The information we have leads us to believe that children are less susceptible to the dangers of coronavirus, but they can still get infected. So why does the virus affect children differently than adults? And what can put your child at risk?
The waves of discussion sparked by Elon Musk’s March 20 tweet, in which the entrepreneur and innovator suggested that children are “largely immune” to the coronavirus, have yet to subside. While all discussions boil down to the fact that an infection with this virus can be fatal for an elderly person, the disease is much more easily passed on in a child. However, there have been several alarming reports of serious illness and symptoms in children. These cases, along with school closures in many countries and strict social distancing measures, are raising concerns among parents about the safety of their children. We have tried to address some of these concerns.
Yes, just like adults, children can become infected with the coronavirus and show symptoms of Covid-19. “At the beginning of the pandemic, it was thought that children did not get infected, but now it is clear that they do, just like adults,” explains Andrew Pollard, professor of infectious pediatrics and immunology at the University of Oxford. “They just have much milder symptoms.” The Chinese Center for Disease Control and Prevention provided data (as of February 20) indicating that children under the age of 19 accounted for 2% of the 72,314 Covid-19 cases, while an American study of 508 patients did not report a single case of death among infected children (with sick children in this group accounting for only 1%).
“Perhaps the virus initially targeted adults because it was transmitted in the workplace and during travel,” suggests Sandjay Patel, consultant in paediatric infectious diseases at Southampton Children’s Hospital (UK). “Now that adults are spending more time with their children, we may see an increase in the number of infected children. Or maybe not.” The global trend suggests that children are less likely to be infected than adults (especially older adults), but it is quite possible that the data are biased by the fact that in some countries testing for the virus is only offered to those admitted to hospital with acute symptoms of Covid-19, and there are very few children among these people. “It is obvious that there are more infected children than we think,” says Patel. “After all, we are not testing every child in the country.”
“In the extensive literature that we already have on this new coronavirus, there is an interesting observation: even those children who have very serious comorbidities and are receiving immunosuppressive therapy or oncology treatment are much more likely to be infected with Covid-19 than adults, especially older adults,” says Andrew Pollard, leader of a group of scientists at the University of Oxford (Oxford Vaccine Group) that recently identified an experimental vaccine (“vaccine candidate”) for the treatment of Covid-19. The number of offers should remain the same: Overall, children with Covid-19 have milder symptoms than adults. However, the deaths of a 12-year-old girl from Belgium and a 13-year-old boy from London have already been reported (March 31). These are the youngest (to our knowledge) victims of the virus in Europe. The death of a 14-year-old teenager in China has also been reported.
In many countries, schools have been closed in an attempt to contain the spread of the virus. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. Episodes End of story: Podcast Advertising. Data from the Chinese study on the prevalence of Covid-19 in children confirm that slightly more than half of those infected experienced mild symptoms such as fever, cough, sore throat, runny nose, body aches and sneezing. About a third of them had signs of pneumonia, often with fever, wet cough, and wheezing, but without the shortness of breath and difficulty breathing seen in more severe cases. Graham Roberts, a consultant paediatrician at the University of Southampton, explains: “Children [with Covid-19] suffer primarily from upper respiratory tract symptoms (nose, mouth, throat), which manifest as cold symptoms. The virus does not go down into the lower respiratory tract – the lungs – and there is not the life-threatening pneumonia picture seen in adults”. The percentage of children who progress to a severe or critical stage with ARDS (acute respiratory distress syndrome) and shock is significantly lower (6%) than in adult Chinese (19%), especially in the older generation with chronic cardiovascular or pulmonary disease. According to the February report of the WHO Mission to China, only 2.4% of those infected are 18 years of age or younger. 2.5% of them have developed a severe form of the disease, while 0.2% have developed a critical form. A small number of children were infected but had no symptoms at all.
“The most important question is whether the majority of infected children have very mild symptoms, or whether children simply do not contract the virus as often as adults,” Patel says. “This virus is so new that we simply don’t know yet,” says Graham Roberts, who runs the Asthma and Allergy Research Centre in Newport, UK, among other things. “One possible reason is that this virus needs a protein on the surface of the cell to enter and begin its destructive activity. It appears that the coronavirus uses the ACE-2 receptor as a gateway. It is possible that children have less of this receptor in their lower respiratory tract, which is why only their upper respiratory tract is affected. This may explain why the symptoms in children infected with coronaviruses are more similar to the common cold. The affinity of coronaviruses for ACE-2 receptors was demonstrated in laboratory experiments in 2003 and again in 2013 when the genomes of the new coronaviruses RsSHC014 and Rs3367 (similar but not identical to the SARS coronavirus) isolated from Chinese horseshoe bats were studied. According to Pollard, there may be another explanation. “Maybe it’s not the children, but the changes in the body that occur with age that make it more susceptible to the virus.” He links these changes to the aging of the immune system, which weakens the body’s ability to fight off new infections. “However, we see that even young adults are more at risk of serious diseases than children. So the aging of the body is an incomplete answer,” he adds. Children’s immune systems differ from those of adults in many ways, primarily because they are still developing. Children, especially those attending daycare or school, are susceptible to a variety of respiratory infections that are new to them, and this may explain the higher levels of antibodies in their blood, higher than in adults.
