America’s Kids are on a Runaway COVID Train (The Science of Back to School #2)
Reported Cases are Increasing in Every Region of the U.S.
by Elizabeth Pathak, PhD, Janelle Menard, PhD, and Jason L. Salemi, PhD
In the early days of the pandemic, there were a lot of messages from experts and the media about COVID-19 in children than turned out to be false. We were told that kids were at very low risk of catching the novel coronavirus, that they weren’t going to get seriously ill, and that they certainly weren’t going to die.
We have since learned that SARS-CoV-2 is a highly infectious, easily transmissible, and stubbornly stealthy pathogen that is equal opportunity in its menace: children can and do become infected, they can transmit the virus to others, and they can become seriously, even critically ill.
As with almost all human diseases, the risk of serious illness and death from COVID-19 does increase dramatically with age – elders are at highest risk, and the “oldest old” – those over 80 years of age –experienced very high rates of morbidity and mortality from COVID-19 in the first 6 months of the 2020 global pandemic.
Thankfully, the majority of children and teens who become infected with SARS-CoV-2 do not develop severe illness. Nonetheless, it is important not to minimize the COVID-19 risks to children and teens. Since April 2020, The COVKID Project has been tracking and reporting all available COVID-19 surveillance data for the pediatric population in the U.S., and as of Labor Day 2020 our nation has hit several grim milestones:
Ø Reported cases in kids have surpassed 615,000, with >10,000 cases in 22 states, and >20,000 cases in 8 states. (“Kids” are 0-17 or 0-19 years depending on the state.)
Ø More than 1,300 children aged 0 to 17 years have become critically ill with COVID-19 and been admitted to a pediatric intensive care unit for treatment.
Ø More than 120 children and teens have died from COVID-19.
Some people have argued that children can catch the coronavirus, but they don’t spread it to others. This is not true – the virus can spread from children to other children and to adults. For example, in a church-based COVID-19 outbreak in Ohio, the virus spread from a 16-yo boy to both parents and 2 younger siblings; from another 16-yo boy to his father; from a 15-yo girl to her father; from a 12-yo girl to her mother and sister; and from a 6-yo girl to 3 older siblings.
Given that schools have been closed in most localities since March, many infected children have likely caught the coronavirus at home from a household member. According to the U.S. Census, most children in the U.S. live with two parents (70.1%), and at least one other child (79.1%). Significant fractions of children live in 3-child households (24.9%), 4+child households (16.3%), and/or with at least one grandparent (10.0%). Nearly 2 out of 5 U.S. children live in households with incomes below 200% of the federal poverty level (38%). In summary, households with children tend to be larger than average in terms of people, and, because of poverty, smaller than average in terms of physical space – unfortunately ideal circumstances for viral spread.
In the absence of the strict mandatory household isolation protocols that were used in China, it is very difficult to prevent within-household transmission of the virus in the U.S. Therefore, to break the chains of viral spread both to and from America’s children, we need to first and foremost protect their parents. Many parents of children under 18 years of age are blue collar and service sector workers. These workers need protection not just at their jobsites, but also during transportation in buses, trains, and carpools.
We also need to eliminate direct exposure of children to the virus outside the home. This means that children of all ages need to wear masks AND practice social distancing consistently, so that they do not bring the virus home and risk infecting their family members.
Finally, we know now that breathing indoor air in group settings is the riskiest modality for catching COVID-19. Eating and drinking are by necessity mask-free activities, so eating and drinking indoors carries a risk for coronavirus infection that is very difficult to mitigate. In the home, shared meals are an important reason that a single infected person may soon transmit the virus to family members. In the community, social proximity in restaurants and bars while unmasked has led to rapid increases in adult COVID-19 cases across the nation throughout the summer.
The World Health Organization recommends that the local COVID-19 test positivity rate fall below 5% before lifting public health restrictions and social measures for pandemic control. When schools reopen in communities where this criterion has not been met, lunchtime will be one of the most difficult problems to solve. Safely eating lunch indoors may be possible with high-quality air purification, sufficient ventilation, and extreme distancing (>16 feet) – but many schools do not have the financial resources or physical space to implement these measures.
From July 11 to August 11, BEFORE schools reopened, the number of children and teens who had ever tested positive for COVID-19 DOUBLED from approximately 225,000 to over 450,000. On a regional basis, the case doubling time for kids ranged from 28 days in the Southeast (inc. Florida), 29 days in the Far West (inc. California), 31 days in Plains states, 33 days in Rocky Mountain states, 34 days in the Southwest (inc. Arizona and Texas), to 36 days in the Great Lakes states. Two regions are experiencing slower, but still upward growth in COVID-19 cases in kids: case doubling time was 71 days in the Mideast (inc. New York), and 79 days in New England.
Even though some schools will postpone resumption of face-to-face instruction this fall, almost all of America’s kids will still be stuck on a runaway COVID train unless we put the brakes on community and household transmission of the novel coronavirus.
The authors are epidemiologists, and leaders of The COVKID Project. Elizabeth Pathak (@BethPathak) is president and Janelle Menard (@JanelleMMenard) is vice president of the Women’s Institute for Independent Social Enquiry (www.wiise-usa.org), a non-partisan think tank. Jason L. Salemi (@JasonSalemi) is an associate professor of public health at the University of South Florida.