Question: I have a follow-up question to Q&A of 4/14 — OK, the good news is that kids don’t usually suffer bad from it. But what about *spreading* COVID? Kids are gross little germ cannons! They bring home all kinds of stuff back from daycares and schools, especially the littler ones. Do we have to worry much about them as carriers?

Answer:  I addressed this question earlier this year (see Q&A of 1/30), but let’s revisit now that we know a bit more about the B.1.1.7 variant, which is now the most widely circulating lineage in the US and elsewhere.  As a quick reminder, accumulating evidence indicates that as compared with adults, children– especially younger children– have lower susceptibility to SARS-CoV-2 infection and possibly lower infectiousness.  The evidence base is, however, even less solid when it comes to variants of concern.  

Focusing on the B.1.1.7 variant, we know that it is far more transmissible among both adults and children.  The variant also increases the risk of mortality among adults, but initial data suggests that the variant does not increase the risk of severe disease or mortality among children.  When it comes to children as carriers, let’s turn to results from a study published last month in the BMJ, Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England.  The study examined the association between living with children and the risk of infection/increased disease severity among adults <65 years old during two time periods (e.g. before and after the September 2020 discovery of the B.1.1.7 variant).  Researchers found that during wave 1 (Feb-Aug 2020), living with a child was not associated with any increased risk of infection or severe disease.  However, during wave 2 (Sep.-Dec. 2020), living with a child was associated with an increased risk of infection and increased risk of hospital admission, though no increased risk of death.  This is not definitive evidence, but it does suggest that the B.1.1.7 variant may also be more likely to be spread by children to adults.  This finding is mirrored in recent observations in Michigan and Minnesota, where cases among children are surging and the B.1.1.7 variant is rapidly spreading.  Ultimately, even if children are not more likely to spread the virus than adults, when more children become infected with the virus, the opportunities for onward transmission increase.