As schools reopen, CDC warns kids now comprise 7.3% of US Covid-19 cases but account for just 22% of population
The true incidence of Covid-19 infection in children is unclear due to lack of widespread testing and the prioritization of testing for adults and those with severe illness, says the agency
The number and rate of coronavirus cases in children in the US have been “steadily increasing” from March to July, the US Center for Disease Control and Prevention (CDC) has warned, underscoring the risk for young people and their families as children go back to classrooms. While children comprise 22% of the US population, recent data reveals that 7.3% of all cases of Covid-19 in the country reported to the CDC (as of August 3) were among children.
At the same time, the experts say that the true incidence of Covid-19 infection among children in the US is not known due to a lack of widespread testing and the prioritization of testing for adults and those with severe illness. The CDC states that community mitigation measures and school closures may have helped reduce the transmission of coronavirus to and among children in the spring and early summer of 2020. This may explain the low incidence in children compared with adults, they add.
Health experts believe the new academic year could bring new challenges, especially in states where daily Covid-19 numbers have been rising. In some cases after reopening, schools have had to readjust their approach following positive tests among students and staff. The Cherokee County School District, for example, decided to close Creekview High School after 25 students tested positive for the coronavirus and 500 of its 1,800 in-person students have been placed under “precautionary quarantine.” “On behalf of the Superintendent, please be advised that we are, effective immediately, temporarily closing in-person learning at Creekview High School. Reopening is tentatively scheduled for Monday, August 31. We understand these closings create hardships and are disappointing to students who want to learn in-person as well as their families, but these are necessary measures to avoid potential spread within our schools,” says an August 16 statement.
The Barrow County School System also announced that it will start the school year with distance learning for all students on August 17. The decision was made after over 90 staff members had to quarantine due to a confirmed or suspected case of Covid-19, or direct contact with a confirmed case, and this is before students returned to the buildings. “We made a very difficult decision based on the increasing number of Covid-19 cases in our county, as well as the concerns over being able to appropriately staff our schools. If today was the first day of school, we would have been hard-pressed to have sufficient staff available to open our schools,” explains Barrow County Schools Superintendent Chris McMichael.
According to the CDC, comparing trends in pediatric infections before and after the return to in-person school and other activities may provide additional understanding about infections in children. “It is unclear whether children are as susceptible to infection by Covid-19 compared with adults and whether they can transmit the virus as effectively as adults. Recent evidence suggests that children likely have the same or higher viral loads in their nasopharynx compared with adults and that children can spread the virus effectively in households and camp settings,” states the new guidelines issued by the CDC along with the current evidence on Covid-19 in children.
What is the evidence so far?
Hospitalization rates in children are significantly lower than hospitalization rates in adults with Covid-19, suggesting that children may have less severe illness from Covid-19 compared to adults. The CDC explains that while children infected with Covid-19 are less likely to develop severe illness compared with adults, children are still at risk of developing severe illness and complications from Covid-19. Recent Covid-19 hospitalization surveillance data shows that the rate of hospitalization among children is low (8.0 per 100,000 population) compared with that in adults (164.5 per 100,000 population), but hospitalization rates in children are increasing. While children have lower rates of mechanical ventilation and death than adults, 1 in 3 children hospitalized with Covid-19 in the US was admitted to the intensive care unit, which is the same in adults.
Current evidence suggests that children with certain underlying medical conditions and infants might be at increased risk for severe illness from coronavirus infection. Of the children who have developed severe illness from Covid, most have had underlying health conditions. The CDC report also reveals that hospitalization rates in the US are higher among Hispanic/Latino children and Black, non-Hispanic children and non-Hispanic Black children compared with White children, which may be related to the higher rates of obesity and other underlying conditions among these populations.
“There is limited evidence about which underlying medical conditions in children might increase the risk for severe illness. Current evidence suggests that children with medical complexity, with genetic, neurologic, metabolic conditions, or with congenital heart disease might be at increased risk for severe illness from Covid-19. Similar to adults, children with obesity, diabetes, asthma and chronic lung disease, sickle cell disease, or immunosuppression might also be at increased risk for severe illness from Covid-19,” write authors.
Children with coronavirus are also at risk of developing multisystem inflammatory syndrome in children (MIS-C). “Similar to adults, children with severe Covid-19 may develop respiratory failure, myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure. Some children with Covid-19 have developed other serious problems like intussusception or diabetic ketoacidosis,” the findings state.
The most common symptoms in children are cough and/or fever. “A recent systematic review estimated that 16% of children with Covid-19 are asymptomatic, but evidence suggests that as many as 45% of pediatric infections are asymptomatic. The signs and symptoms of Covid-19 in children are similar to other infections and noninfectious processes, including influenza, streptococcal pharyngitis, and allergic rhinitis. The lack of specificity of signs or symptoms and the significant proportion of asymptomatic infections make symptom-based screening for identification of SARS-CoV-2 in children particularly challenging,” cautions the CDC.
Testing and isolation
As children return to school and other in-person activities, pediatric healthcare providers should be prepared to answer questions from families about testing and when it is safe to return to school or be with people outside the household, emphasizes the CDC.
If a child has Covid-19 symptoms but has not had close contact or a potential exposure (which includes travel to or living in an area with substantial transmission), he or she should be evaluated for possible other disease processes and should be allowed to return to school according to existing school policies if they are determined to likely not have Covid-19, recommends the agency. Again, if a child has coronavirus symptoms and lives in or has traveled to an area with substantial transmission, the CDC suggests that he or she should be tested for coronavirus, if possible. “If the test result is negative, the child should be allowed to return to school once their symptoms of illness have improved consistent with existing school policy. If testing cannot be obtained, the child should be considered a presumed case of Covid-19 and should isolate according to CDC’s recommendations for discontinuation of home isolation,” it adds.
However, if a child has had a known exposure or close contact to someone with Covid-19, regardless of the child’s symptom status, the advisory says that he or she should be tested for but must remain in quarantine for the 14-day incubation period even if results are negative.