As schools prepare to reopen their doors, researchers are racing to understand the mysterious ways the novel coronavirus affects children.
Being back in school will offer a big boost to children’s mental health, experts say. But what about risks to their physical health, as millions of youngsters share classrooms, bathrooms and playgrounds? Recent evidence of an unusual complication affecting children is driving new concerns.
“Schools should reopen,” said Dr. George Rutherford, an epidemiologist at UC San Francisco. “But keep mixing to a minimum to maintain social distancing.”
According to Dr. Alan Schroeder, a pediatrician at Stanford’s Lucile Packard Children’s Hospital, “at least based on what we know now, there are bigger threats to children right now … and that includes food insecurity and poverty and child abuse.”
Compared with adults, kids don’t get as sick from COVID-19. In California, no one younger than 18 has died from the coronavirus. And the age group accounts for only 5.7% of COVID-19 cases, despite making up 22.5% of the state’s population. Kids who do test positive tend to have milder symptoms than adults.
“COVID-19-related hospitalizations among young people below 18 years of age represent an extremely tiny fraction of the total hospitalizations (for any reason) for that age group,” said epidemiologist George Lemp, former director of the California HIV/AIDS Research Program at the University of California’s Office of the President.
There are also differences in transmission patterns. Adults spread the virus — which can lead to outbreaks — but children don’t seem to be doing the same. Research from the Netherlands found that the virus is mainly spread from adult family members to children. The spread of the virus among children or from children to adults is less common.
But the emergence of a rare complication shows that youth are not completely spared. Children and adolescents infected by the coronavirus have arrived in hospitals with rashes, persistent fevers, abdominal pain and diarrhea. There have also been cases of heart failure.
The Centers for Disease Control and Prevention have named the mysterious new condition “multisystem inflammatory syndrome in children,” or MIS-C. It resembles a rare childhood illness called Kawasaki Disease — with some key differences.
Unlike Kawasaki Disease, which mostly affects children under 5 years old, MIS-C has appeared in older children and adolescents. And there’s a different geographic distribution: While Kawasaki Disease is most common in Asian countries, all confirmed cases of MIS-C have been found in children from the U.S. and Europe.
“It’s very, very striking that they have not seen this” in Asia, said Dr. Susan Kim, a pediatrician at UCSF. That suggests that there may be a genetic component underlying the illness.
Researchers still don’t understand the link between MIS-C and the coronavirus. Curiously, the rash and fever symptoms don’t appear in children when they’re first infected. They appear weeks after when the immune system is ramping up antibody production.
The syndrome is also distinctive because it afflicts youths without any underlying health problems. “These are generally healthy kids, in contrast to many of the adults who are getting sick with COVID-19,” Schroeder said.
Fortunately, MIS-C is rare. There have been several hundred cases worldwide and only one has been reported in the Bay Area so far, though it’s unclear whether the child had MIS-C or Kawasaki Disease.
In most cases, children have recovered following treatments typically used for Kawasaki Disease, though New York State’s department of health has reported three deaths due to the new illness.
“It’s one of the things that we obviously worry about, but I don’t think it’s enough to stop schools,” Rutherford said about MIS-C.
To reduce risks, he recommended finding ways to teach children in smaller groups, staggering schedules and offering both in-person and online coursework.
As COVID-19 case counts wane, other countries have already begun to reopen classrooms, with changes to daily routines. In Denmark, classes have shrunk and desks are spaced out. In Vietnam, some Hanoi students get their temperatures checked upon arrival and are required to wear masks.
Many American parents say they hope there will be similar safety measures to protect their children.
“Until there’s a vaccine, the use of N95 masks by all students and teachers may be effective, along with hand washing, of course,” said Steve Bisset, a parent in Palo Alto.
But some worry that the new measures could make school an upsetting experience.
“If the environment mirrors the apocalyptic images the CDC is recommending, then we will keep her home,” said Angie Evans, a Palo Alto parent whose young daughter is eligible for transitional kindergarten. “It’s not the virus that gives us so much pause — it’s the emotional stress that this new restrictive and isolating version of school could cause.”
While school reopenings — with updates to safety practices — make sense from a public health perspective, teachers worry that the expected state budget cuts will prevent smaller classes and increased testing.
“We can’t reduce class sizes with fewer teachers. We can’t clean more with fewer (support staff),” said Jeff Freitas, president of the California Federation of Teachers. “We can’t do more with less.”
