underway, with some results undermining the conclusions of previous research.
Generally, research suggests children are less likely to develop adverse symptoms if infected with the coronavirus, less likely to have adverse outcomes if infected, and may potentially transmit the virus less frequently.
What we know
Covid-19 symptoms tend to increase in severity with age, with the elderly experiencing adverse outcomes more frequently.
A widely-cited South Korean study found in July that older children aged 10 to 19 were more likely to transmit the virus to a household contact compared to younger children. Last week, a team of Harvard Medical School researchers found that children early on in the infection phase had significantly higher viral loads compared to adults hospitalized with severe Covid-19. This suggests children could play a more significant role in spreading Covid-19 than currently understood.
Compared to adults, less is known about how children react and spread Covid-19. This is, in part, due to a lack of data. It’s possible one contributing reason why a lower proportion of children are testing positive for the virus is that they simply haven’t been exposed to it at the same frequency as adults.
N.C. has had one Covid-19-related death of a minor.
In New Hanover County, 262 children under 18 have tested positive for the virus in total as of Friday, representing 9% of all cases identified locally. Statewide, about 11% of cases have been identified among minors; this is disproportionate to the under 18 population, which is 18% in New Hanover County and 22% in N.C.
New Hanover County Public Health Preparedness Coordinator Lisa Brown said it’s best to be cautious before extrapolating meaning from local Covid-19 data related to children.
“One thing that makes this muddy — schools shut down. We really limited the exposure that children had,” she said. “That’s another thing that’s made it kind of challenging if you try to draw too many assumptions based on how many cases we’ve had in that age range.”
The county’s public health team has identified a total of 48 cases — 25 among children — potentially associated with child care settings as of Aug. 20.
In New Hanover County, two childcare facilities (Kiddie Academy and Milestone Learning Center) were previously designated as a cluster setting last month, defined as places with five or more positive cases within a two-week period. However, as of Aug. 25, New Hanover County has no active clusters in a childcare setting.
Meanwhile, Brunswick County has had no identified clusters in child care settings to date. A total of 10 cases are associated with child care settings, according to the county’s spokesperson. Nearly 12% of all positively identified cases (158) have occurred in children under 18 as of Aug. 25.
The lack of data and preponderance of the belief that children are unlikely to become infected with the virus has caused some families to relax their social distancing protocols.
“Kids absolutely can get Covid-19 and they can absolutely transmit it with each other, with their parents, staff they associate with, and alternative caregivers like grandparents,” Brown said.
Link in the chain
Given how much is still unconfirmed about children and Covid-19, Brown said it’s best for families and young children to diligently follow the three Ws when around non-family members: wear a mask, wash hands, and wait six feet apart.
“They could be the link in the transmission chain in someone that is more vulnerable,” she said. “It’s not like the virus says, ‘Oh you’re eight, I’ll go around you.’ “There’s nothing magical about being 10 years old that all of a sudden, you can’t transmit it,” she said.
According to research published Aug. 21 that analyzed nearly 14,000 studies, there is preliminary evidence that children and young people have a lower susceptibility to Covid-19. Children have about 43% lower odds of being an infected contact, according to the research.
Still, there’s weak evidence that children play a lesser role in the transmission of the virus, the study concludes. Simply put, research shows children may not as easily contract the virus compared to adults, but they may just as easily spread the virus around.
Brown also is hesitant to conclude that children are at a lower risk of spreading the virus compared to adults. “I wouldn’t want to say — it makes me nervous when we talk about it being low risk. Because I don’t think we know that,” Brown said. New Hanover County Personal Health Services Assistant Director Carla Turner added, “There’s so much we don’t know.”
Emerging details about a new disease, multisystem inflammatory syndrome in children (MIS-C), also gives public health officials pause. Though there are few instances of MIS-C locally, with 23 identified in N.C., it’s a relatively rare but serious phenomenon.
MIS-C tends to appear after young people under 21 are infected with Covid-19 and multiple organ systems become inflamed. Recent research found 42% of children with MIS-C had one or more underlying health conditions in a study group; this is troublesome because a majority of cases may be occurring in children with no previously-existing health issues.
“That’s what’s concerning about this. It’s not necessarily limiting itself to children that are higher risk,” Brown said.
Mask guidance is mixed
Guidance is somewhat confusing when it comes to children wearing masks. N.C. Governor Cooper’s standing executive order states children under 11 are exempted from the mask mandate. Specifically, children under 11 in child care settings are not required to wear masks.
But recent state guidance for reopening schools states all students must wear masks and does not include an age cut-off.
Monday, the World Health Organization presented new recommendations, stating children aged six to 11 should wear masks. The WHO recommends children under six should not wear masks.
The CDC recommends children two years and older should wear masks. Children and babies under two should not wear masks, according to the CDC and N.C. guidance, because of the risk of suffocation.
This mixed messaging has created confusion, particularly among parents of younger children, as to what they should require them to wear when in public.
New Hanover County public health officials urge children two and older to wear masks when in public around non-family members.
Turner recalled a recent trip to the grocery store where she saw a family with at least two toddlers not wearing masks.
“From a public health standpoint, that was frustrating for me because I knew that at least 2 of those children, they weren’t being protected,” she said.
Child care centers, which took a big hit to their business in the spring when everything shut down, should be enticed to limit outbreaks to prevent closing again, Turner said. So even though the law doesn’t require children under 11 to wear masks, Turner said it’s safer and good business practice to require it.
“Just from a business standpoint, it’s important to keep those children safe,” she said.
Statewide Covid-19 trends have made “fragile progress,” as Secretary of the North Carolina Department of Health and Human Services, Mandy Cohen, described it recently. The positivity rate (that is, the rate of tests that come back positive) was 7.4% as of Monday, marking an improvement from months prior but still above the 5% rate Cohen would like to see.
“Keep wearing the mask,” Brown said. “Don’t get lax about it now. It’s working.”
Both Brown and Turner said reopening schools can be accomplished without spurring outbreaks and widespread transmission so long as explicit guidelines are being followed diligently by all parties.
For Brown, the responsibility falls on the parents — not just local public health officials and school nurses. “As a parent, I’d like to put the onus back on some parens. Because all of the work being done by public health and school officials – that is only as good as the responsibility that we each take individually as parents,” she said. “Don’t show up to school symptomatic. Don’t give them Tylenol to mask a fever.”
Growing resentment of mask-wearing and widespread misinformation related to their effectiveness is both frustrating and confusing for public health officials.
“Its such a cheap, simple thing,” Turner said. “It’s just a piece of cloth.”
“You know what, if it turns out, it’s less effective, what’s the worst thing about that? Versus if all of the public health experts are correct? You might save somebody’s life,” she said.
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