New Study: Children Don’t Pass the Coronavirus on to Adults

According to a new study children don’t pass the Coronavirus on to adults. If true, given the fact that the mortality rate for kids from this virus is near zero.
Among the study's findings are: 
  • A China/World Health Organization joint commission couldn’t find a single case of a child passing the virus to an adult. 
  • Low case rates among children may be due more to higher numbers remaining asymptomatic, rather than a lower infection rate. 
  • Analysis of Chinese data in confirmed and suspected cases showed that 32% of affected children aged 6-10 years were asymptomatic. 
  • Precise details regarding
  • To date, only a handful of coronavirus deaths have been reported in children.
  • Very few newborns or infants contract Covid-19 and generally they do well in overcoming the virus.
The study is contained in a hard to read on mobile PDF so I added most of the text below. 

In order to help facilitate the best possible care for children with COVID-19, we sought to aggregate and rapidly review all of the original research being produced pertinent to children, making it available to everyone. Speed has been essential, and in order to keep pace with the rapid production of new evidence, we have proceeded with informal, rapid, evidence synthesis. There have been a handful of studies which were obtained and deemed not suitable for inclusion, due to poor quality or patient overlap. A list of studies not included is available. 

Our evidence summaries have undergone internal peer review, as well as being open to external review from our readers. We would like to highlight that due to the speed with which the evidence has been produced, much is of low quality. Many studies include few patients. There are 3 other significant issues:
  1. Heterogeneous denominators. There is a significant amount of heterogeneity in the way cohorts or cases have been collected, and many of these are not directly comparable.
  2. Overlap. Much of the current evidence has come from a few regions in China. We have tried to identify where cases series were at risk of including the same patients multiple times, but this remains a risk. 
  3. Non-peer reviewed evidence. Many included papers have come from pre-print servers. Whilst they appear of sufficient quality to be useful, they require caution when interpreting. 
We hope this evidence review proves useful in helping manage children with COVID-19
Contributors: The project was coordinated by Alasdair Munro. Reviews were conducted by Alasdair Munro, Alison Boast, Henry Goldstein, Dani Hall, and Grace Leo. Digital/technical support was provided by Tessa Davis.

Epidemiology

Following the initial epidemiological data released from China, it appeared children were significantly less affected by infection with SARS-CoV-2 than their adult counterparts. This was reflected both in total case numbers, but also severity, with very few cases in young children and no deaths in children under 10yrs in the initial report. This finding has been reproduced in subsequent data from other countries, most notably Italy, which showed much lower rates of infection in children and no deaths in those under 30 years of age. Low numbers of childhood cases have been seen in the rest of Europe, as well as the USA, where 1/3 of childhood cases are in late adolescence. Some concerns exist that low case rates reflect selective testing of only the most unwell, however data from South Korea and subsequently Iceland which have undertaken widespread community testing, have also demonstrated significantly lower case numbers in children. This has also been seen in the Italian town of Vo, which screening 70% of its population and found 0 children <10 years positive, despite a 2.6% positive rate in the general population.

More detailed information has emerged from China into childhood severity of COVID-19. A large number of children appear asymptomatic. Critical illness was very rare (0.6%) and concentrated in the youngest infants. It should be noted that large numbers of “suspected” cases in this group leave room for a significant number of illnesses to have been caused by other, familiar respiratory viruses. In the USA CDC data, infants appear most likely to be hospitalised, although rates of PICU admission do not appear to be significantly different as yet. To date, deaths remain extremely rare in children from COVID-19, with only a handful of reported cases.

Transmission

Precise details regarding paediatric transmission remain unclear. Low case numbers in children suggest a more limited role than was initially feared. Contact tracing data from Shenzen in China demonstrated an equivalent attack rate in children as adults, however this has been contradicted by subsequent data in Japan which showed a significantly lower attack rate in children. This, coupled with low case numbers would suggest at least that children are less likely to acquire the disease. The role of children in passing the disease to others is unknown, in particular given large numbers of asymptomatic cases. Notably, the China/WHO joint commission could not recall episodes during contact tracing where transmission occurred from a child to an adult. A recent modelling study from the London School of Hygiene and Tropical Medicine (pre-print, not peer reviewed) however has suggested the most plausible explanation for low case rates was that children are more likely to be asymptomatic, rather than less likely to acquire the disease. Studies of multiple family clusters have revealed children were unlikely to be the index case, in Guanzhou, China, and internationally A SARS-CoV2 positive child in a cluster in the French alps did not transmit to anyone else, despite exposure to over 100 people.

Several studies have now shown that SARS-CoV-2 can be detected by PCR in the stool of affected infants for several weeks after symptoms have resolved. This has raised the possibility of faecal-oral transmission. Research from Germany failed to find any live, culturable virus in stool despite viral RNA being detectable, suggesting this represents viral debris rather than active virus. Further studies will be needed to shed further light on this.

Clinical Features

A significant proportion of children with COVID-19 do not appear to develop any symptoms, or have subclinical symptoms. In the absence of widespread community or serological testing, it is uncertain what this proportion is. The most detailed paediatric population data from China showed 13% of confirmed cases had no symptoms (cases detected by contact tracing). Considering both confirmed and suspected cases, 32% of children aged 6-10yrs were asymptomatic.

Clinical features in symptomatic children are somewhat different to adults. Children tend to have more mild illness. The most common presenting features are cough and fever, occurring in over half of symptomatic patients. Upper respiratory tract symptoms such as rhinorrhoea and sore throat are also relatively common, occurring in 30-40% of patients. It is not uncommon for children to have diarrhoea and/or vomiting (around 10% of cases), even in some cases as their sole presenting features.

Blood tests also show slightly different features to adults. Lymphocytopaenia is relatively rare in children, with the majority having normal or sometimes raised lymphocyte counts. Inflammatory markers such as CRP and Procalcitonin are often raised but only very mildly. Slight elevations in liver transaminases appears common.

Radiographic features in children are also somewhat different to their adult counterparts. Chest X-rays are often normal, and many CT chest scans are also normal. When present abnormalities are often less severe, however a reasonable number of children have bilateral pneumonia. Changes may be found on CT even in asymptomatic children. Common features in abnormal CT scans include mild, bilateral ground glass opacities, but with less peripheral predominance than is reportedly found in adults.

There appears to be little in the way of clinical signs in children to differentiate COVID-19 from other childhood respiratory virus infections.

Read more details on the report here

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