A hotly debated question is how efficient is the transmission of COVID-19 from children and adolescents to household contacts. This question has immediate resonance as we anticipate reopening schools for children of all ages, especially those twelve and under who will be unvaccinated at the start of the school year. A recent study provides an answer to this question: children and adolescents transmit SARS-CoV-2 efficiently to household contacts and some of these contacts require hospitalization. The study, done last year, was completed before the advent of the still more contagious and dangerous Delta variant. The study was published by The New England Journal of Medicine in July of 2021.
The SARS-CoV-2 infected children that returned from camp — 88% of whom had symptoms — had 526 household contacts, mainly parents and siblings. Twelve percent of those household contracts that agreed to be tested were infected. Ten percent of those infected required hospital care. The hospital stays ranged from five to eleven days. No one younger than eighteen required hospitalization. While none of the household contacts died, several have underlying medical conditions that put them in danger.
Testing was voluntary and participants reported results themselves. For that reason, the secondary attack rates are likely underestimated. Another confounding effect on that study includes a third of the index patients who began to have symptoms while still at camp. These campers may have been less infectious by the time they got home, compared with those whose symptoms started after they returned. While two-thirds of campers adopted social distancing measures upon their return home, transmission was likely reduced throughout the household.
Children ill from COVID-19 pose a special risk for parents and caregivers. They must try to minimize their exposure and this of other household members, particularly those who might be a risk. Dr. Victoria Chu, a lead researcher involved in the study suggests, “the child should be cared for and monitored using the proper combination of physical distancing, isolation when feasible, and mask use to prevent household transmission as much as possible”. In the absence of clear guidance, most parents do not know what to do to follow this sage advice.
A mother of two young grade school children I spoke with summarized the challenge for parents and children alike, “This study sends chills up my spine. With schools reopening this fall and the options for remote learning much more limited than they were last year, this study is a reminder of how risky indoor activities are for our kids and for their families. I can only hope that our government, community leaders, and school administrators will ensure that kids are properly protected with masks, social distancing, and ventilation—all the things that can keep them safe indoors, especially for those who are too young to be vaccinated. Imagine the burden a child would have to bear if they were to bring a life-threatening disease home to their families, from the simple act of going to school or to camp—this year has already taken an unimaginable toll on our kids. We should do everything possible to ease their burden this fall if we can.
The study is an eye-opening look into what the fall could look like with schools reopening and children gathering without proper social distancing measures. With the more infectious and dangerous Delta variant on the rise, it is important, now more than ever, that we limit the spread and vaccinate children over the age of twelve who are eligible. We must also take the steps to mentally prepare children for their return to the classroom by explaining to them the necessary precautions to ensure their family’s safety during a global pandemic. While no mother or father wants to see their child sick, the government and school districts must take steps forward to ensure the safety of our children, while parents must also be educated in doing what is best for their child as COVID-19 is a continuous risk to the nation’s health.