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I'm an Infectious Disease Doctor and Have This Warning for Fall

Despite what you may have heard, children are not immune to COVID-19.
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Ever since the first cases of COVID-19 were reported in Wuhan, China, in December 2019, it has been clear that the highly infectious virus does not have the same impact on children as it does adults and the elderly. However, there is one incredibly dangerous myth circulating right now, and believing it could have fatal repercussions.

Children Are Not "Immune" to Coronavirus

During an August 5 appearance on Fox and Friends discussing the reopening of schools, President Donald Trump made a statement about children's role in spreading the virus. 

"This thing is going away, it will go away like things go away. My view is that schools should be open," he said during the interview, which he later posted on his social media accounts. "If you look at children, children are almost, I would almost say definitely, but almost immune from this disease. So few. Hard to believe. I don't know how you feel about it but they have much stronger immune systems than we do somehow for this. They don't have a problem."

Both Facebook and Twitter responded by removing the post, claiming that it violated policies on coronavirus-related misinformation. "This video includes false claims that a group of people is immune from COVID-19 which is a violation of our policies around harmful COVID misinformation," Facebook spokesperson Andy Stone told Axios.

"While it is true in general children tend to get milder disease, they are not immune," says Thomas Murray, MD, Ph.D., an associate professor at the Yale University School of Medicine in the Department of Pediatrics, Section of Infectious Disease. "There is a subset of children that can get really sick from COVID-19. Even some children who initially have mild symptoms can develop the post COVID-19 MISC (multisystem inflammatory syndrome in children). Children can become very sick from MISC and end up in the intensive care unit with some dying from this complication. So, no children are not immune!"

According to the American Academy of Pediatrics, as of July 30 children represent about 8.8% of all cases in states reporting cases by age, with over 338,000 children testing positive for COVID-19 since the start of the pandemic. However, it is true that children don't typically experience the wrath of the virus similar to adults and the elderly. "At this time, it appears that severe illness due to COVID-19 is rare among children," they explain. 

"Thus far, as a group, children have been relatively spared from the effects of the virus. However, there has been an increasing body of evidence to suggest that some do become critically ill," says Carlos Oliveira, MD, a Yale Medicine pediatric infectious disease doctor and assistant professor Pediatric Infectious Diseases & Global Health at Yale School of Medicine. "Children with COVID-19 have been hospitalized for a wide array of reasons, from respiratory failure to neurologic symptoms, like seizures, and even rapid-onset heart failure. Unfortunately, we do not yet know why some children get severely ill and why others do not."

Pediatric Coronavirus Infections Are Actually on the Rise 

According to the AAP's latest statistics, more children are testing positive for COVID than before. From July 16 to July 30, 97,078 new child cases were reported (241,904 to 338,982) — a 40% increase. 

"The question of how likely, or unlikely, a child is to get infected with COVID-19 after exposure remains to be convincingly answered," says Dr. Oliveira. "During the early phases of the pandemic, school closures were among the first social-distancing measures introduced by most countries. This is worth noting because it likely has biased the existing measures of risk in children, as their opportunities for exposure to the virus have been largely limited to their household contacts. There is also the question about how we should be testing children to find the virus. By and large, to confirm the diagnosis of COVID-19, we look for the virus with a nasal or oral swab. However, this may not be the optimal method for the pediatric population. Several studies have shown that children often do not manifest with respiratory symptoms like cough or congestion. Rather, they predominantly have gastrointestinal symptoms, like abdominal pain or diarrhea. However, clinicians rarely look for the virus in the stool. Thus, the current estimates of risks to children, and their contacts, could be understating their potential role propagating this pandemic."

However, the chances of a pediatric infection leading to hospitalization or death is very unlikely. Children accounted for only 0.6%-3.7% of total reported hospitalizations, with 0.6%-8.9% of all child COVID-19 cases resulting in hospitalization.

In terms of mortality, children accounted for just 0%-0.8% of all COVID-19 deaths, with 20 states reported none. In total, just  0%-0.3% of all child COVID-19 cases resulted in death.

"Parents Need to Continue to Take the Virus Seriously"

One study, published in JAMA Pediatrics in May, detailed the characteristics of seriously ill pediatric COVID-19 patients in North America.

"The idea that COVID-19 is sparing of young people is just false," study coauthor Lawrence C. Kleinman, professor and vice chair for academic development and chief of the Department of Pediatrics' Division of Population Health, Quality and Implementation Science at Rutgers Robert Wood Johnson Medical School, explained in a press release. "While children are more likely to get very sick if they have other chronic conditions, including obesity, it is important to note that children without chronic illness are also at risk. Parents need to continue to take the virus seriously."

Children May Spread the Virus Similar to Adults 

Another recent study from Ann & Robert H. Lurie Children's Hospital of Chicago also published in JAMA Pediatrics found that children younger than 5 years with mild to moderate COVID-19 have much higher levels of genetic material for the virus in the nose compared to older children and adults, and could be spreading it similarly to adults and older children. 

"We found that children under 5 with COVID-19 have a higher viral load than older children and adults, which may suggest greater transmission, as we see with respiratory syncytial virus, also known as RSV," lead author Taylor Heald-Sargent, MD, PhD, pediatric infectious diseases specialist at Lurie Children's and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine, explained in a press release. "This has important public health implications, especially during discussions on the safety of reopening schools and daycare."

"As social distancing measures begin to relax, and schools begin to reopen, it is critical that we not let our guard down and continue to closely monitor infection rates in children," adds Dr. Oliveira.

As for yourself, do everything you can to prevent getting—and spreading—COVID-19: Protect your kids, wear a face mask, get tested if you think you have coronavirus, avoid crowds (and bars, and house parties), practice social distancing, only run essential errands, wash your hands regularly, disinfect frequently touched surfaces, and to get through this pandemic at your healthiest, don't miss these 37 Places You're Most Likely to Catch Coronavirus.

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