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The Evidence on Kids and Covid
Rare serious cases bear watching, but overall risk appears to be low.
By The Editorial Board
May 20, 2020 7:24 pm ET
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Health professionals transported a baby with an oxygen cylinder attached to a stretcher in New York, April 8.
PHOTO: VANESSA CARVALHO/ZUMA PRESS
Horrific stories are emerging of children developing rashes, cardiac abnormalities and other inflammatory symptoms that are linked to the novel coronavirus. Parents and public health officials are understandably worried, but some perspective is in order given the virus’s apparent overall low risk to children.
The Centers for Disease Control and Prevention reported last week that 15 children under age 15 in the U.S. have died of Covid-19 since February compared to about 200 who died of the flu and pneumonia. Children represent 0.02% of virus fatalities in the U.S., and very few have been hospitalized.
A study in the Journal of the American Medical Association (JAMA) Pediatrics last week found that only 48 children between March 14 and April 3 were admitted to 14 pediatric intensive care units in the U.S., and 83% had an underlying condition. The most common was “a long-term dependence on technological support (including tracheostomy) associated with developmental delay and/or genetic anomalies,” the authors note. The fatality rate for children in ICUs was 5% compared to 50% to 62% for adults.
Another new JAMA study examines children treated for cancer at New York’s Memorial Sloan Kettering. Twenty of 178 pediatric patients tested positive for coronavirus—an infection rate of 11.2%—but only one required noncritical hospital care. Thirteen of their 74 adult caregivers also tested positive—an infection rate of 17.6%. “Together, our results do not support the conjecture that children are a reservoir of unrecognized SARS-CoV-2 infection,” the authors conclude.
Children also appear at lower risk of infection based on population antibody studies, including a recent one from Spain that found a sharp age gradient. Just 1.1% of infants under age one carried antibodies; 2.2% of those between one and four; 3% between five and nine; 3.9% between 10 and 19; and 4.4% between 20 and 39. Antibodies were most prevalent (about 6%) in Spaniards 60 and older.
Scientists are puzzling over these age disparities. One theory is that children have stronger “innate” immune response that allows them to quickly clear the virus without developing antibodies. Another is that the virus may not bind as easily to the ACE2 receptors in children’s nasal passages that are the cellular entry-way for invading the body.
It’s also possible that children have cross-protection from earlier coronavirus-causing common colds. Two new studies find that antibodies and white blood cells that individuals developed to fight recent cold infections also react against the novel coronavirus. La Jolla Institute for Immunology researchers discovered that about half of stored blood samples from 2015 to 2018 carried helper T-cells that react against the novel coronavirus.
Yet unlike with other respiratory viruses, children don’t appear to be large spreaders. Australia’s National Centre for Immunisation Research and Surveillance tracked Covid-19 cases at 15 schools from March 1 to April 16. At the outset, 18 individuals were infected. After six weeks only two of their 863 close contacts at the schools had become infected. There were no cases of students passing the virus to teachers. Studies from China show kids were more likely to pick up the virus from their parents than vice versa. While Taiwan has lower case and fatality rates than Western countries, it did not impose widespread school closures.
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Parents and public-health officials are now nervous about reopening schools because some children in virus hot spots are developing fevers, rashes and inflammatory symptoms that resemble Kawasaki Disease, which was discovered in Japan a half century ago and whose cause is unknown though it has been found to follow infections.
The syndrome afflicts 20.8 of 100,000 children in the U.S. under age five (about 4,800) each year. A study in the journal Lancet last week reported 10 children with the inflammatory syndrome in Bergamo, Italy—the city with the highest rate of fatalities and infections—about 30 times higher than the normal incidence. Most were older and suffered more severe cardiac symptoms than those typically found with Kawasaki. But the authors also estimated that probably no more than 0.1% of children who had been exposed to the virus were affected. All hospitalized patients had been discharged, and the authors recommend treating patients with steroids to calm their immune system.
During these times parents and doctors need to be especially vigilant. But as a society we also need to keep in mind that the risks to children from the coronavirus are small, especially relative to others. The Foundation for Research on Equal Opportunity projects that children under 15 are 6.83 to 20.07 times more likely to die of the flu or pneumonia than coronavirus—assuming 150,000 Covid-19 fatalities in the U.S. this year—and 128 times more likely to die of an accident.
All of this bears more study, and nobody wants to endanger children. But the risks to children are not enough to justify the continuing destruction of lockdowns.