Does coronavirus threaten your child: 12 questions about children's health during a pandemic
'14.04.2020'
Source: Air force
The 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? Tells Air force.
The waves of discussion have not yet subsided, which sparked a tweet from Elon Musk on March 20, when the innovative entrepreneur suggested that children are “mostly protected” from the coronavirus. So far, all the discussions boil down to the fact that although infection with this virus can be fatal for an elderly person, the disease is much easier for a child.
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. We 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, it was thought that children did not get infected, but now it is clear that it happens in them in the same way as in adults,” explains Andrew Pollard, professor of infectious pediatrics and immunology at the University of Oxford. "They just have much milder symptoms."
The Chinese Center for Disease Control and Prevention cited data (February 20) that children under 19 years old accounted for 2% of 72 Covid-314 patients, and in the American study of 19 patients, there was not a single death among infected children (while sick children in this group accounted for only 508%).
“Perhaps the virus was initially chosen by adults because it was transmitted in the workplace and on travel, travel,” suggests Sanjay Patel, consultant for childhood infectious diseases at the children's hospital in Southampton, UK. “Now adults are spending more time with their children, and we can see 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 symptoms. 19, and among such people there are very few children.
“There are obviously 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 vast literature that we already have on the topic of the new coronavirus, there is a remarkable observation: even those children who have very serious comorbidities and who are receiving immunosuppressive therapy or treatment for cancer, get sick [Covid-19] much more easily than adults, especially older adults, ”says Andrew Pollard, who leads the Oxford Vaccine Group that recently identified an experimental vaccine (“ candidate vaccine ”) for the treatment of Covid-19.
In general, in children with Covid-19 the symptoms of the disease are easier than in adults. Nevertheless, the death of a 31-year-old girl from Belgium and a 12-year-old boy from London was already reported (March 13). 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.
Covid-19, a Chinese study of the incidence of children in children, 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, moist coughs and wheezing, but without the shortness of breath or difficulty breathing that is seen in more serious cases.
Graham Roberts, consultant pediatrician at the University of Southampton, explains: “Children [with Covid-19] are predominantly affected by the upper respiratory tract (nose, mouth, throat), so they develop cold symptoms, the virus does not descend into the lower respiratory tract - in lungs, and there is no life-threatening picture of pneumonia like in adults. ”
The proportion of children in whom the disease has progressed into a serious or critical stage with ARF (acute respiratory failure syndrome) and shock is much lower (6%) than in Chinese adults (19%) - especially the older generation, with chronic cardiovascular or pulmonary diseases.
According to the February report of the WHO mission in China, only 2,4% of those infected are 18 years old and younger. In 2,5% of them, the disease turned into a serious form, in 0,2 - in a critical one.
A small proportion of children, despite the infection, did not have any symptoms at all. “The most important question is whether the majority of infected children have very mild symptoms, or whether children simply do not get the virus as much as adults,” 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, heads the Asthma and Allergy Research Center in Newport, UK.
“One of the possible reasons is that this virus needs a protein on the cell surface to get inside and start its destructive activity. Apparently, the coronavirus uses the ACE-2 receptor as a gateway. It is possible that children have less of it in the lower respiratory tract. Therefore, only the upper respiratory tract is affected ”.
This may explain why the symptoms in children infected with the coronavirus are more like the common cold. The attraction of coronaviruses to the ACE-2 receptors was demonstrated in laboratory experiments back in 2003, as well as in 2013 - during genome studies of the new coronaviruses RsSHC014 and Rs3367 (close but not identical to the SARS coronavirus) isolated from Chinese horseshoe bats.
There may be another explanation, Pollard said. “Perhaps it’s not about children, but about the fact that with age, the body changes 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 serious illness than children. So the aging of the body is an incomplete answer, ”adds the scientist.
The immune system of children is in many ways different from that of an 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.
“Children seem to react more intensely than adults to viral infections, such as high fever, which is not so common in adults,” says Roberts. "It is very possible that the child's immune system is better able to control the virus, localize it in the upper respiratory tract, prevent it from causing 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.
On the subject: How to compensate a child for lack of fresh air during quarantine
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.
“Very few children develop the serious infectious disease Covid-19,” says Pollard. "It means there is something fundamentally different about 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.
Although this hypothesis remains to be verified in the case of Covid-19, studies of the children's immune response to 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,” stresses Roberts. - Many people think that children are not in much danger, so there is no need to worry about them. Yes, this is true for children who do not have chronic diseases, immunodeficiency states. But at the same time people forget that children are perhaps one of the main ways of spreading infection in society. "
Coronavirus is transmitted through direct personal contact through droplets in the breath (sneezing and coughing) and by touching surfaces infected with the virus. So children can easily spread the virus and transmit it to others - especially their family members and elderly relatives.
“Children with mild illness may be among the main contributors to the virus in society,” Roberts said. “This is why it is so important to close schools to slow 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 in hospitalization, resuscitation, or even death,” Roberts notes.
And he says something else important: “A few years ago the British government introduced influenza vaccination for children. 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 to 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 prone to [serious illness],” Roberts emphasizes. "They have smaller airways, they are not as strong as older children to fight a dangerous infection."
7. What about teens?
“At some point in life, kids start to turn into adults,” says Roberts. - In teenagers, the immune system matures and begins to behave like an adult. This means that it is less effective in controlling the virus that has entered the body. However, it is important to remember: we know very little about this virus so far, we are only making assumptions, trying to understand why we see what we see. "
In a Chinese study, there were no deaths 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 of an 19-year-old (with concomitant diseases) from Covid-18 and on April 1, a 13-year-old Londoner.
8. Is Covid-19 dangerous for newborns?
Yes.
Although the pandemic is still only spreading to many regions of the planet, 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).
However, it is worth noting that those conclusions were based on two small studies. However, British health authorities warn that pregnant women are at risk of serious illness if they contract the coronavirus, and advise them to take particularly strict precautions - social distancing, etc.
On the subject: 10 easy and fun ways to keep children quarantined
10. How can a family protect their child from coronavirus infection?
Washing your hands thoroughly, not coming into direct contact with others, and disinfecting surfaces and objects that may be exposed to the virus are the main ways to prevent the further spread of Covid-19 - just like regular flu.
“Responsibly follow the ground rules,” Patel says. "If you are on the street, in a public place, you touched something, under no circumstances touch your face until you have properly washed your hands."
The site British National Health Service There is information on measures that must be taken in the family to protect themselves from Covid-19.
UNICEF also released 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 many families walking, where grandparents and parents and children were together,” says Patel.
“In my opinion, it was absolutely frightening: the data shows that the elderly, especially those with pre-existing medical conditions, are the main risk group. And to exclude contacts of children with them is the most correct thing. Why take such a 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 have to do: tell their 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 adolescents worry about their families,” says Lennea Karlsson, professor at the University of Turku (Finland) and child psychiatrist. "We need to explain to them that now are exceptional circumstances, and that if not for this, we would not have asked them to do such unusual things."
“We need to explain that in a situation like this, we have to take care of everyone, not just ourselves and our family.”
