One of the key reasons for reopening schools in the fall has been the idea that kids don’t get COVID-19, or if they do get it, it’s not so severe. I want to address these topics in this post based on the current data available at the time of this writing.
I’m going to lead with a statement that isn’t particularly sciency and say this: considering that kids spread just about everything else with apparent ease, why do we somehow think that they magically don’t spread COVID-19? The reasons given for this are based, somewhat, on fact. But I will argue that the facts have been poorly interpreted. First, the early observed rates of COVID-19 in kids in the United States was originally quite low. Second, at the current time, when we look at other countries that are successfully reopening, the rates of spreading in schools and juvenile social situations is basically negligible. So that’s it, right? Nothing to see here. Let’s move along and reopen everything school related.
With regards to the first issue, if we presume that kids don’t get COVID as severely as adults and that only severe cases that present for hospitalization are tested, then it means that we are undersampling kids. Also, once we understood that COVID-19 was going to be a serious problem, we locked down the schools. So using the smart thermometers (yes, they are internet connected if need be), one can track how flu+covid incidence.
It’s not just that local district, but the effect has been reported elsewhere. New Scientist reports that flu is way down in Australia due to the lockdowns compared to previous years. This trend has also been reported on in Singapore and more globally. All this points to the idea that if you are looking at the low COVID-19 rates in kids to be an indicator that they don’t get it or can’t spread it, you are likely mistaken. We’ll see that there are other lines of evidence pointing this way.
What about the idea that since other countries can safely reopen schools, we can too? Well, in theory, that’s a nice sentiment. However, let’s remember that schools here are already severely underfunded and that teachers in some districts often buy supplies for their students because the students can’t afford them, and the districts won’t pay for them. Additionally schools are not only not getting extra money to adapt to the situation, schools are being threatened with a loss of funding if they don’t reopen. The situation is dire. Therefore, the expectation that schools here can do what schools in Europe or Japan are doing is nonsense at the get go. Likewise, the other countries we are comparing ourselves to have much lower rates of COVID-19 than we do.
So kids aren’t great indicators of the spread of COVID-19 due to factors mentioned above. But, let’s presume, for argument sake, that the conclusion – that kids don’t spread COVID-19 – is actually true. Why not reopen schools? If this is the case, then all those extra precautions everyone is taking might be overkill, right? What is not being accounted for are the caregivers, bus drivers, teachers, and other adults in their lives who are more susceptible and who will now have contact with each other. Remember that one doesn’t have to have a disease to spread it. Although we are trying to keep everything clean and not touch our faces, invariably something slips through the cracks, and there is a source that a kid or adult touches. Think this isn’t an issue? See this video.
The nurse who made it isn’t infected with the green goo she touches, but she does spread it everywhere.
There are signs that despite institutions taking recommended precautions, COVID-19 spread remains an issue. For example, a number of summer camps have closed due to campers and staff testing positive for COVID-19. The worst of these involved 82 infected individuals at a camp which followed relatively strict guidelines for social distancing. But a number of other camps have been affected as well as noted here and here.
There is also a case in which three teachers had been teaching together, virtually from the same classroom it seems, and all three came down with COVID-19 and one died. It seems from that article that no students were even involved, just the teachers. The teachers all claim to have followed CDC guidelines to the letter. This last example might be an argument for closing it all down except for truly essential businesses.
If we look at the CDC page on pediatric infections with COVID-19, it’s clear that their presentation is based on early work and is not up to date. The data they present seems to indicate that COVID-19 is simply not much of a problem in kids. I’ve copied part of their page to here and added my comments in italics.
"Pediatric cases of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have been reported. However, there are relatively fewer cases of COVID-19 among children compared to cases among adult patients.1-5
In the United States, 2% of confirmed cases of COVID-19 were among persons aged <18 years.4 (article dated Apr 6, 2020 - 44,672 cases with age reported, 965 of them under 18, majority had missing data on symptoms, report published early after testing – so pediatric outcomes were largely unknown, prioritization of testing given to those with severe cases, so it is almost certain that the case count is under-reported.)