It is possible that the surface of children’s lung cells has less protein than that of adults, and the virus cannot attach to anything. “It appears that children’s bodies respond more intensively than adults’ to viral infections, for example, with a high fever, which is not often seen in adults,” says Roberts. “It’s very possible that the child’s immune system is able to better control the virus, localize it in the upper respiratory tract, prevent it from causing further damage, and eliminate it.” “It is also possible that children who have previously been infected with four other types of coronavirus are partially protected by this experience,” Patel adds. In addition, the authors of the study on infection cases in China believe that children also benefit from a lower incidence of cardiovascular and respiratory diseases compared to adults. “Very few children develop severe Covid-19 infection,” says Pollard. “That means there is something fundamentally different about how their bodies deal with the virus.” There is another reason. In severely ill adults, a cytokine storm (hypercytokinemia, an overreaction of the immune system to the virus) does more harm than good, often leading to organ failure and death. The underdeveloped immune system in children does not produce a strong cytokine response. And while this hypothesis remains to be tested in the case of Covid-19, studies of children’s immune response to the SARS outbreak in 2003 have demonstrated this.
Yes, they can. “This is a big problem,” Roberts points out. “Many believe that children are not threatened by much, so there is no need to worry about them. Yes, this is true for children who do not have chronic diseases or immune deficiencies. But people forget that children can be one of the main vehicles for spreading infection in society. Even if the virus does not cause the same serious symptoms as in adults, the child will still be a carrier and spreader of Covid-19. Coronavirus is spread by direct person-to-person contact through droplets in the air (sneezing and coughing) and by touching surfaces contaminated with the virus. Thus, children can easily spread the virus and transmit it to others, especially their family members and elderly relatives. “Children with mild symptoms may be among the primary carriers of the virus in the community,” Roberts points out. “That’s why it’s so important to close schools to reduce the rate of pandemic transmission in the country.”
Yes, this is what happens with the flu virus. “Flu in children can be limited to a runny nose, while in adults and the elderly it can end in hospitalization, intensive care, and even death,” notes Roberts. And he says something else important: “A few years ago, the British government introduced the vaccination of children against influenza. This was done not so much to protect the children themselves, but to prevent them from passing the virus on to their elderly relatives, who suffer severely from this disease”. This is also true for the coronavirus. The risk of Covid-19 for children themselves is low, but the risk of them infecting vulnerable elderly people, people with pre-existing chronic diseases is high.
It seems so. Chinese data suggest that very young infants are more susceptible to the virus than other age groups. Serious or severe forms of the disease have been observed in one in 10 infected infants, but this rate drops sharply in older children: for example, severe forms of the disease have been observed in only three to four out of 100 children aged five and older. “Preschoolers are more vulnerable [to serious illness],” Roberts points out. “They have smaller airways, they have not been strengthened as much as older children to fight off a dangerous infection.” “At a certain stage of life, children start to become adults,” says Roberts. “In teenagers, the immune system matures and starts to behave more like an adult’s. And that means it is less effective at controlling the virus that has entered the body. However, it is important to remember that we currently know very little about this virus, we are only making assumptions in an attempt to understand why we see what we see”. In the Chinese study, there were no reported deaths among children nine years of age and younger, and only one death among those under 19 years of age (a 14-year-old teenager). On March 23, the death of an 18-year-old (with underlying health problems) from Covid-19 was reported in the United Kingdom, and on April 1, a 13-year-old Londoner died from Covid-19.
Yes. Although the pandemic is still in its infancy in many regions of the world, there have already been at least two confirmed cases of infection in newborns – one in Wuhan and the other in London. It is not yet known whether the children were infected in utero or after birth. In both cases, the mother tested positive for the virus. Not much is known. Coronaviruses, which can cause SARS and MERS, can cause miscarriages, premature births, and slow fetal growth (no such observations have been made in mothers infected with Covid-19).
Although it appears that children are less susceptible to coronavirus, this does not mean that they should not take all precautions. It is worth noting that these conclusions are based on two small studies. Nevertheless, British health authorities warn that pregnant women are at risk of serious illness if infected with the coronavirus, and recommend that they strictly adhere to precautionary measures – social distancing, etc. Washing your hands thoroughly, avoiding direct contact with others, and disinfecting surfaces and objects that may have the virus are important ways to prevent the spread of Covid-19, as well as the common flu. “Follow the basic rules to the letter,” says Patel. “If you’re outside in a public place and you’ve touched something, never touch your face until you’ve washed your hands thoroughly.” The website of the British National Health Service provides information on measures to be taken within the family to protect against Covid-19. UNICEF has also published a guide for parents.
Yes, but it will not be easy. Of the three main measures (thorough washing of hands, disinfection of surfaces and objects, social distancing), only the last can be called a reliable protection mechanism against infection for the elderly and those weakened by illness. Of course, this method works not only for children, but also for adults. “As I observed what was happening on Mother’s Day, I saw a lot of walking families where both grandparents and parents were with their children,” says Patel. “In my opinion, it was absolutely frightening: the data show that the elderly, especially those with pre-existing conditions, are the main group at risk. And excluding children from contact with them is the most appropriate thing to do. Why take such risks?” Separating seemingly healthy children from their grandparents, grandfathers, and other elderly relatives may seem excessive.
However, it is important to remember that coronavirus infection in children is either asymptomatic or very mild. At the same time, they are still spreading the virus.
Preventing the spread of coronavirus depends not only on the success of science and medicine. It depends on our behavior, on our willingness to change it.
“We talk a lot about Covid-19 among ourselves, in society, in the media, but there is one important thing that parents should do: tell their child that they will not die from Covid-19. It is very important for children to understand this,” Patel says.
“All pediatricians know that children fear the worst, but they don’t always admit it. Pollard agrees. He suggests that all parents reassure their children and convince them that they are unlikely to get seriously ill from Covid-19 under almost any circumstances.
“Children and teenagers are worried about their families,” says Lennaea Karlsson, a professor at the University of Turku, Finland, and a child psychiatrist. “We have to explain to them that these are exceptional circumstances, and that we wouldn’t ask them to do such unusual things if it weren’t so.”
“We need to explain that in a situation like the current one, we should take care of everyone, not just ourselves and our families.”
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The original article can be read on the BBC Future website.