What do we really know about COVID and kids?

Families/Kids Infection and Spread

A: There are more questions than answers.

What we know:

✅ Kids are capable of getting COVID-19 and transmitting it to both adults and other kids.

✅ Children who are infected with COVID-19 are more likely to have no symptoms or only mild symptoms, and more likely to recover quickly and without the need for hospitalization, compared to adults.

✅ Children are much, much less likely to die of COVID-19 compared to adults.

✅ There is a little evidence of an age gradient in both severity and transmission, with younger children faring better than older children.

But what we don’t know far outweighs what we know, and in some cases we’re not even sure what questions to ask.

❓ We don’t know how likely children are to be infected with COVID-19 when they’re exposed to it.

❓ We don’t really know *why* kids tend to have mild disease, though there are a few hints emerging that it has something to do with the age at which a particular cell surface enzyme emerges in the nasal passages (ACE2).

❓ We don’t know how kids’ likelihood of transmitting disease to others compares to that of adults.

❓ We don’t know exactly what the relationship is between COVID-19 infection and the very rare but troubling emerging syndrome known as multisystem inflammatory syndrome in children (MIS-C). While we’re at it, we don’t know if COVID Toes are caused by COVID at all.

❓ We don’t know what the long-term consequences of childhood COVID-19 infection might be, because no one has ever had COVID-19 for more than a few months at this point in the brand-spanking-new-problem timeline. (In fact, this is also unknown with respect to adults).

❓❓❓ And we do not know what will happen in the U.S. when schools reopen in the presence of widespread community transmission, insufficient testing, and limited contact tracing.

These points are highlighted in a recent brief from the Kaiser Family Foundation, which summarizes the evidence so far with an eye toward school reopenings.

Kaiser Family Foundation (KFF) is one of the Nerdy Girls’ favorite sources of just-the-facts health science information for the public. We ❤️ this snippet from their about us page: “Our product is information, always provided free of charge.”

One of the issues with what we DON’T know is that it’s hard to predict what might happen as schools reopen when we haven’t observed kids in their normal school-year activities in the presence of the pandemic in full force. Almost as soon as COVID-19 reached the United States, schools closed down in almost all locations. That means we have no observations of kids coming and going to classrooms alongside COVID-19 in general circulation.

Other countries have reopened schools, but they have NOT reopened schools with the levels of community transmission currently found in many parts of the U.S., coupled with continued limitations on testing and contact tracing.

From the KFF brief: “While other countries that reopened schools have generally not experienced outbreaks in school settings, almost all had significantly lower levels of community transmission than the U.S. and greater testing and contact tracing capacity.” In other words, we can’t look to the experience of other countries for answers about what will happen in the U.S. context come September.

KFF also recently fielded a poll of parents, and found that most parents–especially parents of color–think it is better to “open schools later to make sure the risk of getting coronavirus is as low as possible.”



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