Evidence is therefore emerging that children could be significantly less likely to become infected than adults. On the other hand, children could have a more transient upper respiratory infection with minimal viral shedding, or the less likely scenario of showing minimal symptoms despite significant viral shedding. A further key question is the ability of infected children to spread SARS-CoV-2. A collection of international family clusters found that children were not likely to be the index case in households, only being responsible for around 10% of clusters.9 https://www.medrxiv.org/content/10.1101/2020.03.26.20044826v1 Data from Guangzhou have supported this, finding an even lower rate of children as index cases in households at 5%.8 https://www.medrxiv.org/content/10.1101/2020.04.11.20056010v1
A case study of a cluster in the French Alps included a child with COVID-19 who failed to transmit it to any other person, despite exposure to more than a hundred children in different schools and a ski resort. 10 https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa424/5819060
In a school study from New South Wales, Australia, a proportion of 863 close contacts of 9 child and 9 teachers were followed for seroconversion as a marker of recent exposure.11 http://ncirs.org.au/sites/default/files/2020-
04/NCIRS%20NSW%20Schools%20COVID_Summary_FINAL%20public_26%20April%202020.pdf No evidence of children infecting teachers was found.
In The Netherlands, separate data from primary care and household studies
suggests SARS-CoV-2 is mainly spread between adults and from adult family
members to children.12 https://www.rivm.nl/en/novel-coronavirus-covid-19/children-and-covid-19
From https://www.rivm.nl/en/novel-coronavirus-covid-19/children-and-covid-19 (Netherlands) Based on reports from the GGDs- (Municipal Public Health Services in the Netherlands), children aged 0-17 years only represent 1.3% of all reported patients with COVID-19, although they comprise 20.7% of the population. Only 0.6% of the reported hospitalizations involved children under the age of 18. There are no reports of children who have died from COVID-19.
Data from the GGD (Municipal Public Health Services in the Netherlands), test lanes show that more than 16,500 tests were administered to children up to 12 years of age between 1 and 25 June; 0.3% of those tests were positive. More than 4,800 tests were administered to children between the ages of 13 and 18 years, and 1.4% were positive. In the same period, nearly 14,000 people working in education or childcare were tested. 0.5% of these employees tested positive. This percentage is lower than the total
of 1.3% of all people tested in the test lanes in the same period. This data shows that COVID-19 is primarily spread between people who are about the same age. The figure below shows data on 693 paired patients, displaying the ages of both the source patient and the patient that they infected. Transmission of the virus appears to take place mainly between people of about the same age, and less frequently between parents and children (of all ages).
Based on source and contact tracing from the beginning of the epidemic, we see the following: looking at 10 COVID-19 patients who were <18 years old, they had 43 close contacts, and none of them became ill, whereas 8.3% (55/566) of the close contacts of the 221 patients who were ≥18 years old became ill.
At the start of the epidemic, all municipal public health services (GGDs) conducted source and contact tracing. They kept track of each source patient and monitored how many of their contacts also became infected. The upper chart shows the absolute numbers (infected/non-infected) of infected contacts according to the age of the source patient. The lower chart shows the percentage of the contacts who also became infected, according to the age group of the patient. Source patients under 18 who were monitored in this context did not infect others.
Schools have now reopened in various other European countries. RIVM is in close contact with sister organizations in these countries to evaluate the impact of this policy on the spread of the novel coronavirus there. Denmark was the first country to reopen childcare and primary education, as of 15 April. They have not reported any negative effects after reopening the schools and are not seeing any increase in the reproduction number. A study from Australia showed that there had been confirmed cases of COVID-19 in 9 children and 9 employees. 735 children and 128 employees had been in close
contact with these patients. Two other children may possibly have been infected by one of these 18 patients. No other teacher or staff member contracted COVID-19. A study from Ireland looking at 3 children and 3 adults in schools, dating from before the school closure, showed that there were no infections by children in school. The study looked at 1155 contacts in total and identified two patients; these two were both adults that were related to two adult source patients, and the infection took place outside the school. There were 924 children and 101 adults who had had close contact with one of the
source patients at school, and none of them had COVID-19.
