The original post is this note from Dr. Hoeg. Her reasoning, while sound at the time, might be faulty, in that the New York Times reports that children have been now shown to harbor large loads of the virus in their nasal mucosa - see here
From Tracy Hoeg MD PHD: (UC Davis)
I wanted to give an update on the research regarding COVID in children.
I
should back up briefly and state that I am a physician with a PhD in
Epidemiology who became very interested in this topic when a colleague
and friend of mine, Jennifer Kasten, MD MSc, wrote a systematic review
of COVID epidemiology in children (https://www.facebook.com/
Last month, I did my own summary of the data (https://www.facebook.com/
*Very limited transmission if any from children ages 12 and under to either other children or adults
*Children
appeared to be at least 10 times more likely to die of influenza than
Covid and are more likely to be struck by lightning (I rechecked the CDC
website today 7/13 and they are still reporting 3 deaths in children
under 18 due to confirmed COVID; for comparison, there have been 185
deaths due to influenza in this population in the 2019/2020 season. If
anyone has an updated death count in the pediatric population due to
COVID, please share).
*Countries that reopened
elementary schools as a first step in their country's reopening did not
see an uptick in cases (these include numerous European and Asian
countries, some of which are displayed in Figure 4. Reopenings not
causing and uptick in cases is consistent with children not being a
major vector for the disease. Figure 3 shows age of the source of the
cases of COVID in Holland, with none ages 18 and under in their study,
as just an example of these data.
What have we learned in the last month?
1.
We now have a generally accepted mechanism for younger children getting
milder disease and transmitting significantly less than adults, which
is paucity of ACE2 receptors in the respiratory tract compared with
adults (this is the receptor SARS COV2 uses to enter the cells of the
body). This could explain why children get COVID less, have milder
disease (lower viral load) and are less contagious (if contagious at
all). Yet another way COVID is unlike typical influenza! https://jamanetwork.com/
(Figure 2)
2.
Consistent with this was the study showing lower viral load (lower
amount of the virus) in children up to age 18. (Figure 1). The original
non-peer reviewed print of this article from Drosten et al was
reanalyzed as per UCSF Grand Rounds and does indeed show significantly
lower viral load in children as seen in image 1.
3.
This is great news for teachers and children, because not only are
children significantly less likely to transmit COVID, but IF they do,
the dose of the "inoculum" will be expected to be lower and there is
mounting evidence (though inconclusive at this point) that the lower the
dose of the virus you get, the less severe your disease will be if you
even get symptoms at all (https://www.reliasmedia.com/
4.
I am sensing many of your are STILL skeptical we can safely open
elementary schools in the US. Well, thankfully we have really good data
from the YMCA childcare for essential workers in the US, which has been
providing childcare throughout the pandemic (our kids go there) and was
even open in NYC at the height of the outbreak and they have had
0/>40,000 kids (ages 14 and under) contract COVID. They have also not
had any outbreaks, though a few staff at different sites tested
positive (presumably contracted from another adult per the above data)
and quarantined so no more than 1 positive case a just a limited number
of sites. Adults wear masks, kids don't, temperature checks at the door,
each kid has a small "cohort" of kids they do everything with. More
details can be seen in this article, but it shows that WE CAN DO THIS
SAFELY in the US - even in areas hit severely by the virus and with
truly minimal resources. https://www.npr.org/2020/06/
Edit:
The small cohorts in children may actually not be necessary and the
data I am using to support this is guidelines for return to school in
Holland in quotes below and from their Ministry of Health Website (https://www.rivm.nl/en/novel-
"Children
up to and including 12 years of age do not have to keep 1.5 metres
apart from each other and from adults. This also applies to childcare
and primary education.
Young people aged 13 until 18 years old
(i.e. 17 years old and younger) do not have to stay 1.5 metres apart
from each other. In secondary schools, this applies to all pupils,
regardless of their age."
