Pediatric Experts Review COVID-19 Transmission in Children and School Reopening

Current Understanding of COVID-19 Impact on Children

Pediatric infectious disease experts have recently examined studies regarding COVID-19 transmission among children. Their focus centers on the critical question: “Should schools reopen?” Evidence suggests that children are less severely affected by COVID-19 compared to adults, often exhibiting milder symptoms. Nonetheless, there remains a concern about the potential for asymptomatic children to transmit the virus to others.

Findings from Recent Studies

The experts from the University of Vermont’s Larner College of Medicine reviewed multiple studies on SARS-CoV-2 transmission in children. One notable study from the University of Geneva tracked Swiss patients under 16 years old with confirmed infections between March and April 2020. Among over 4,300 cases, only 40 were in children. Most experienced mild illness, with just seven requiring hospitalization, none needing intensive care or specific COVID-19 treatments. Remarkably, all children had fully recovered within a week of diagnosis. Analysis of family contacts indicated that in only 8% of households, the child was the initial case, implying that transmission primarily occurred from adults to children.

Two additional studies from China further investigated household transmission. A contact tracing study in Qingdao revealed that 96% of 68 hospitalized children were linked to previously infected adults. Similarly, a report from Wuhan indicated that out of 10 hospitalized children, only one showed possible transmission from a child to an adult.

In a broader school context, a report from France highlighted a child who interacted with over 80 classmates across three schools, with no subsequent infections among those contacts. An Australian study involving 15 schools found that, among 735 pupils and 128 staff exposed to COVID-19, only two secondary infections were reported, with no instances of child-to-adult transmission.

Children’s Role in SARS-CoV-2 Transmission

The cumulative evidence suggests that children are not significant drivers of SARS-CoV-2 transmission. Dr. William Raszka, a co-author of the commentary, emphasized, “The key takeaway is that children are not driving the pandemic.” He noted that children are less likely to get infected and appear to be less infectious.

While the exact reasons for this phenomenon remain unclear, a study from Germany revealed that children carry viral loads comparable to adults. It is possible that their milder symptoms, such as reduced coughing, result in fewer infectious particles being released.

Mathematical modeling supports the notion that children do not significantly contribute to virus transmission. These models indicate that community-wide social distancing and the widespread use of face masks are more effective strategies for controlling SARS-CoV-2 spread than closing schools. Moreover, the reopening of schools in several Western European countries and Japan has not led to an increase in community transmission rates.

Conclusion on School Reopening Strategies

The authors of the review argue that the current evidence strongly advocates for the development of public health strategies that enable schools to reopen safely. They stress the importance of keeping schools operational, even during periods of COVID-19 spread, to mitigate the social, developmental, and health challenges that children face until effective treatments or vaccines are available.

References

1. Posfay-Barbe KM, Wagner N, Gauthrey M, et al. COVID-19 in children and the dynamics of infection in families. Pediatrics Published online July 10, 2020. DOI: https://doi.org/10.1542/peds.2020-1576
2. Lee B, Raszka WV. COVID-19 transmission and children: the child is not to blame. Pediatrics Published online July 10, 2020. DOI: https://doi.org/10.1542/peds.2020-004879
3. University of Vermont, Press release 10 Jul 2020. Commentary in pediatrics: children don’t transmit COVID-19, schools should reopen in fall. https://www.eurkalert.org/pub.releases/2020-07/uov-cip070720.php