How Are Children Affected by Coronavirus?

Initial reports into how coronavirus affects children appears to suggest that most will only experience mild symptoms if they are infected with the SARS-CoV-2 virus. Initial figures suggested only a small proportion of children experienced severe health impacts and—until recently—no deaths for this group had been reported.

However, as COVID-19 spreads, there are more cases of children suffering from severe effects. In Atlanta, a 12-year-old girl who is not believed to have had any pre-existing medical conditions was said to be "fighting for her life," after testing positive for the virus, her uncle told CNN.

So far just a handful of studies have looked at how coronavirus affects children. On March 18, the NEJM published an article that included the first known death of a child. The case involved a 10-month-old child who died four weeks after being admitted into hospital. They had been suffering from intussusception, where the bowel gets twisted, and had multiorgan failure.

An article published in Paediatrics also reported the death of a 14-year-old boy from Hubei province, China. Details on whether he had underlying health conditions were not provided.

Dr. John Williams, who is the chief of the Division of Pediatric Infectious Diseases at the UPMC Children's Hospital of Pittsburgh, told Newsweek that the infant's death was probably not caused by COVID-19.

The NEJM article said that in China, less than 1 percent of cases were in children under the age of 10. Of the 1,391 assessed and tested between the end of January and the end of February, three patients needed to have intensive care support and were placed on a ventilator. All three had pre-existing health conditions.

"In contrast with infected adults, most infected children appear to have a milder clinical course," the researchers wrote in the NEJM article. "Asymptomatic infections were not uncommon. Determination of the transmission potential of these asymptomatic patients is important for guiding the development of measures to control the ongoing pandemic."

In the Paediatrics paper, researchers found children of all ages were susceptible to the virus, however, the health impacts were "generally less severe" than those in adults. It also said that among children affected, infants and those who are preschool age were "more vulnerable to infection."

Williams told Newsweek that the findings presented in both papers "likely apply to children in most of the world." He said most infections are not significantly different between different populations, and they are monitoring the situation for COVID-19 cases in children. "There are many children in the U.S. with underlying conditions such as immune compromise, transplant, etc," he said. "We aren't hearing about a lot of cases in those kids yet, but we are watching closely."

He said the reports suggest most children with the virus were either asymptomatic or mild or moderate in severity. "These data from China and the rest of the world suggest very strongly that in otherwise healthy children, SARS-CoV-2 does not cause serious disease. As to why, we really don't know. Some have speculated that children's less mature immune systems cause less of an inflammatory response, but we just don't know. There is no evidence that other common human coronaviruses that circulate every year provide children with cross-protective immunity. These 'normal' human coronaviruses are pretty distinct from SARS-CoV-2 and wouldn't be expected to provide any immunity."

Harish Nair, Chair of Paediatric Infectious Diseases and Global Health at the U.K.'s University of Edinburgh, also said children and infants under the age of five appear to be at higher risk of developing more severe symptoms.

"This is consistent with the age profile at highest risk for child pneumonia," he told Newsweek. "Even if children are at comparatively lower risk for severe disease, children with underlying health conditions are at substantially higher risk."

He continued: "Why children are less affected with severe disease is not very clear. It could be related to immunological response, and certainly infants being at higher risk would support that. There are other hypotheses that are plausible—cross protection from other human coronaviruses."

Williams said his biggest concern is for children with underlying conditions. Children's hospitals, he said, are doing as much as they can to protect vulnerable children while trying to establish whether they are at greater risk.

"The emergency preparedness leaders at my hospital have done a terrific job planning, preparing, and mobilizing. We are seeing cases in adults in our area, but not yet in kids. Nonetheless our hospital is ready."

Both Williams and Nair said that if a child shows any symptoms, they should be isolated. Nair said parents should seek urgent care if their child develops breathing difficulty, poor feeding, lethargy, fingernails or lips going blue, or are generally going downhill. Williams added: "If a child has a runny nose or cough, but isn't having trouble breathing and is drinking ok, they don't need to be tested and are probably best kept at home."

A regularly updated map created by Education Week, a news organization that covers K-12 education news, shows the level of school closures across the U.S. As of Sunday, 46 states have closed schools. In total, over 120,000 public and private schools have now been shut because of COVID-19, impacting more than 54 million students.

Williams said parents who have their children at home should keep their kids in as much as possible to stop them spreading the virus. "Social distancing only works to reduce spread if we all do it and don't cheat," he said.

"This means, unfortunately, no play dates or parties. Outdoor activities that don't involve close contact with other kids, such as a walk in the park, are great to get out of the house and get fresh air. There are lots of educational and fun online things to do. And video chatting with friends and family can really help all of us, even kids, deal with the isolation we feel."

Nair said: "If we are to benefit from the suppression measures, then parents should not arrange playdates or allow them to engage in contact sports... But they could take them to parks, encourage games that don't require physical contact, on swings etc and ensure the hand hygiene as is being advised by WHO and public health agencies."