Keeping Children Safe in the Pandemic

Most young people, infants to teenagers, fully recover from COVID-19, but not all. And even without symptoms, they can spread it to others. A cautionary tale.

SARS-CoV-2 doesn’t discriminate – it infects everyone regardless of age. But the severity of disease differs: Older people, particularly those with pre-existing conditions, are at high risk of more severe cases, whereas children mostly have mild cases. But that doesn’t mean that we don’t have to worry about them getting infected. 

According to our best numbers, children make up about 10% of all COVID-19 cases. In Austria, the Austrian Agency for Health and Food Safety (AGES) reports that 8.3% of the 66,611 confirmed positive cases as of October 20 are children under the age of 14. Because children may be asymptomatic or have mild, cold-like symptoms, it’s likely that they’re not getting tested, so the numbers could be significantly higher. 

A child’s age appears to correlate with disease severity with infants and young children under five years of age at a higher risk of more severe illness compared with older children. Only a small percentage of children become severely ill. The US Centers for Disease Control has reported that hospitalization and death in school-aged children seem low, but also that Hispanic and black children are disproportionately affected.They also reported twice as many adolescents infected as younger children; but very few die from the disease. Similarly, in Austria, 940 children under 5 and 4,599 between 5 and 14 have tested positive and none has died.

Symptoms of COVID-19 in children 

When a child does have a severe form of SARS-CoV- 2, however, their symptoms are the same as adults. Suppose a child has COVID-19 especially after being in contact with someone with the disease, they could develop a fever, cough, headache, body aches, sore throat, a runny nose and sneezing, shaking chills, diarrhea, vomiting, fatigue, and rashes. In severe cases, they might have shortness of breath and difficulty breathing and may also lose their sense of smell and taste. 

After being infected with COVID-19, children can develop a multi-system inflammatory syndrome (MIS-C) usually a fever for more than 24 hours associated with vomiting, diarrhea, abdominal pain, shortness of breath, rash, bloodshot eyes, excessive fatigue and lethargy, headache, confusion, and irritability. A child with these symptoms must be treated immediately in the hospital.

A child is under one year is at higher risk if they have a pre-existing condition, such as severe heart disease, sickle cell disease, obesity, diabetes, cystic fibrosis, or a compromised immune system. But even without these conditions, children may develop severe illness in a way we can’t yet predict. 

Long-term consequences for children with COVID-19

Long-lasting symptoms can follow COVID-19 patients – so called “long haulers” – for months even after a mild illness. One study reported collegiate athletes with heart damage following COVID-19. But it’s not clear yet whether either happens to younger children.

Why Are Children Spared From Severe COVID-19?

There are several theories about why SARS-CoV-2 is less problematic for children. 

One possibility is that children have low levels of the angiotensin-converting enzyme II (ACE-2) receptor, which is a protein that the virus binds to infect sour cells. Lower ACE-2 receptor expression could mean reduced SARS-CoV-2 binding and a lower dose causing mild infection. Another possibility is that children may express ACE-2 receptor mostly in their nose and throat, and not in their lungs, which could explain why they mostly have colds and not severe lung disease. 

Children with allergies and asthma may also be protected from severe COVID-19, because allergic-type white blood cells called eosinophils reduce ACE-2 receptor levels. Children might also be protected by the viruses that cause the common cold that can interfere with viral replication and reduce the infectiousness of SARS-CoV-2. Some viruses in children may also decrease ACE-2 receptor levels. 

Other factors, like a less mature immune system in children, might also be protective, as well as lower levels of inflammatory cytokines, which are a significant in severe adult cases. It’s also possible that a child’s immune system may just be better at fighting off viral infections. 

What To Do When You Think That Your Child Has COVID-19

If your child has moderate to severe symptoms

  • Immediately call your pediatrician or emergency line or take your child to your nearest emergency room if your child has the following symptoms: a sustained high fever, difficulty breathing, blue lips or skin, excessive coughing, vomiting or diarrhea, not urinating or producing tears, lethargy, chest pain or pressure, confusion, or severe abdominal pain

If your child has mild symptoms or has known contact with a person with COVID-19, 

  • Call the Coronavirus hotline at +43 1 1450 and your pediatrician (Kinderarzt), who can help you get a COVID-19 test for your child. 
  • Stay at home away from others until they are not contagious – unless you must leave your home to have a test. 
  • Maintain physical distancing with all other than the primary caretaker to protect elderly and vulnerable relatives from infection.
  • Avoid direct physical contact especially with at-risk relatives, friends, and neighbors.
  • Wear a cloth mask.
  • Frequently wash your hands. 
  • Avoid touching your face.
  • Clean frequently touched surfaces.
  • Wear gloves when removing dirty tissues and transferring items from the sick child’s area.”

How To Avoid Your Children Becoming Infected

  • Like adults, children need to practice social distancing.
  • Always remind your child to keep his or her distance when playing with friends.
  • Children 2 years and older should wear a cloth mask to reduce the danger of infection.
  • Go to public parks or playground parks when they’re not crowded.
  • Limit in-person playtime with other children.
  • Make sure that they wash their hands often with soap and water or sanitizing gel if in public.
  • Remind them to avoid touching their face with their hands.
  • Disinfect commonly used surfaces and objects. 
  • Keep your child’s immunizations up to date. 

Children Can Spread Disease 

And most of all, be on guard: Even though children have less severe cases, they can still transmit disease, and children with mild and asymptomatic COVID-19 can all too often be infecting others.

Dr. Michelle Epstein
Michelle Epstein is a medical doctor graduated from the University of Alberta in Canada, who has specialised in Internal Medicine at the University of British Columbia and Allergy and Clinical Immunology at Yale University. Since 2004, she has been a Lab Leader at the Medical University of Vienna’s Division of Immunology.

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