A recent study carried out in France dove into the contribution of very young children to the transmission of SARS-CoV-2. The study included 22 daycare centers that remained open for essential workers’ children during a nationwide lockdown between March 15 and May 9 of last year, prior to the arrival of variants.
327 children between the ages of 5 months and 4.4 years, 197 daycare center staff, and 164 adults who are not occupationally in contact with infected patients were enrolled to estimate SARS-CoV-2 seroprevalence. 3.7% of children and 6.8% of daycare center staff tested positive for the virus. The comparator group came close with a seroprevalence of 5%. This indicates that infected children were most likely exposed to the virus at home.
While these results seem to suggest that intrafamily transmission is more likely than transmission in daycare centers, they are part of an exploratory hypothesis and further research is necessary. Many saw this study as positive news that might lead to schools re-opening, but it is too early to make such claims. The study was not carried out in the right setting, and it does not take new, more dangerous variants into consideration.
The environment the study was carried out in was too controlled to accurately represent day-to-day life. The centers operated at limited capacity, taking in fewer children, respecting social distancing rules among adults, wearing face masks, and regularly disinfecting surfaces. Parents were also instructed to remain outside the centers, and to screen their children for symptoms prior to sending them in.
We do not know how the new variants of SARS-CoV-2 affect young children yet. What we do know is that the new strains have a higher affinity for ACE2 receptors, making them more likely to infect the cell. Initially, children were at a lower risk of infection as they have less ACE2 receptors, but this is no longer true. Prematurely opening schools could lead to a surge in SARS-CoV-2 cases in children.
Another rising threat to children is Multisystem Inflammatory Syndrome in Children, or MIS-C. The condition is associated to SARS-CoV-2, with most patients either testing positive for antibodies or for active infection. The syndrome can afflict infants and children up to 20 years of age, but it is uncertain what exactly predisposes children to the condition. While MIS-C remains rare, an increasing percentage of patients are becoming critically ill. Whether or not the new variants have a role to play in increasing the fatality of MIS-C, governments should acknowledge the severity of the condition and reconsider re-opening public schools.
More studies on the different strains and in different environments must be carried out before we can use the findings of the French study as a reason to ease restrictions. France has also not been exemplary in fighting the virus. Averaging at around 18,000 cases daily, it is the country with the second most cases in Europe.
The study is more of a cautionary tale for country leaders not to act too quickly in the name of science. We must monitor the rising number of Covid-19 infections and MIS-C cases in children ages 1 to 10 carefully, and be prepared to adjust policies governing daycare centers and school re-openings and based on emerging data lest the sharply rising numbers of Covid-19 variants hit us where it will hurt the most, our precious children and grandchildren.