In China, 2.2% of confirmed cases of COVID-19 were among persons aged <19 years old.1 (article dated Feb 24, 2020 - 44,672 cases with age reported, 965 of them under 18. The total number of tests was not reported – so it’s not clear how many individuals under 18 were tested compared to individuals over 18.) [https://jamanetwork.com/journals/jama/fullarticle/2762130]
In Italy, 1.2% of COVID-19 cases were among children aged <18 years.2 (22,512 cases reported. Article dated Mar 17, 2020 - This article is an infographic only and also does not report the number of tests given.) https://jamanetwork.com/journals/jama/fullarticle/2762130 ]
In Spain, 0.8% of confirmed cases of COVID-19 were among persons aged < 18 years.5 (The study cites the following information: “At the end of the second week, 41 of 365 patients (children) (11.2%) had positive test results (Table).” So while 0.8% of cases were in persons < 18 years, 11.2% of kids tested had COVID-19. Note also that after March 9 when Madrid was declared an area of community transmission, “the recommendation was to test only hospitalized children with symptoms and signs of COVID-19 or patients with comorbidities and a high risk of complications. Some children at risk of hospitalization were also tested, although they were ultimately discharged.”) [https://jamanetwork.com/journals/jamapediatrics/fullarticle/2764394]
If we look at the early US data regarding infections of kids, remember that 1) there was very little testing available until late April/early May and it was reserved for severe cases, and 2) starting from beginning to middle March, schools in most places in the US were shut down, and kids stayed home with their parents or caregivers. In the meantime, many adults continued to go to work since they were either “essential personnel” or else their state shut the schools but only had very limited shutdowns of private companies.
So who tests positive mostly during this time period? Adults. It is only after Memorial Day when everyone came out of lockdown and ran out to the beach or to graduation parties or some such that we start seeing a spike in cases for kids. In Florida where 54,022 kids under 18 were tested for COVID-19 as of July 15, a third of them tested positive. This is a rate much greater than for adults in the state, although it is possible that it is simply due to the increased rate of testing.
Is it just Florida where kids are getting infected or is it a one off? English data from the start of July indicate no significant differences between infection rates in different age groups. However, their data do not cover group homes, and it is expected that the rate of infection may be higher in the elderly.
A study of 59,073 contacts of 5,706 COVID-19 index patients in South Korea indicated that kids from 0-9 spread the disease less than adults, but kids older than that spread the disease at the same rate. An analysis of viral load in 3,712 patients in Germany found that the viral load (a measure of infectivity) of children was not significantly different from that of adults. Their conclusions are that: “Based on these results, we have to caution against an unlimited re-opening of schools and kindergartens in the present situation. Children may be as infectious as adults.” This may be borne out by what we saw in Israel. While children there followed social distancing and face mask protocols, things were good. However, when these protocols were let up, things took a turn for the worse. Time Magazine reports:
While Israeli children initially followed the “bubble model” when they returned to school on May 3, limitations on class sizes were lifted two weeks later. During a heatwave, children were even permitted to leave their masks at home.
By June 3, the Israeli government was forced to close down schools after 2,026 students, teachers and staff had tested positive for COVID-19. 28,147 students were placed under quarantine due to possible exposure to the virus, according to the education ministry. At one single school, there were over 130 cases.
A good recent summary (July 23, 2020) of these studies and others on children is given in Smithsonian Magazine here.
I’d be remiss if I didn’t mention article written by my cousin Eric Niiler at Wired which indicates that under the right conditions it may be possible to reopen safely. However, this largely depends on what’s happening in the outside community and the resources given to the school. If there is rampant community spread and a school is not using bubbling, masks, and other risk reduction strategies, COVID will spread. But the Israeli case indicates that even when things go well, it doesn’t take much to screw up badly. Until there is a vaccine that is proven safe and effective, it looks like we’re in it for the long haul.
