Education Week - June 10, 2020 - 10

EDWEEK EXPLAINS

How Is COVID-19 Affecting Children's Health?
pandemic will end, then conservatively, we're talking about

While it may seem like it's been forever, the first cases of the

another 18 months at the earliest," said Dimitri Christakis, a

deadly respiratory disease COVID-19 were identified less than

pediatrician and the director of the Center for Child Health,

five months ago, and states just over two months ago began

Behavior and Development at Seattle Children's Hospital, in

widespread school closures to slow the spread of the new

a city that weathered one of the earliest U.S. outbreaks, "but

coronavirus that causes the disease.

that would mean that kids would spend two years in a distance

That means education leaders are grappling with how to safely
reopen schools in the coming months amid a still-evolving

learning environment.
"Think about what that means for a 5-year-old or 6-year-

understanding of how the disease infects and affects children,

old. Even a child from a well-to-do family is going to suffer

and how best to prevent them from carrying it to others.

detriments, but for low-income kids, the effects are going to be

"If the idea is that we're going to keep the schools closed
until we have a vaccine, which is the most likely way that this

How can the coronavirus affect your students?
Let's back up a bit.
COVID-19 comes from a newly discovered coronavirus, part
of a family of spiky, spherical-looking viruses also responsible for
illnesses from the annoying common cold to the deadly severe
acute respiratory syndrome (SARS) and Middle East respiratory
syndrome (MERS). Different members of the coronavirus family
affect children differently.
Your common everyday cold viruses account for 17 percent of
all outpatient respiratory infections among adolescents in the
United States, and 6 percent of U.S. children hospitalized for
serious lung infections. It's still unknown how many children
contracted the first SARS (COVID-19 is technically SARS-CoV-2)
and the Middle East syndrome virus was not prevalent at all
among children worldwide during a two-year global study.
Young people, and especially school-age children, seem to be
more resistant than adults to the coronavirus that causes COVID19. Fewer of them have caught the virus, and of those, more than
a third have shown no symptoms. Studies have found children to
be less likely than adults to show severe breathing problems, and
more likely to show symptoms like fever, coughing, sneezing, and
stomach upset, in line with other common childhood illnesses.
Only 3.6 percent of all U.S. coronavirus cases so far have been
of those under age 18. Of the more than 100,000 Americans who
had died from COVID-19 as of May 23, the Centers for Disease
Control and Prevention estimates only 176 were younger than
25, including 10 infants through age 4; 14 children ages 5 to 14,
and the rest ages 15 through 24. The Pediatric COVID-19 U.S.
Case Registry at St. Jude Children's Research Hospital, which
has tracked more than 1,000 new COVID-19 cases among U.S.
children this spring, found about 1 in 5 needed to be hospitalized,
and four had died as of June 2.
Take all these studies with a grain of salt, though, because
children overall have been significantly less likely to be tested
for the novel coronavirus because they tend to show fewer
and milder symptoms that can be mistaken for other common
illnesses. They also have been less likely to be part of largescale studies exploring COVID-19's effects, which tend to focus
on older and more vulnerable groups-though there is some
evidence that black and Native American children and those with
existing respiratory problems like asthma may be at higher risk of
serious illness than other students.
"The exclusion of children from COVID-19 clinical trials is
a tremendous lost opportunity to generate timely knowledge
to guide treatment of pediatric populations," argued Thomas
Hwang, a pediatric researcher at Boston Children's Hospital,
Harvard Medical School. Hwang and his colleagues found that of
275 COVID-19 treatment studies started by early April, only 30
have included patients younger than 18. And as more time passes,
researchers are discovering some children have longer-term
complications from the virus.

Are children exposed to coronavirus likely
to get a later disease, even if they don't
get sick immediately?
Earlier this month, health experts raised concerns about
a severe and at times deadly immune reaction in children
10 | EDUCATION WEEK | June 10, 2020 | www.edweek.org

enormous and carry forward through the child's entire life. So
we can't take a wait-and-see attitude."

and young adults exposed to the coronavirus. Multisystem
inflammatory syndrome in children, or MIS-C, has been
likened to toxic shock syndrome, in that children's immune
systems seem to go into overdrive after being exposed to the
virus.
In more than 200 cases across 20 U.S. states and other
countries, children and young adults experienced high fever for
several days, stomach pain and upset, red eyes and rashes, and
swelling of the hands and feet, as well as the heart and other
organs. Most did not have active COVID-19, but did test positive
for antibodies to the virus, suggesting they had been exposed to
the virus a few weeks before. Some researchers theorize that the
same strengths in children's immune systems that seem to make
them less vulnerable to a COVID-19 infection can also make
hyper-immune responses more likely.
At least three children have died from the inflammatory
syndrome, but unlike COVID-19, MIS-C is treatable with
steroids and antibody therapies if identified early, and most
children recover completely.

