• Joe Xie

How Does Children Contribute to the Spread of COVID-19?

As more and more schools, kindergartens, and childcare centers re-open across the US, one topic that continues to pop up is whether children below the age of 18 (and especially younger children) can catch and spread SARS-CoV-2, the novel coronavirus that causes COVID-19.

The following is stated on the American Academy of Pediatrics' (AAP) website:

"Although children and adolescents play a major role in amplifying influenza outbreaks, to date, this does not appear to be the case with SARS-CoV-2. Although many questions remain, the preponderance of evidence indicates that children and adolescents are less likely to be symptomatic and less likely to have severe disease resulting from SARS-CoV-2 infection. In addition, children may be less likely to become infected and to spread infection."

It is important to note that scientists the worlds over are still learning about SARS-CoV-2 since the virus is so new, and evidence that either support or contradict the above highlighted line from the AAP is still growing.

A new study (Park, et. al.) that came out of South Korea, where they analyzed 59,073 contacts of 5,706 COVID-19 index patients reported in South Korea during January 20–March 27, 2020, found some interesting statistics regarding how children helped spread the virus:

"We also found the highest COVID-19 rate (18.6% [95% CI 14.0%–24.0%]) for household contacts of school-aged children and the lowest (5.3% [95% CI 1.3%–13.7%]) for household contacts of children 0–9 years in the middle of school closure. Despite closure of their schools, these children might have interacted with each other, although we do not have data to support that hypothesis. A contact survey in Wuhan and Shanghai, China, showed that school closure and social distancing significantly reduced the rate of COVID-19 among contacts of school-aged children (8). In the case of seasonal influenza epidemics, the highest secondary attack rate occurs among young children (9). Children who attend day care or school also are at high risk for transmitting respiratory viruses to household members (10). The low detection rate for household contacts of preschool-aged children in South Korea might be attributable to social distancing during these periods. Yet, a recent report from Shenzhen, China, showed that the proportion of infected children increased during the outbreak from 2% to 13%, suggesting the importance of school closure (11)."

However, the AAP's own journal published a paper (Lee et. al.) which reviewed cases of transmission around the world from first half of 2020 and concluded that:

"Almost 6 months into the pandemic, accumulating evidence and collective experience argue that children, particularly school-aged children, are far less important drivers of SARS-CoV-2 transmission than adults. Therefore, serious consideration should be paid toward strategies that allow schools to remain open, even during periods of COVID-19 spread."

In contrast, another recent paper (Heald-Sargent et. al.) out of Chicago, which analyzed 145 patients aged less than one month to 65 years old, concluded that: