Reopening schools: What science says about health risks children face
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Durban - Reopening schools in the country after the Covid-19 lockdown raises unnerving questions for working parents.
Instead of coming home with a snotty nose, is your child going to bring back the virus?
The short answer is that some key questions still cannot be answered because of a frustrating lack of research. For example, it’s hard to say how much children transmit the disease among themselves or to others.
The dearth of research about the coronavirus and children is “a huge loss”, said Dr Ashish Jha, the incoming dean of the Brown University School of Public Health. “The idea that we’re not using every opportunity to study this stuff blinds us when making
decisions,” he said.
But the experts agreed that economic realities will force most families to make decisions on the safety of childcare and school settings long before there’s increased testing capacity or scientific certainty.
“We can’t wait for a vaccine; it’s too far off,” said Dr Caitlin Rivers, an epidemiologist and assistant professor at Johns Hopkins Centre for Health Security. “We can’t wait for a therapy to come to prevent severe illness.”
Children infected with the virus do not get as sick as adults. That has consistently been shown in studiies.
“Doctors have hospitalised very few children with Covid-19,” said Raphael Viscidi, a paediatric virologist at Johns Hopkins University School of Medicine.
“That’s been true across the world. When we look at the other objective measure of judging how bad is this - death - it’s extremely rare,” he said.
In recent weeks, there have been alarming headlines about a severe inflammatory syndrome in children associated with Covid-19.
It’s likened to Kawasaki disease, which is a rare, multisystem inflammatory syndrome whose symptoms include fever, low blood pressure, abdominal pain and heart inflammation. Here again, the prevalence is extremely rare. And Dr Lance Peterson, the retired director of clinical micro-
biology and infectious disease research at NorthShore University Health
System, said even if a child develops the syndrome, “there are treatments so mortality risk should be fairly low”.
The trickier questions are whether children are as susceptible as adults to becoming infected and, if infected, how likely they are to spread the virus to others. At this point, there’s a limited number of studies, and the science is far from conclusive, but three of the four studies ProPublica looked at found that children are not contracting the virus as often as adults.
Two studies out of China show that children had lower rates of infection.
One study of 105 confirmed Covid-19 patients and the 392 people they came in contact with in their households found that the infection rate among adults in the households was “dramatically higher” than that of children, with 20.5% of adults falling sick, compared with 4% of those younger than 18. Another household contacts study, in Guangzhou, China, found similar rates in children.
That study has yet to be published in a journal, but it was posted online.
In Iceland of 13080 residents, 100 (or 0.8%) tested positive for an infection. None of the 848 children under age 10 tested positive. Frustratingly, at least one study has had contrary finding: a study in Shenzhen, China, tracked 391 cases of Covid-19 cases and their 1286 close contacts and found that the infection rate among children under age 10 was 7.6%, similar to the population average of 6.6%, leading the authors to conclude that “children are at a similar risk of infection to the general population”.
Okay, maybe you’re not that worried about your child getting severely sick, since that’s rare. What you really want to know is if your child can become a carrier of the virus and bring it home to endanger people living with you who are elderly or have compromised immune systems.
Experts say those early studies showing lower rates of infection in children are a positive sign. But there is another study by a group of German researchers that is causing some concern. It found children and adults who are infected have similar viral loads.
An infected person’s viral load is a measure of the amount of virus being emitted from his or her cells. It’s generally considered a proxy for how infectious a person is, though an imperfect one.
“Based on these results, we have to caution against an unlimited re-
opening of schools and kindergartens in the present situation,” the authors wrote. “Children may be as infectious as adults.”
Experts hope answers will come as new research begins, in-
cluding a US National Institutes of Health study on what
percentage of infected children develop symptoms, and a study at 35 children’s hospitals that will attempt to determine why children aren’t getting sick in the same numbers as adults.
The hospital study will also look at viral shedding in children, a measure which is considered a proxy for how infectious a patient is.
For concerned parents, one quandary posed by the virus remains tough to navigate: research shows that an infected person can transmit it to others before showing symptoms of Covid-19. This makes it difficult to be certain it is safe to venture out because screening people for symptoms can still miss carriers of the virus.
Household risk will be higher if you live with or frequently see an elderly family member, or someone with a compromised immune system. Chronic illness is also a consideration.
The US Centres for Disease Control and Prevention says that people with underlying conditions, such as severe obesity, diabetes, kidney disease or heart disease, are at higher risk of severe illness from Covid-19.
For parents who have been juggling full-time childcare or Zoom classes at home, there is also a worry that seems selfish to say aloud during a pandemic: what are the social and emotional costs of so much isolation? And is there a time when those costs can be considered as risk factors?
“It’s something people are having trouble expressing because it somehow feels wrong,” said Emily Oster, a Brown University economics professor and author of data-driven parenting books. “It feels like we’re all supposed to be saying we would do anything to prevent the spread of Covid-19.”
A survey in China on two of the hardest-hit areas in that country found that after more than a month of lockdown on average about a fifth of students experienced depression or anxiety. Missing classes or school can also cause academic setbacks and restrict access to services that students or pupils with mental health needs depend on, research shows.
Some parents and experts worry children may miss out on language development if they cannot see their caregivers’ faces or expressions.
Families may be willing to accept a small risk for the emotional and developmental benefits to their children.
The social needs of children “is an important piece,” when talking about reopening safely, Popescu said. Still, the safest decision is for families to keep their children at home, “but not everybody is in a position to actually implement that recommendation,” said Dr Angela Rasmussen, a virologist at Columbia University’s Mailman School of Public Health.
Day-care facilities and schools introduce more teachers, staff, and children, into the equation, thereby increasing the possible exposure.
The age of children is also a factor. Infants and toddlers put things in their mouths and are unable to stay away from each other. The more intense care required at this age - nappy changing, bottle feeding - also cannot be done without almost continual close contact and requires more adults per child, increasing the inherent risk. Hygiene efforts and distancing should be more successful with older children.
Experts say, and studies show, childcare workers should follow the health authority’s guidelines to reduce the risk of exposure as much as possible: caregivers and children should be regularly screened for coughing, difficulty breathing, fever and other symptoms.
Proper hand-washing and disinfecting of toys, tables and other surfaces should routinely occur. Activities that don’t allow for social distancing should be cancelled. - ProPublica
- Allen is a reporter investigating the cost and quality of our health care. Rose reports on criminal justice. Chen covers health care. Chris Hendel also contributed reporting.