Coronavirus and Kids: Doctors Answer Parents’ COVID-19 Questions

Mar 18, 2020

The coronavirus is here and parents have questions about the threat COVID-19 poses to the health of their children. As of now, answers have not been satisfactory, consistent, or satisfactorily consistent. Early studies out of China suggest that though mortality rates are low — though still highly worrisome at a population level — novel coronavirus does pose a serious risk to some children, specifically some children with pre-existing conditions. That said, all children can be vectors for the disease and scientist have not yet uncovered any patterns in infection that might justify complacency. Outcomes among infants, in particular, have been varied and have many front-line medical workers we’ve spoken to are worried.

This story, which will be updated frequently until scientific consensus is reached on the questions posed, is intended to be an up-to-date accounting of what epidemiologists, doctors, and public health workers know so far. All quotes are timestamped because information is becoming outdated rapidly. Answers should be understood in light of that fact. Just because we believe we know something now does not mean that thing is true. A lot of hypotheses have yet to be tested. In the meantime, the best approach is to maintain social distance and to stay informed.

Will coronavirus kill or hurt my kids?

Dr. Jan Dumois, Pediatric Infectious Diseases physician at Johns Hopkins All Children’s Hospital. March 16, 2020 (4:30PM): “There’s a new article where they review 2100 kids who were suspected to have COVID-19. There was one child who died — teen. Only one. Otherwise, all the other kids survived, but they did have different degrees of severity of illnees. Sicker kids tended to be younger and needed more aggressive medical care before they were sent home. … not just showing up to the emergency room and being sent home. Patients who ended up in hospital because they needed oxygen. Or they were found to have pnuemonia. Then there were some uncommon cases that needed to be on a respirator. Younger children more likely to be sicker and require hospitalization. Or to be on a ventilator. Sometimes heart. Or the dysfunction of the kidney. It was more common in children less than one. “

Barun Mathema, Assistant Professor Epidemiology Columbia University March 18 (11AM): I’ll preface this by saying we’re all confused. Initially, it was confusing that kids weren’t hit because we were wondering if the disease would follow the patterning of pandemic influenza where the curve is a beautiful bell with age on the bottom. Seasonal flu is the opposite, a u-shape. And initially, this didn’t fit either scenario. COVID-19 seemed like a geometric curve from low to high in terms of severity, but now that picture is getting muddled. We’re seeing folks under 50 with morbidity. We’re seeing teenagers and younger kids with fairly severe symptoms.

There was a sliver of pediatric cases and a sliver of pediatric deaths in China. Kids get colds a lot so there was a theory that some are caused by coronaviruses and so there’s partial immunity. There was also the thought that the ACE2 receptor might not be well expressed in children so there could be inefficient entry. Arguably we should be seeing a huge surge in cases, but questions remain unresolved. One can simply say that given a large sample size and a small morbidity we’re still talking about a big number.

Ryan Demmer, PhD, University of Minnesota Division of Epidemiology and Community Health. March 16, 2020 (11AM): Kids who had preexisting conditions, particularly chronic or complex medical conditions, were more likely to have adverse medical outcomes and more likely to have severe ones at that. The co-morbities that seemed to be the most troubling are with asthma and cystic fibrosis. Children with upper respiratory disease seem to be at risk.

While the absolute numbers are low in terms of mortality among young people, there’s a .01 percent mortality rate for flu in youth and early numbers in kids with COVID-19 put the figure around .2. That’s not high, but it’s a 20 fold-increase. If I told you a plane was twenty times more likely that other planes to crash, you would not get on that plane.

When should I get my kid tested?

Juan Dumois, March 16, 2020 (4:30PM): “One of the main things that’s going to be changing the way we deal with the pandemic is the availability of testing. It will become more available as the weeks go on. We have more availability this week than last. And tons more this week… some are doing it in their hosptials. We hope to be able to do that test sometime in the next month. As the ability to rapidly and readily do a test where you get results in a few hours and few days will change the dynamic of people we aren’t currently testing.

Something that might happen int he next six months would be a doctor in the clinic to swab a patient’s nose and get results the next day. Right now we can’t offer the test to everybody and it’s taking 5 days to get results back.”

