Q&A: Are asymptomatic children driving the spread of COVID-19?
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To date, reported cases of COVID-19 have been less common among children than adults, and children appear to experience milder illness from the disease, although some have developed a new and serious inflammatory syndrome.
As the debate about whether to reopen schools continues, we wanted to know: Could asymptomatic children with COVID-19 be quietly spreading the novel coronavirus?
We posed this and other questions to Infectious Diseases in Children Editorial Board Member C. Buddy Creech, MD, MPH, associate professor of pediatrics and director of the Vanderbilt Vaccine Research Program at Vanderbilt University Medical Center.
Question: What role do have children had in the transmission of SARS-CoV-2?
Answer: Thus far, quite a lot is different about this pandemic. Most notably, children have not been a primary driver of disease, and transmission from child to adult appears limited, particularly among young children.
Q: What does the science say about the potential for children to be asymptomatic drivers of transmission?
A: There is still much to learn about the kinetics of the virus in children. For the most part, symptoms are mild in children and we do not yet know the burden of asymptomatic disease in children. Once we have more reliable antibody testing, we may be able to determine seroprevalence more precisely.
Q: Are we betting too much on children not being major drivers of the epidemic in the United States — ie, reopening schools too early?
A: We are not on an island. Several European, Asian, and Middle Eastern countries have opened schools with varying levels of success. Many countries, like Denmark, have been in school for 2 to 3 months without a corresponding increase in overall disease activity.
Q: Kids play a major role in the seasonal influenza epidemic. How is this infection different?
A: We are still examining the ways SARS-CoV-2 is different than other respiratory infections in children. Whether it is due to cross-protection from recent infections with non-SARS coronaviruses, a result of decreased expression of the SARS-CoV-2 receptor angiotensin-converting enzyme 2 in children or a yet to be determined difference between children and adults, we know that this pandemic disproportionately affects older adults and adults with underlying health problems.
Editor’s note: New data published in JAMA Pediatrics suggest children aged younger than 5 years with mild to moderate COVID-19 have high amounts of SARS-CoV-2 viral RNA in their nasopharynx compared with older children and adults. The discussion about the role of children in the transmission of SARS-CoV-2 is ongoing. Check back with us often for the latest updates.
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