Update: Kids and COVID-19

| August 21, 2020

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Written by Michelle Ries

As North Carolina starts the school year, all-virtually in some places and with an in-person/virtual hybrid plan in others, many questions remain about COVID-19 and kids: Are kids as likely to get infected as adults? Are they as likely to spread the virus? Are their cases severe? Researchers have been working to answer these questions.

How likely are kids to get infected with the virus that causes COVID-19? How likely are they to spread it?

In North Carolina, about 11% of COVID-19 infections have been among children age 0-17 (children this age make up 21.9% of North Carolina’s population). According to the CDC, children are less likely than adults to contract the virus that causes COVID-19. However, a recent study has shown that older children (age 10 and up) are more likely to contract the virus than younger children, and also may be more likely than younger children, and as likely as adults, to spread it within their households and communities. It is unclear why younger children are less likely to contract or spread the virus; some researchers believe they may have some natural immunity due to increased exposure to other coronaviruses. It may also be due to children exhaling less virus, or exhaling the virus closer to the ground, where adults are less likely to breathe it in.

Do kids get severe symptoms when they have COVID-19?

Just as children are less likely to get infected with the virus that causes COVID-19, they are also less likely to develop severe symptoms than adults. Children with COVID-19 may not present with even mild symptoms, such as cough and fever, as often as adult patients. Among a large study of 2,000 children with COVID-19, nearly 90% had mild cases (mild symptoms including fever, fatigue, and cough) or moderate cases (moderate symptoms and pneumonia or abnormal chest imaging). 5.6% of children in this study had severe or critical illness. In North Carolina, one child under the age of 18 has died from COVID-19 since the start of the pandemic.

In addition, some children have developed a rare condition called multisystem inflammatory syndrome in children (MIS-C), a condition in which different body parts—including the heart, lungs, eyes, skin, kidneys, brain, or gastrointestinal organs—can become inflamed. While doctors do not know what causes this syndrome, many children recently diagnosed with MIS-C had the virus that causes COVID-19, or were exposed to someone who had it. While MIS-C can be serious or fatal, most children with this syndrome recover.

What does this mean for child care and schools?

While children are less likely than adults to contract the COVID-19 virus or experience severe illness, many questions remain about the safety of opening child care facilities and schools. Teachers and staff remain at higher risk than children, and many may have underlying health conditions that make them more susceptible to severe illness. In addition, increasing children’s exposures in child care or school may make them more likely to expose family or other community members.

The virus that causes COVID-19 is spread through respiratory droplets that enter the air when people cough, sneeze, or talk. It is also thought that these droplets can settle on surfaces and potentially be spread when people touch these surfaces then touch their mouths or noses. Because of this, experts have recommended personal protection practices such as handwashing, wearing masks, staying home while sick, and maintaining social distance of 6 feet from other people. These practices, plus diligent environmental cleaning and disinfecting and screening procedures, must be followed in child care and school settings in order for these settings to operate safely. North Carolina has issued extensive requirements and guidance for child care facilities and schools to implement these practices in order to open and operate safely.

To prepare for reopening, school districts were required to create three plans based on the level of restriction necessitated by the direction of the metrics. These plans must meet restrictions as outlined in the StrongSchools NC toolkit, described as Plan A: Minimal social distancing; Plan B: Moderate social distancing (requires increased restrictions); and Plan C: Remote learning only (school buildings would be closed). Many districts with widespread community transmission (including Wake County, Durham County, and Mecklenburg County) have chosen to operate public schools under Plan C until cases decrease and schools are better prepared to implement health requirements. (Check back next week for an update to school reopening blog post.)

Policymakers must continue to monitor the changes in how we understand COVID-19’s impact on children, and children’s role in the spread of the virus, as they make decisions about schools, child care, and other community institutions.