With many respiratory illnesses, specifically the flu, children play a critical role in community spread. Also, their younger age equates to a simpler immune system, therefore, they tend to be more severely affected by such viruses.
The dynamic between children and COVID-19 is complex and far less understood. However, as puzzling as it may be, it has become apparent that children suggestively play a lesser role in coronavirus outbreaks than other common viral infections, not to mention, the far majority do not become as ill if they do get it.
Although several proposed reasons for this, it likely comes down to two main hypotheses: children having fewer ACE2 receptor cells in their respiratory tracts (necessary component for coronavirus to enter) and since the severity of COVID-19 seems directly linked to the body’s own immune response, children having a less complex immune system may be protective.
Not only may children be less likely to contract the viral infection themselves but also, it seems they may not transmit it as easily to others – an important factor when deciding to re-open schools.
A seroprevalence study out of Geneva, where scientists looked for antibodies in children and adults, demonstrated a significantly lower presence of antibodies in children aged 5–9 years compared with those aged 10–64 years. Also, a multi-national study estimated that susceptibility to infection in individuals under 20 years of age is approximately half that of adults aged over 20 years.
Across the globe when children who have returned to school do test positive for the virus, it's far more common for them to be infected by a family member, rather than at school.
Swiss researchers analyzed data on 39 children younger than 16 years of age and found that in nearly 80 percent of cases, the illness came from an adult in the house, according to a recent study in the journal Pediatrics. This data mirrors others produced by China, Netherlands and other countries that have reopened schools.
Although virtual learning is a great alternative when necessary, as a mother to three boys who were all home during the stay-at-home orders, I can tell you, it is not a long-term solution and certainly not equivalent to in-person education. Even the American Association of Pediatrics strongly urged all considerations for education this fall to include in-person classes:
“…The AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school.”
Not only are the educational fundamentals subpar with distance-learning, but the lack of physical interaction is detrimental to their mental health and social development, especially our children <10 years old. Our teenagers and young adults have been socially distancing before it became fashionable with their social media and digital connectivity at all-time highs (which is not necessarily a good thing as I discuss in my book), so their development may be less affected.
Taking what we know about COVID-19, coupled with the recognized determinantal consequences of children staying home, we must be able to find a solution.
I understand our educators and multigenerational-home families are nervous returning to in-person classes. So am I! I live with an autoimmune disease that requires regular injections to tamper my immune system. When COVID-19 started and we saw people with comorbid conditions becoming severely ill, I was worried – I still am.
Like the many other front-line workers (grocery store clerks, janitorial staff, first responders, police officers and many more), I have taken the information we have learned the last few months to keep myself, my family and my patients safe. I am diligently arming myself with a mask, goggles and face shield, as well as hand washing and physically distancing as much as possible while indoors – all of which has allowed me to continue caring for others while also living my life. As public safety, grocery stores and medical care could not stop, childhood development, especially in our younger children, can't either.
Although much of the evidence is limited on the viral transmission amongst children since schools and playgrounds have largely been closed, it may take reopening schools for the picture to come into clearer focus. Within a month of reopening schools, it will become clear what the transmissibility of the virus amongst children and their caregivers is. It won’t be subtle.
And when we have our children go back to school invariably there will be outbreaks of a variety of respiratory viruses including colds, flu and COVID-19, which is why we should consider creating segregated bubbles throughout our school systems (social circles and workplaces should also consider this).
The Washington Post reported on how Germany has been able to manage clustered outbreaks while keeping schools open. The German model creates “classroom bubbles” by limiting integration amongst students and teachers. When a student or educator tests positive for COVID-19, that “bubble” is put into a two-week quarantine with remote online learning, while the remainder of the school continues uninterrupted.
If viral transmission remains high in a community, school openings will likely fail, mostly out of fear. It would be terrible to open schools just to close them again. As adults, it is up to us to decrease the amount of community virus prior to schools re-opening and throughout flu season.
If we commit to, at minimum, the next two weeks of diligent hand hygiene, avoidance of large outdoor gatherings and wearing a mask when unable to maintain 6 feet from others, then we will effectively lessen the amount of circulating virus, so our schools have no reason to adjourn.
The economic risk of not having children attend daycare/elementary school plus the developmental risk to the children themselves is a major public health emergency that cannot be marginalized.
Our children are the future and their educators are the front-line workers tasked with caring for their well-being. As a community we must step up to lessen community transmission and ensure the schools have the arsenal of protective equipment they need. Additionally, local, state and federal services must guarantee the support required to safely have our schools open.