Children Might Spread Coronavirus More Than We Thought—and Get Different Symptoms

Children infected with the coronavirus have been found to carry high levels of the germ, according to the authors of a study who warned students could fuel the pandemic if the correct precautions aren't taken when schools reopen.

The study published in the Journal of Pediatrics involved 192 participants. They ranged from newborns to 22-year-olds (but all classed as children), who visited Massachusetts General Hospital (MGH) Respiratory Infection Control clinics for symptoms associated with COVID-19, and a condition known as multisystem inflammatory syndrome that is linked to the coronavirus.

The volunteers provided the team with throat or nose swabs, and/or blood samples. The team examined these for traces of SARS-CoV-2, the name of the coronavirus germ that causes COVID-19. They also compared the levels of the receptor the virus uses to enter the body in this group and children who had check-ups at the institution during the pandemic, as well as adults evaluated for COVID-19.

Of the 192 volunteers, 49 tested positive for the coronavirus. Some 25 of the children, or just over half of those with the coronavirus, had a fever. The team noted that of those who had symptoms, they were nonspecific to COVID-19.

Co-author Dr. Alessio Fasano, director of the Mucosal Immunology and Biology Research Center at MGH, told Newsweek: "The presence of the virus does not correlate with symptoms."

He said: "In children, the SARS-CoV-2 infection translated mostly into no symptoms or non-specific, mild symptoms that included runny nose, cough and or low fever."

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The levels of the virus were highest in children in the first two days that they showed symptoms, and were "significantly higher than hospitalized adults with severe disease," the authors wrote.

Co-author Dr. Lael Yonker, director of the MGH Cystic Fibrosis Center, told Newsweek this may be because the infection can move from the upper airways to the lower airways and the lungs in adults, where it can cause severe pneumonia leading shortness of breath and the need for assisted ventilation. In children, the infection seems confined to the upper airways, she said.

The age of participants didn't affect the viral levels, but children under the age of 10 were less likely to express ACE2, the enzyme that the coronavirus uses to enter our bodies.

Existing studies suggest that children are less likely to become seriously ill from catching SARS-CoV-2, but those without symptoms can spread the infection.

Yonker said the study couldn't prove that children are more contagious than adults. But she said: "In other viral infections like influenza, a higher viral load in the secretions indicates increased infectivity. In these children, these high SARS-CoV-2 levels in the respiratory tract suggest an increased ability to spread infection."

Fasano said the study "proves that they [children] may be equally as contagious as adults and, therefore, they should not be overlooked when public health policies are being developed to fight the pandemic."

Showing that children, even if asymptomatic, can carry "very high" amounts of virus in their respiratory secretions is "important" and "has implications for the potential for children to fuel the pandemic as children return to school," Yonker said.

"We showed that no age was 'protected' from the virus, and that all ages can carry high levels of the virus," she said.

"This study warns that children may play a larger role in the spread of this pandemic if proper precautions are not taken." These include wearing masks, social distancing, persistent hand washing, the option of remote learning, and possibly frequent viral swab screening for coronavirus infection, she said.

Monitoring children for symptoms or fever screenings "will not effectively identify children with COVID-19," she said.

Fasano said: "If we do not take these new data into account as we reopen schools, there is the chance of a third wave of the pandemic being driven by children."

According to Yonkers, the study may seem limited because the children were from one hospital, but as screenings in the state happened at centralized COVID-19 testing sites the team actually captured a wide range of children from geographical and socioeconomic settings.

Fasano said the relatively small number of participants was a drawback of the study, caused by a short supply of testing kits.

Alvaro Moreira, assistant professor in the department of pediatrics at UT Health, San Antonio, who did not work on the study, told Newsweek the study provides a "theoretical framework that children may be more contagious than previously thought. Future research can build on these concepts to determine how infectious children are in the community."

Moreira said: "An important concept that needs to be reinforced is that children are not immune to COVID-19. The difference lies in that they have better outcomes than adults.

"While an adult patient may require intubation, mechanical ventilation, and a prolonged hospital stay, a child may only manifest symptoms of an upper respiratory infection."

The headline on this article has been updated.

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A stock image shows a child wearing a mask. A study has shed light on the role children play in the COVID-19 pandemic. Getty
Children Might Spread Coronavirus More Than We Thought—and Get Different Symptoms | Health