Barun Mathema; March 18 (11AM): Public health is a very socialist approach. It means health for all trumps health for the individual. This is the antithesis of precision medicine. At this point, as a parent and a public health person, I feel that if a kid is exhibiting alarming symptoms — not a runny nose, but maybe a fever or something that looks unlike a regular cold — parents should consider taking the kid in. But, on some level, it’s important to recognize there’s nothing you’d do differently if your kid tested positive. If children are heavily symptomatic, take them in and get them admitted. Otherwise, you’re going home and observing. Still, there’s some virtue in knowing that you likely have it and that other people in your network likely have it as well.

My child has the virus. Now what?

Barun Mathema; March 18 (11AM): I have kids. If they got it, as a public health person, I would be more concerned about them giving it to someone else. Let your healthcare provider know and then basically take care of your child and enhance social distancing. If you have a nanny, give them a call. The health department doesn’t have the capacity to do that.

I have coronavirus, now what?

Barun Mathema; March 18 (11AM): This is a tough question. If you have coronavirus and kids you get tested and you find out that you’re positive. At that point, you can assume that a fraction if not all household members are positive. It’s different if you’ve flown in or been screened prior to symptoms. So you may want to self-isolate. But those lines are blurring. All the quarantining will be a moot point because we’ll all be there. The question is just how extreme or expansive. It’s a guessing game, but you want to isolate you and probably your family.

How can I avoid getting the virus?

Juan Dumois, March 16, 2020 (4:30PM): The biggest study was able to detect some patients that had no symptoms but were infected. Found quite a few of those. Almost 100. The study wasn’t really designed to look for asymptomatic kids. That study hasn’t yet been published.

Barun Mathema; March 18 (11AM): Just because the elderly and folks with preexisting conditions are vulnerable doesn’t leave everyone else off the hook. This is a serious infection. We read about asymptomatic carriers and minor disease and, yes, many people have had it and will without even noticing. That’s true. It’s also true that three to five percent of otherwise healthy individuals will end up with a serious disease that could require ventilation. Many will recover but it will be an uphill battle. Social distancing and flattening the curve are the answer to this, especially given that a middle age group will wind up responsible for taking care of most people.

How scared should I be for my parents?

Ryan Demmer, March 16, 2020: I think we should move forward with caution because mortality rates aren’t just linked to the properties of the disease. They are often a product of the environment or context of the disease. China is not America. In America we have varied healthcare access and high rates of asthma. That could portend worse outcomes in this country. I should state clearly that there’s no evidence of that yet, but we should be cautious.

Dr. Logan Spector, Division Director and Professor, Pediatric Epidemiology and Clinical Research at University of Minnesota, March 18, 2020 (11AM): Look to Italy. One of the reasons it is hit so hard is that it had one of the oldest populations in Europe. I really doubt that’s going to change at all. There’s been nearly 200k reports and we can say with pretty good statistical certainty who are impacted and it’s very clear the elderly are hardest hit. It’s still not clear to me how much of that is just reduced immune function versus co-morbidities. The older you are, the more likely you are to have a pulmonary disease that compounds the effect of a respiratory virus. But there is still a risk in older people who don’t have co-morbidities. That points to lower immune function as we age.

When will things go back to normal?

Ryan Demmer, March 16, 2020:From a population health perspective the main issue remains not infecting others. There’s no evidence kids don’t get infected or transmit, just that they’re less effected by the disease. Our key goal has to be social distancing. The growth curve is still coming.

The question is where the peak will be. Probably May-ish. And I’m not saying it’s going to go away…. After the peak, we’ll start coming down. What I’m interested in from an ecological point of view is what’s happening in South Korea and Wuhan. They’re saying there’s one case in the province which I find dumbfounding. And there was impressive decline in South Korea. So if that’s true —and there’s no second peak — that would be fantastic news…. If there’s a second peak that could be as bad if not worse. COVID-19 could come back in the Fall only to finish off in the spring of 2021 when we have a vaccine. That’s a harsh but not unrealistic scenario.

Logan Spector, March 18, 2020 (11:10AM EST): Obviously this is unprecedented in modern memory. Everyone is talking about the 1918 flu pandemic and there a lot of the same characteristics as most flu, but the problem with COVID-19 is that there seems to be asymptomatic transmission. Isolating people with symptoms is a first response — and it’s a logical one. When SARS and MERS came out, this was done as well. But those did not seem to have the asymptomatic transmission. I think everyone is trying to do their part including those working from home, but it will take time.

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