In a new commentary, two doctors warn that understanding how the new coronavirus affects children is critical for accurately assessing the impact of the COVID-19 global pandemic, as well as for figuring out ways to treat or prevent the disease.
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Dr. Steven L. Zeichner, Ph.D., the head of the Division of Pediatric Infectious Diseases at the University of Virginia in Charlottesville, and Dr. Andrea T. Cruz, MPH, a pediatric emergency medicine physician at Houston’s Baylor College of Medicine in Texas, authored the paper.
In it, Drs. Zeichner and Cruz use prior studies that have looked at the risks of contracting SARS-Cov-2 — the virus that causes COVID-19 — in children, as well as the risks of complications from the virus.
Using existing research, they also evaluate the role that children could have in disease transmission.
The commentary appears in the journal Pediatrics and is freely accessible to the public.
Drs. Zeichner and Cruz single out a few “salient points” in their paper.
Firstly, they say, although children are less likely to develop a severe form of COVID-19, we should not overlook the smaller number of children that are more vulnerable to the disease.
They cite research that found Chinese children with acute respiratory distress syndrome (ARDS) were more likely to contract the new coronavirus than children with human metapneumovirus.
Also, the authors note a study of Norwegian children that found “coronaviruses in 10% of hospitalized children with respiratory tract infections.” They add:
“Younger age, underlying pulmonary pathology, and immunocompromising conditions have been associated with more severe outcomes with nonCOVID-19 coronavirus infections in children.”
Secondly, write Drs. Zeichner and Cruz, it is difficult to assess the real effects of COVID-19 in children, especially since, according to some prior studies, two-thirds of children with coronaviruses also have other viral coinfections.
In the Chinese study of children with ARDS mentioned above, “children without virologic confirmation were more likely to have severe disease than children from whom COVID-19 was detected, potentially because their symptoms were caused by other pathogens,” explain the authors of the commentary.
Thirdly, and importantly, it is essential to understand the crucial role that children may play in community-based viral transmission, say the researchers, even when children are asymptomatic.
For instance, the researchers cite a study that found the new coronavirus persisted in the stools of children for several weeks after diagnosis.
This leads to “concern about fecal-oral transmission of the virus, particularly for infants and children who are not toilet trained, and for viral replication in the gastrointestinal tract.”
The CDC recommend that all people wear cloth face masks in public places where it is difficult to maintain a 6-foot (2-meter) distance from others. This will help slow the spread of the virus from asymptomatic people and people who do not know that they have contracted it. People should wear cloth face masks while continuing to practice physical distancing. Instructions for making masks at home are available here. Note: It is critical that surgical masks and N95 respirators are reserved for healthcare workers.
“Many infectious diseases affect children differently than adults, and understanding those differences can yield important insights,” continue the authors. “This will likely be true for COVID-19, just as it was for older infectious diseases.”
“Since many children infected with COVID-19 appear to have mild symptoms or even no symptoms at all, it is important to practice all the social distancing, hygiene, and other precautions being recommended by public health authorities to minimize transmission from children to others.”
– Dr. Steven Zeichner
This includes “family members who may be at greater risk from the infection, such as grandparents or family members with chronic medical conditions,” adds Dr. Zeichner, who is also working on potential SARS-Cov-2 vaccines in his lab.
“In addition, studies of the reasons why children are affected differently than adults by the infection may yield insights that can be helpful in understanding the disease and ways to treat or prevent it.”
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