Coronavirus and Children: 12 questions about what threatens your child

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Photo from youtube: Nucleus Medical MediaThe information we possess suggests that children are less prone to the threats posed by the coronavirus, but they can still get infected. Why does the virus affect children differently than adults? And what could threaten your child? 

The waves of discussions that caused Ilona Mask tweet on March 20 when a pioneering entrepreneur suggested that children are “mostly protected” from coronavirus. So far, all discussions have come to the conclusion that, although infection with this virus can have fatal consequences for an elderly person, the disease in a child goes much easier. 

However, there have already been several alarming reports of a serious illness in children. These cases, plus schools closed in many countries, plus strict measures to maintain distance in society, make parents wonder about the safety of their children. BBC Future tried to answer some of them.

1. Do children get coronavirus?

Yes. Like adults, children who become infected with coronavirus become infected and show symptoms of Covid-19. 

“At the beginning of the pandemic, they thought that children were not infected, but now it’s clear that they do it exactly like adults do,” explains Andrew Pollard, professor of infectious pediatrics and immunology at Oxford University. “It’s just that they’re much lighter symptoms. ” 

China Center for Disease Control and Prevention cited data (dated February 20) that children under 19 years old accounted for 2% of 72 314 cases of Covid-19, and in American study Of the 508 patients, there was not a single death among infected children (while sick children in this group accounted for only 1%).

“Perhaps the virus at first chose adults because it was transmitted at workplaces and on trips, travels,” said Sanjay Patel, consultant for childhood infectious diseases at the Southampton Children’s Hospital in the UK. “Now adults spend more time with their children, and we can observe an increase in the number of infected children.” Or maybe not”. 

The global trend suggests that children are less likely to become infected than adults (especially older adults), but it is possible that the data are distorted by the fact that in some countries, virus testing is offered only to those who are hospitalized with acute Covid- 19, and among such people there are very few children. 

“Obviously, there are more infected children than we think,” Patel says. “We don’t check every child in the country.” 

2. How does the course of the disease in children differ from adults?

“In the extensive literature that we already have on the topic of the new coronavirus, there is a remarkable observation: even those children who have very serious concomitant diseases and who receive immunosuppressive therapy or treatment for oncology, get sick [Covid-19] much easier than adults, especially older adults, “says Andrew Pollard, who leads a team of scientists at Oxford University (Oxford vaccine group), which recently identified an experimental vaccine (“candidate vaccine”) for treatment with Covid-19. 

In general, in children with Covid-19, the symptoms of the disease are easier than in adults. Nevertheless, the death of a 12-year-old girl from Belgium and a 13-year-old boy from London was already reported (March 31). These are the youngest (known to us) victims of the virus in Europe. The death of a 14-year-old in China was also reported. 

Data Chinese study Covid-19 children’s morbidity confirms that slightly more than half of those infected experienced mild symptoms such as fever, cough, sore throat, runny nose, body aches, and sneezing). 

About a third had signs of pneumonia, often with fever, a wet cough and wheezing, but without shortness of breath and difficulty breathing, which are observed in more serious cases. 

Graham Roberts, a pediatrician consultant at the University of Southampton, explains: “In children [с Covid-19] the upper respiratory tract (nose, mouth, throat) is predominantly affected, so they show symptoms of the common cold, the virus does not sink into the lower respiratory tract – into the lungs, and there is no picture of life-threatening pneumonia, as in adults. ”

The proportion of children in whom the disease has gone into a serious or critical stage with ONE (acute respiratory failure syndrome) and a shock condition is much lower (6%) than Chinese adults (19%) – especially the older generation, with chronic cardiovascular or pulmonary diseases. 

According to a February report from a WHO mission in China, only 2.4% of those infected are 18 years old or younger. In 2.5% of them, the disease turned into a serious form, in 0.2 – in a critical form. 

In a small proportion of children, despite infection, there were no symptoms at all. “The most important question is that most infected children have very mild symptoms, or the kids just don’t get the virus as adults do,” Patel muses. 

3. Why do infected children tolerate coronavirus more easily than adults? 

“This virus is so new that we just don’t know yet,” says Graham Roberts, who, among other things, leads the Asthma and Allergy Research Center in Newport, UK. 

“One possible reason is that this virus needs protein on the surface of the cell to get inside and start its destructive activity. Apparently, coronavirus uses the ACE-2 receptor as a gate. Perhaps children have less in the lower respiratory tract. Therefore, only the upper respiratory tract is affected. “

This may explain why the symptoms of coronavirus-infected children are more like a cold. The attraction of coronaviruses to ACE-2 receptors was demonstrated in laboratory experiments back in 2003, and also in 2013 during genome research new coronaviruses RsSHC014 and Rs3367 (close, but not identical to SARS coronavirus) isolated from Chinese horseshoe bats. 

According to Pollard, there may be another explanation. “Perhaps this is not a matter of children, but of the fact that with age, changes occur in the body that make it more vulnerable to the virus.”

He associates such changes with the aging of the immune system, which weakens the body’s ability to fight new infections. 

“However, we see that even young adults are at greater risk of becoming seriously ill than children. So aging the body is an incomplete answer,” the scientist adds. 

The immune system of children is in many ways different from the adult – primarily because it is still being formed. 

Children, especially those attending kindergarten or school, are susceptible to many new respiratory infections for them, and this may explain the increased level of antibodies in their blood, greater than in adults.

“It seems that in children the body reacts more intensively than in adults to viral infections, for example, with a high temperature that is not often seen in adults,” says Roberts. “It is very possible that the children’s immune system is able to better control the virus, localize it in the upper respiratory tract, prevent him from doing more harm and eliminate it. ” 

“It is also possible that children previously infected with the other four types of coronavirus are partly protected by this experience,” adds Patel. 

In addition, the authors of a study of cases of infection in China believe that children are also helped by a smaller, compared with adults, number of cardiovascular and pulmonary diseases.

“A very small number of children develop a serious Covid-19 infectious disease,” says Pollard. “This means that there is something fundamentally different in how their bodies deal with the virus.” 

There is one more reason. In critically ill adults, the so-called cytokine storm (hypercytokinemia, an overreaction of the immune system to the virus) causes the body harm rather than benefit, often leading to organ failure and death. 

An undeveloped children’s immune system does not produce the same potent cytokine response.

And although this hypothesis remains to be verified in the case of Covid-19, immune response studies children on the SARS outbreak in 2003 proved just that.

4. Can children with mild symptoms or no symptoms transmit the coronavirus to others? 

Yes they can.

“This is a big problem,” Roberts emphasizes. “Many people think that little is threatened by children, so do not worry about them. Yes, this is true for children who do not have chronic diseases, immunodeficiency conditions. But people forget that children are arguably one of the main pathways of infection in society. ” 

Coronavirus is transmitted by direct personal contact through droplets in the breath (by sneezing and coughing) and by contact with virus-infected surfaces. So that children can easily spread the virus and pass it on to others – especially their family members and elderly relatives. 

“Children with mild illness may be among the main distributors of the virus in society,” Roberts emphasizes. “That’s why it is so important to close schools to slow down the spread of the pandemic in the country.” 

5. Is there a similar spread of infection in children in cases of other diseases?

Yes, this happens, for example, with the flu virus.

“In children, the flu can be limited to a runny nose, and in adults and the elderly, it can end up in hospitalization, intensive care, or even death,” Roberts said. 

And he says something else important: “A few years ago, the British government introduced vaccination of children against influenza. And this was done not so much to protect the children themselves, but to prevent them from transmitting the virus to their elderly relatives who are hard tolerate this disease. ” 

This is true for coronavirus. The risk of Covid-19 is low for children themselves, but the risk that they will infect vulnerable older people, people with already existing chronic diseases, is high. 

6. Do children of different ages get sick differently?

It seems so. Chinese data suggest that very young infants are more vulnerable to the virus than other age groups. 

Serious or severe forms of the disease were observed in one of 10 infected babies, but this indicator drops sharply in older children: for example, in five-year-olds and older, only three to four cases out of 100 showed serious forms of the disease. 

“Preschoolers are more predisposed [к серьезной болезни]- emphasizes Roberts. “They have less airways, they are not as strong as older children to fight a dangerous infection.”

7. What about teens? 

“At a certain stage in their lives, children begin to turn into adults,” says Roberts. “For teens, the immune system matures and begins to behave like an adult. This means that it less effectively controls the virus that has entered the body. However, it’s important to remember: about this virus we know very little so far, we are only making assumptions, trying to understand why we see what we see. ” 

IN Chinese study there was no death among children nine years old or younger and only one death among those under 19 years old (14-year-old teenager). 

On March 23, Britain reported the death from Covid-19 of an 18-year-old (with concomitant diseases) and on April 1, a 13-year-old Londoner. 

8. Is Covid-19 dangerous for newborns? 

Yes. 

Although the pandemic has just reached many parts of the world, at least two confirmed cases of infection of newborns are already known – one in Wuhan, the other in London. 

It is still unknown whether the children were infected in the womb or after birth. In both cases, the mother’s test for the virus gave a positive result. 

9. Do we know how coronavirus affects an unborn baby?

Not much is known. Coronaviruses that cause SARS and MERS can lead to miscarriages and premature births, and can slow down fetal growth (no observations have been made with mothers infected with Covid-19). 

True, it is worth noting that those conclusions were based on two small studies. However, the British health authorities warn that pregnant women are at risk of developing the disease if they become infected with coronavirus, and recommend that they take special precautions such as social distance and so on. 


10. How can a family protect their child from coronavirus infection? 

Wash your hands thoroughly, do not come into direct contact with others and disinfect surfaces and objects that the virus might be on – these are the main ways to prevent the further spread of Covid-19 – like regular flu. 

“Respect the basic rules responsibly,” Patel says. “If you are on a street, in a public place, touch something, never touch your face until you wash your hands properly.” 

On the British website National Health Service There is information on measures that must be taken in the family to protect themselves from Covid-19. 

UNICEF Organization also released a memo for parents (English). 

11. Can a family protect their elderly and vulnerable members from being infected by the virus transmitted by children? 

Yes, but it will not be easy. Of the three main measures (thorough hand washing, disinfection of surfaces and objects, social distance), only the latter can be called a reliable protective mechanism of protection against infection of old and weakened diseases. This method, of course, works not only in the case of distributing children, but also with adults. 

“When I watched what was happening on Mother’s Day, I saw a lot of walking families, where both grandparents and parents with children were together,” Patel says. 

“In my opinion, it was absolutely frightening: the data indicate that the elderly, especially those with existing diseases, are the main risk group. And to exclude children from contact with them is the most correct thing. Why take this risk?”

Separation of seemingly healthy-looking children with grandparents and other elderly relatives, at first glance seems somewhat excessive. However, it is worth remembering: in children, coronavirus infection either does not appear in any way, or has very mild symptoms. But at the same time, they still carry the virus.

Suppressing the spread of coronavirus depends not only on the success of science and medicine. It depends on our behavior, on whether we are ready to change it.

12. Why is it so important to talk with children about Covid-19

“We talk a lot about Covid-19 among ourselves, in society, in the media, but there is one important thing that parents should do: tell your child that he will not die from Covid-19. It is very important that the children understand this” – emphasizes Patel. 

“All pediatricians know that children are afraid of the worst, but they don’t always admit it.” 

Pollard agrees. He offers all parents to reassure the children, to convince them that under almost any circumstances they are not in danger of getting Covid-19 seriously ill.

“Children and teenagers are worried about their family,” said Lennea Karlsson, professor at the University of Turku (Finland) and a child psychiatrist. “We need to explain to them that these are exceptional circumstances, and that if it weren’t for this, we would not be asked to do such unusual things”.

“We need to explain that in a situation like this, we must take care of everyone, not just ourselves and our family.” 

You can read the original of this article at BBC Future website.

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