A: If we look at the data to date (we can’t know about data that we don’t have!), children are much less likely to get COVID-19 than adults after exposure.
The data also tell us that it is likely that fewer children are infected in the community than adults and that they are less likely to be the cause of infection within a household. We don’t know if children are/are not more infectious than adults, but there is no evidence to lead us to believe that this is true (in other words, let’s not call our children super-spreaders!). They also typically have the same symptoms that we are familiar with: cough, respiratory symptoms, fever, chills, and muscle pain. Let’s break this down.
1) Epidemiology: The early data we have from China is consistent with newer data across Europe and the U.S. Children are less likely to be affected by COVID-19 (with most cases in adolescents), children can be asymptomatic, and it is rare for children to be hospitalized (even more rare for children to have critical illness). Of children hospitalized, infants are most likely to require hospitalization (this may be in some part due to hospital protocols on fevers and appropriate work up). There may be subgroups of children who are at higher risk for complications (those with respiratory illness or comorbidities), but we do not have all the data to show this as of yet.
2) Transmission: It is difficult to draw conclusions about transmission without wider spread testing and sero-surveillance. However, studies from Japan, South Korea, and Germany suggest that children are less likely to transmit within a household (a primary driver of transmission). Still, emerging evidence notes that children may shed the virus for longer periods of time post-infection (in stool for example, although it is yet to be determined if that represents active virus) and that their propensity towards all the upper respiratory illnesses that they normally have (think of your child wiping a cute nose on a sleeve) may contribute to transmission. We need more data on this in real time.
3) Clinical presentation: There are few differences in clinical symptoms with cough and fever presenting commonly as well as runny nose and sore throat. Gastrointestinal symptoms (diarrhea and vomiting/nausea) have also been reported in up to 10% of children with less common reports of rashes on the feet and toes. More data is emerging on the hyper inflammatory response syndrome (Kawasaki like) that has recently gained attention in the media; studies are now emerging to determine cause and mechanism of this phenomenon.
If you want to diver further into the literature, we found this reference very helpful for quick citations on recent articles and data.
And if you are curious about children’s COVID-19 data in the U.S., here is an easy infographic.
Remember to stay safe with social and physical distancing, good hand hygiene, staying home if not well, and seeking medical attention when needed!
~Aparna