A new study found that younger children have less of a receptor called
angiotensin-converting enzyme 2 (ACE2), which the virus needs to enter
cells. Expression of the gene for this receptor is lowest in 4- to 9-year-olds. It is
higher in 10- to 17-year-olds, although still lower than in adults.
From March 10 to April 10, 2020, all children <16 years of age diagnosed at Geneva University Hospital (N = 40) underwent contact tracing to identify infected household contacts (HHCs). Of 39 evaluable households, in only 3 (8%) was a child the suspected index case, with symptom onset preceding illness in adult HHCs. In all other households, the child developed symptoms after or concurrent with adult HHCs, suggesting that the child was not the source of infection and that children most frequently acquire COVID-19 from adults, rather than transmitting it to them.
…in China…Of 10 children hospitalized outside Wuhan, China, in only 1 was there possible child to adult transmission, based on symptom chronology.8 Similarly, transmission of SARS-CoV-2 by children outside household settings seems uncommon, although information is limited. In an intriguing study from France, a 9-year-old boy with respiratory symptoms associated with picornavirus, influenza A, and SARS-CoV-2 coinfection was found to have exposed over 80 classmates at 3 schools; no secondary contacts became infected, despite numerous influenza infections within the schools, suggesting an environment conducive to respiratory virus transmission.9 In New South Wales, Australia, 9 students and 9 staff infected with SARS-CoV-2 across 15 schools had close contact with a total of 735 students and 128 staff.10 Only 2 secondary infections were identified, none in adult staff; 1 student in primary school was potentially infected by a staff member, and 1 student in high school was potentially infected via exposure to 2 infected schoolmates.
In a pandemic, the proportion of deaths among the young should increase, but this has not been the case. A review of 72,314 cases in China showed less than 1% were in children younger than 10. Out of 16,749 hospital admissions in the UK, only 239 patients (2.0%) were under 18 years and 139 patients (1.1%) were under 5 years old. In Italy, three deaths have been recorded in the age group 0- to 19 years. In under 45-year olds, ONS data in England and Wales reveals that 384 (1.2%) deaths have occurred out of 33,365 COVID cases with only two deaths in under 14-year-olds.
From March to mid-April this year, nine students and nine staff from 15 New South Wales Schools in Australia had confirmed COVID-19. 735 students and 128 staff were in close contacts – no teacher or staff contracted COVID-19 and only one primary and one high school child may have contracted COVID-19. A French study that identified secondary cases linked to the index case reported that one symptomatic child, visited three different schools but did not transmit the disease despite close interactions.
The newly issued Report of the WHO-China Joint Mission on Coronavirus Disease 2019 COVID19) revealed the attack rate in individuals <18 years of age was only 2.4%, and no death was reported in this age group.16 According to the data released by the Chinese Centers for Disease Control and Prevention,17 416 cases were reported among children 10 years old and younger (with no cases of death), accounting for 0.9% of total COVID-19 cases.
My conclusion is that Covid is infrequently found in Children, and even less frequently transmitted by a child to an adult. An adult is much more likely to receive transmission of Covid from another adult than from a child. Is it possible for a child to get Covid- yes. Is it possible to for a child with Covid to transmit to an adult- I believe the answer to this is yes as well, though it seems to be rare. There are dozens and dozens of articles on this very subject- I just googled “Do children transmit covid” and was overwhelmed with scientific studies. I read through several of them for about 2 hours. On a general level, I think schools should open with wide doors and children should attend. At the same
time, those with high-risk need to be careful and should avoid getting the virus. Tough decision for some for sure. I am hopeful that with the speed that information is flying around right now, that we will know even more in the coming weeks. \
From: https://www.nejm.org/doi/full/10.1056/NEJMoa2007764 “Remdesivir was superior to placebo in shortening the time to recovery in time to recovery in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection”
“…treatment with hydroxychloroquine alone and in combination with azithromycin was associated with reduction in COVID-19 associated mortality.”
“Two doses of vaccine prompted high levels of neutralizing antibody activity that were above the average values seen in convalescent sera obtained from persons with confirmed COVID-19 disease.”
(This vaccine has more trials to be conducted and will be available late 2020 at the earliest.)