COVID 19 in Children and How it Occurs or Does Not Occur in Families

An interesting article published in Paediatrics by Klara, M. and others looked at the dynamics of family infection.

It is known that children have been less affected than adults in terms of severity and frequency.  They account for less than 2% of cases. 

Unlike with other viral respiratory infections, children do not seem to be a major vector of severe acute respiratory syndrome SARS-CoV-2 transmission.  Most paediatric cases are described inside familial clusters and there was no documentation of child-to-child or child-to-adult transmission.  The authors studied the clinical presentation of 40 paediatric cases of COVID-19 in Geneva and the dynamics of their familial clusters.

Over a period of one month, March 10 to April 10, all patients under 16 years old with SARS-CoV-2 infection were identified.  A total of 4310 patients were diagnosed with SARS-CoV-2 and 40 of these were under 16 years old.

Most children in their study had mild or atypical presentations – headache and nasal discharge were described in more than half of cases, anosmia, loss of smell and abdominal symptoms were described in less than 20%. There may be an underreport of symptoms as younger patients are unable to describe them.

In 79% of these households greater than or equal to one adult family member was suspected or confirmed for COVID-19 before symptom onset in the study child. This confirmed that children are infected mainly inside familial clusters.

Surprisingly, in 33% of households, symptomatic household contacts tested negative despite belonging to a familial cluster with confirmed SARS-CoV-2 cases. This would suggest an underreporting of cases. In only 8% of households did a child develop symptoms before any other household contact, which is in line with previous data and which has shown that children index cases in less than 10% of SARS-CoV-2 familial clusters. 

The outcome of this study was that children infrequently transmit COVID-19 to each other or to adults and that if schools follow appropriate social distancing guidelines and take into account rates of transmission in their community, they can and should reopen in the autumn. 

This study revealed that contact tracing showed only 3, 8% of the study population, that the child was a suspected index case with symptom onset preceding illness in adult household contacts.

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