Kids are faring better with COVID-19, but are still affected
In the past week, COVID-19 has been confirmed in four California kids, including a child who attended Maeola R. Beitzel Elementary School in Elk Grove and a little girl at Copperopolis Elementary School in Calaveras County.
Both of those children had exposures to a household member with COVID-19.
Calaveras County public health officials said the little girl in their county lived with an adult male family member who became infected while working in a non-contiguous county.
No information is available for the other two children who tested positive.
Although the severity of COVID-19 is generally less in children, they may suffer other effects related to the SARS-CoV-2 coronavirus, including anxiety, worry about their safety and uncertainty about their school closing.
COVID-19 has also been identified in children in Washington, Texas and New York, as well as other states, but the full extent of pediatric cases is not yet known, in part because some states are not yet reporting cases by age.
“We have tested 1,500 to 2,000 children since mid-February and have had only three or four cases here,” said Dr. Janet Englund, professor of pediatric infectious diseases at Seattle Children’s Hospital, which uses approved viral tests.
Washington has been one of the hardest hit states in the outbreak.
Englund is an expert on respiratory viral infections, including influenza, and vaccine development.
She said that even with testing in their research lab they haven’t detected many positives in children.
Initially, most children with mild symptoms didn’t meet CDC criteria for viral testing. With less restrictive eligibility for testing and increasing availability of tests, the number of positive tests is expected to skyrocket.
What is known about COVID-19 and children?
Much of what is known about the novel coronavirus is based upon China’s experience.
According to a World Health Organization report at the end of February, only 2.4% of COVID-19 cases and no deaths were reported in children in China. The fatality rate for people 10 to 39 was 0.2%, remarkably lower than the nearly 22% for people age 80 and older.
One possibility is that children get infected less often, but this doesn’t appear to be the case. Data from case tracing in China show that after exposure, children seem to get infected at rates similar to adults.
COVID-19 symptoms in children are those typical of a “common cold,” including runny nose, cough and low-grade fever. Severe disease with pneumonia and acute respiratory distress syndrome, the main causes of death in the elderly, has been reported in children, but appears to be very uncommon.
Intestinal symptoms, including vomiting and diarrhea, have also been reported but less frequently.
Why do children get milder disease?
Healthy children, as well as healthy adolescents and young adults 10 to 39, generally develop mild or no symptoms when they get infected.
“Why? is the question that everyone is asking me,” said Englund, “We don’t know.”
She said the clinical course of acute respiratory distress syndrome, which often has an abrupt onset about five days into a person’s illness, suggests that disruption of the immune response may be a factor. But, why this appears to be age-related isn’t understood.
Research with animal models is under way to assess the age-related immune responses, which may help guide development of treatments and vaccines.
Interestingly, the related coronaviruses that caused the SARS outbreaks in 2002-03 and MERS in 2008 also caused milder illnesses in children.
Persons at higher risk for severe COVID-19
On Monday, the Centers for Disease Control and Prevention stated that community mitigation efforts should emphasize actions to protect individuals at higher risk for severe disease, including those older than 60, and people with underlying health problems, such as heart or lung disease, diabetes or weakened immune system.
Although there are limited data, the CDC also recommends that children with underlying health conditions, such as asthma, cancer or weakened immune systems, as well as pregnant women, also be considered at increased risk for severe disease.
Public health recommendations
On Thursday, Gov. Newsom issued an executive order which restricted non-essential gatherings to no more than 250 people.
Nearly all colleges and universities in California have suspended in-person classes, opting for alternatives such as online instruction.
California Department of Public Health released three documents for dealing with the coronavirus in mass gatherings, K-12 schools and higher education institutions.
CDPH recommendations for K-12 schools are described as layered, based upon the presence of a COVID-19 case in a school, the district or local community.
Across California, several school districts have suspended classes. Stanislaus County, along with neighboring districts in Merced, Mariposa and Tuolumne County, have remained opened as of Saturday.
Englund said, “The issue of closing schools is controversial.”
She said some schools in the Seattle area closed earlier than others, and people were complaining about the ones that stayed open and others were unhappy that some schools closed. Now, all K-12 schools in Kings County are closed until April 12.
“We have data that closing schools for a winter snow storm in Seattle helped to delay and reduce the height of a seasonal influenza outbreak,” said Englund.
The delay and spreading out the peak helped decrease the number of cases and helped spread out the demand for health care resources, referred to as flattening the curve.
“Flatten the curve” is trending on social media.
Although shuttering schools may help curb the spread of the virus, it also poses problems, including arranging for childcare for parents who must work.
Englund said that public health in Washington estimated that school closures could decrease the health care workforce by 40%, because parents would need to stay home with their kids.
School closures may also mean going hungry for children who rely on school meals to fend off hunger. To minimize this, California obtained a waiver from the U.S. Dept. of Agriculture to allow food service to continue in the event of a school closure.
“The needs of California kids must be met regardless of whether their school is open or closed,” said Gov. Newsom in a press release on Friday, ensuring that schools would continue to receive state funding during the pandemic.
Actions to take to help protect children and your family
- Prepare your dwelling in case your family needs to stay home for an extended period, for example, make an emergency kit and plan as described by the American Red Cross
- Involve children in planning for a home stay, such as gathering supplies for a craft or gardening activity or buying a new board game, if your budget permits
- Make contingency plans with your employer, such as arranging for a staggered schedule or working from home
Stay informed about the status of your child’s school
Practice and teach “stay healthy” actions
- Wash your hands often with soap and water for at least 20 seconds. If soap and water isn’t available, alcohol-based (at least 60%) hand sanitizer can be used
- Teach children and teens good hand hygiene
- Practice social distancing, allowing 3 feet to 6 feet space from other people
- Avoid sick people and teach your children to not go close to others if they’re ill
- Practice — and teach your children — cough hygiene using disposable tissues or coughing and sneezing into a bent elbow
- Clean and disinfect your home as usual using regular household cleaning products
- Avoid touching your face, and teach your children, too — but be realistic
- If possible, avoid travel to areas with high rates of coronavirus
Talk to children and teens about coronavirus
Children hear the news and also pick up on the anxiety and fears of adults. Talking to them helps, but use language appropriate for their age and development.
Little children, such as those younger than 5, may not have words to express their anxiety but show it with behavior changes. It’s still good to talk to them and provide reassurance.
On their website for parents, the American Academy of Pediatrics offers tips to help children cope:
- Provide reassurance, including that someone will always take care of them
- Give kids power with giving them control of things that they can do, helping to keep things clean and caring for pets
- Monitor children’s media consumption, including avoiding scary images and unreliable sources, including some social media sites
- As much as possible, stick to the normal daily routine — children take comfort in the predictable
“The most important message for the community is that infected children, including those with mild or no symptoms, can still spread it to their contacts, including grandparents and individuals in the high risk groups,” said Englund, “Social distancing has to be respected, especially for our high risk adults.”
This story was produced with financial support from The Stanislaus County Office of Education and the Stanislaus Community Foundation, along with the GroundTruth Project’s Report for America initiative. The Modesto Bee maintains full editorial control of this work.
This story was originally published March 14, 2020 at 3:45 PM.