Can children spread COVID-19 even if they
don't get sick?
For common childhood illnesses like colds and flu, people
become contagious around the same time they start to feel sick,
making it more likely a sick student will stay home from school.
But COVID-19 has spread so quickly in part because people
become contagious up to five days before they feel sick, and
more than 40 percent of infections have come from people who
had no symptoms.
It's hard to tell how infectious children actually are compared
with adults, because they haven't had as much opportunity to
spread the disease. A majority of children who tested positive for
COVID-19 were living with someone who had the disease first.
An analysis of 700 studies found children seemed to have lower
rates of transmitting COVID-19 and were very rarely the first
case in a new outbreak.
"One of the huge caveats in all this research is that children are
the most isolated group in the population, because no one that
is under the age of 15 is an essential worker, they're not much
out in the community. ... So it's a big black box right now," said
Erin Bromage, an associate biology professor at the University
of Massachusetts Dartmouth who teaches on the ecology of
infectious diseases.
An April study in China found children under 15 about a
third less likely to contract the coronavirus than older people,
but predicted that when schools open they would be exposed
to three times as many people, putting them at the same risk
as adults. Some children in France and South Korea have
contracted COVID-19 since schools in those countries reopened,
but it was not clear that all students in the outbreaks had actually
gotten the virus at school.
In Australia, for example, officials tracked what happened to
nine students and nine staff members who were confirmed to
have COVID-19 and were exposed to other students and staff at
15 schools. While 735 students and 128 staff members came into
close contact with the students while they were contagious, the
researchers found only one elementary school student and one
high school student may have contracted the virus from school.

Getty

By Sarah Sparks

No teachers became ill from school.
Siouxsie Wiles, a microbiologist and expert on "superbug"
diseases at the University of Auckland, told the Sydney Morning
Herald that the cluster of infections could have been driven as
much by parents gathering and chatting at drop-off and pick-up
as by teachers and students passing the infection in class.
All that means school leaders and teachers will need to be
alert to gatherings of parents, not just students, and act on even
mild symptoms, according to Danielle Dooley of the National
Children's Hospital in Washington, D.C.
There have been no studies so far about how often and how
widely schools would need to test students, either for a fever or
for the virus itself, for such a screening to be effective, Dooley
said. While some coronavirus tests now can return results in
15 minutes, they can only be run one at a time, making them
impractical for schools to use on every student daily, but more
useful to stop an emerging outbreak as students start to develop
symptoms.
Bromage agreed, noting that schools will also need to push a
massive culture change among parents: "We absolutely need to
be keeping symptomatic kids out of school. That's going to be
a big one that parents need support on, to not give kids a dose
of Tylenol to bring their fever down or a cough suppressant and
send them to school sick. That's about as bad as we possibly can
do. Everybody needs to be on board with this, to understand that
a child that is sick cannot be in school."

How can schools limit infections?
Schools can be a hot spot for the coronavirus, but that seems
to have less to do with how infectious children are and more to
do with the structure of the schools themselves, which in many
places have narrow travel spaces, inadequate ventilation, and
crowded classrooms.
A sick student running around outside on the playground may
be less likely to spread infection than that same student sitting in
a classroom-particularly if he happens to be sitting near an air
conditioner uptake vent.
"The data that does exist suggests that outdoors is much safer,
certainly from a viral transmission standpoint, than indoors,"
said William Massey, assistant professor for public health and
human sciences at Oregon State University. "And if we think
about the school environment, being outside on the playground,
whether it be for recess or for outdoor class periods, is going
to be a reduced risk as compared to being on the bus, sitting
indoors in a classroom, touching the doors."
That may run counter to plans in many districts to cut
out recess or other outdoor times to limit potential virus
transmission on equipment and prevent students from getting
too close to each other. But the American Academy of Pediatrics
recommended that careful hygiene practices, including regular
handwashing and cleaning equipment, can mitigate the risk.
And new research suggests time in the sun may be helpful for
killing the virus on surfaces.
"If we deprived [students] of those things [like recess], we're
also depriving them of health and learning opportunities. And
so I think we can get creative with solutions to minimize and
mitigate transmission risk, but also ensure that we're giving our
children what they need," Massey said.

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Education Week - June 10, 2020

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