--I also want to
briefly address the many "clickbaity" articles in the popular press
lately about school and day care outbreaks. Specifically I will mention
the school outbreaks in Israel where there were some infections in high
school aged children but the "outbreaks" in the elementary schools were
among adults only. Also, if you carefully look at the reports of day
care outbreaks in our country, most appear to be involving staff that
infect each other and, if kids are affected they are infected by the
adults and are asymptomatic/have mild disease. I challenge you all to
look at the articles coming from the popular press with the above data
in mind and you will be surprised in the elementary age group that the
adults appear to be the ones responsible for the outbreaks (though it is
hard to get all of the info from those articles) and the ones who are
severely affected by the disease.
--What are the bottom lines?
1.
Kids 13-14 and below (likely around puberty) do not appear to be
driving the spread of COVID. They rarely (one can never say never)
transmit the disease. Tracing the source case with 100% certainty can be
very challenging, but the data overall indicate pediatric transmission
to be quite rare compared with adults.
2. Kids
up to 18 years of age tend to get mild disease if any symptoms and death
in this age group is less likely than getting hit by lightning.
3.
In school settings, adults can and will give to adults and kids, so
teachers need to be socially distancing while at work. Adults also
should be wearing masks and getting tested and staying home if they have
symptoms.
4. Data and guidelines from Holland
suggest distancing among children <19 and="" as="" be="" been="" children="" countries="" div="" economy.="" even="" first="" has="" in="" it="" masks.="" may="" necessary.="" not="" of="" opened="" out="" pointed="" reopening="" scandinavia="" schools="" should="" step="" successful="" that="" the="" their="" these="" wearing="" without="">
5.
I have previously discussed the many downsides of not having kids in
school in person this fall: further entrenching socioeconomic
disparities, job loss for parents who can't afford childcare worsening
poverty and neglect, abuse of children (which will be underreported),
lack of support for children with special needs, anxiety, depression and
lack of physical activity and peer relationships in children. The list
goes on and on. But I want this post to focus more on the science of the
disease so it can inform our public policy decisions.
6. I hope the above data are reassuring. The more we know, the better we can tackle and live with this disease.
Edit:
Now that this post has been shared hundreds of times (never imagined
this), I want to say first of all, that I in no way am intending to
detract from the seriousness of COVID-19. It is imperative our country
get this disease under control -by social distancing, closing indoor
businesses which are not essential, wearing masks, etc, but the above
data at least suggest to me that children are not driving the pandemic;
adults are. And I also want to say that a lot of what I shared above was
recently discussed in the UCSF combined Medicine and Pediatric Grand
Rounds lecture (an inspiration for me to write this to get this
scientific info to the public). I encourage anyone interested in the
above data to watch this recording of the Grand Rounds : https://www.youtube.com/watch?
And this article about the above UCSF physicians' stances on reopening schools and transmission in children: https://missionlocal.org/2020/
I
welcome any data or questions you have. The science about COVID in
pediatrics is evolving and we don't have all the answers (far from it),
but I hope people can use the above data to help them make informed
decisions about children's activities and school openings.
Now
in my OPINION- elementary school is an essential service of a country.
All other first world countries prioritized opening their elementary
schools BEFORE their economies. When one considers the number of couples
or single parents who are essential workers, or now working again in
the US, with kids too young to watch themselves - I ask you- where will
they go if not to school? And will the alternative be better? These
children with either be 1. in school, 2. in a day care (IF their parents
are privileged enough to afford this) or 3. neglected/potentially left
alone at home and not learning and without their usual resources. It is
our job together as American people to figure out what is in the best
interest of all our children (regardless of socioeconomic status) - they
are truly the future of our country and figuring how to open schools
safely is infinitely more important than reopening Disney World (WHY is
this open??). I hope we can use the above data and strategies of other
countries (as well as our own YMCA daycares!) that have successfully
managed this pandemic to guide us. Having NO plan for how to most safely
open our elementary schools is not an acceptable modus operandi for our
country.
******************************
Edit to add new data:
7/16:
In Germany, a study of over 2,000 children: "Scientists from Dresden
Technical University said they believe children may act as a “brake” on
chains of infection." https://news.yahoo.com/german-
7/16:
Study performed by the Swedish and Finish Ministries of Health "closure
or not of schools had no measurable direct impact on the number of
laboratory confirmed cases in school-aged children in Finland or Sweden.
The negative effects of closing schools must be weighed against the
positive indirect effects it might have on the mitigation of the
covid-19 pandemic." https://www.
