Happy Spring!

Question: My kids are going back to school soon and my wife is very worried about them getting sick. However it appears that many schools across the country have reopened without major issues. I have heard several theories as to why children seem far less likely to contract COVID and get sick, but what does the latest science say? I would like to help alleviate her fears to the degree possible.

Answer: Just three days ago, CDC updated its Science Brief on transmission of SARS-CoV-2 in K-12 schools.  It offers a helpful overview of children and risk and I’ve included some of the main points in the below bullets.  When it comes to why children are more likely to experience asymptomatic infection and less likely to experience severe outcomes, hypotheses abound (see Q&A of 5/9).  A recent review published in December in Archives of Disease in Childhood further synthesized what we know (Table 1), but its authors concluded that we still just don’t know enough to draw conclusions.  Finally, a number of studies have been published in the last couple of months, which show that when schools implement effective prevention measures, risk of in-school transmission is low (see here, here, and here).  However, when risk mitigation measures are not well implemented– as with this recently documented high school football experience— the risk of transmission is much higher.  This is why it’s imperative that we focus on *how* schools reopen, not whether schools reopen (see Q&A of 1/31 and Q&A of 11/5).   

COVID-19 among Children:

• Data compiled by CDC’S COVID Tracker show that compared with adults, children are less likely to become infected with SARS-CoV-2 and less likely to experience severe disease (death).  As of 21 March:
  • Children ages 0-17 represent approximately 22% of the US population (74 million of 330 million), but just 12% of all US cases.
    • A total of 450,532 children ages 0-4 have tested positive (2% of all cases in the US).
    • A total of 2,191,689 children ages 5-17 have tested positive (9.6% of all cases in the US).
    • It’s unclear whether differences in incidence between adults and children are due to biological differences or differences in exposure/testing.
  • COVID-related deaths to children are rare, with 313 deaths reported to date, yielding a case fatality rate of 0.021%.
    • A total of 96 children ages 0-4 have died of COVID (<0.1% of all deaths in the US).  For comparison sake, in 2019 a total of 24,597 children ages 0-4 died from all causes per CDC Wonder.
    • A total of 217 children ages 5-17 have died of COVID (0.1% of all deaths in the US). For comparison sake, in 2019 a total of 10,005 children ages 5-17 died from all causes per CDC Wonder.
• Hispanic ethnicity and Black race are associated with increased risks for hospitalization and ICU admission among children. Among children who are hospitalized or admitted to the ICU, underlying medical conditions are more commonly reported. (see MMWR report here)
• Children can spread SARS-CoV-2 to others. (see Q&A of 1/31)
• Younger children (<10 years of age) may be less likely to be infected than adolescents. (see JAMA article)

Table 1. Factors Protecting Children (from Archives of Disease in Childhood)