Children and COVID-19 Infection

A review of papers published in Nature Journal looks at how children are affected by the SARS-CoV-2 virus and their resulting symptoms with COVID-19. 

The role of children in spreading the coronavirus has been a key consideration. 

Children represent a small fraction of confirmed COVID-19 cases; less than 2% of reported infections in China, Italy and the United States are under 18 years old.

Scientists and medics are divided as to whether children are less likely than adults to get infected and spread the virus.  It is thought that evidence shows children are at a lower risk. 

Alasdair Munro, a paediatric researcher at Southampton University Hospital feels they are not responsible for the majority of transmission and he feels schools should be opened.

Children in Germany and Denmark have already returned to school.

Students in areas of Australia and France are set to go back gradually over the coming weeks. 

With many schools closed, it is felt that children have not been exposed to the virus as much as adults.  Children are also not getting tested as often because they tend to have only mild or no symptoms. 

Gary Wong, a researcher in paediatric respiratory medicine at the Chinese University of Hong Kong does not feel there is any reason to believe that children do not get as infected.  He feels that a reopening of schools will likely facilitate transmission.  He says good surveillance and testing systems should be in place before schools reopen. 

This hypothesis will be tested in the coming weeks, particularly in countries where children have already returned to school.  It would then be expected that infections will spike in these countries. 

A study from The Lancet Infectious Diseases looked at households with confirmed COVID-19 cases in Shenzhen, China dated 27 April.  It found that children younger than 10 were just as likely as adults to get infected but had much reduced symptoms. 

Could children then be spreading the infection? 

Other studies, however, from South Korea, Italy and Iceland where testing was more widespread, show lower infection rates among children and indeed a study published in Science on 29 April from Hunan, China showed that for every infected child under the age of 15, there were close to 3 people infected between the ages of 20 and 64. 

Studies for teenagers aged 15 years and older appeared to show that their risk of infection is similar to that of adults. 

What is even less understood is how infected children spread the virus and whether it is similar to spread in adults.

A cluster of cases in the French Alps showed that a nine-year-old who attended three schools and a skiing class with symptoms of COVID-19 did not infect a single person. 

Kirsty Short, a virologist in the University of Queensland in Brisbane found that children were rarely the first people to bring the infection home.  This could be considered reassuring because even if there were lots of infected children, they are not actually infecting others.  However, the research behind this may have been biased.

Few studies exist for transmission from schools to the broader community, but an Australian report suggests that it is limited and much lower than other respiratory viruses such as influenza. 

Among more than 850 people who had been in contact with nine students and nine staff members confirmed to have COVID-19 in primary and high schools in the state of New South Wales, only two cases of COVID-19 were recorded among those contacts, both in children. 

On this evidence, Munro says that children should be allowed back to school. However, there should be lots of restrictions and changes such as moving desks apart and closing playgrounds. 

Immune Response

Most researchers, however, agree that children tend to deal with the COVID-19 better than adults.  The majority of infected children have mild or no symptoms, but some do get very ill or even die as in the reports of a small number of children in London and New York who developed an inflammatory response similar to the rare childhood illness Kawasaki disease.

The reason that children may have milder symptoms is due to the fact that the lungs might contain fewer or less-mature ACE2 receptors.  These proteins are the ones that the SARS-CoV-2 virus uses to enter cells.

Here at The London General Practice we are continuing to offer an excellent full family practice service while wearing PPE for our patients of all ages.

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