Children are “silent spreaders” of COVID-19 and have higher levels of virus in their airways than severely ill adults, triggering concerns about a third wave if schools don’t reopen properly, according to a researcher of the most comprehensive study of coronavirus pediatric patients to date.
“If we don’t do right with reopening schools, we will have a third wave that will be carried out by kids,” said Dr. Alessio Fasano, director of the Mucosal Immunology and Biology Research Center at Massachusetts General Hospital and senior author of the study published in the Journal of Pediatrics.
Risk of coronavirus contagion is greater with a high viral load, and although children with the virus are less likely to become very ill, they can still spread infection and bring the virus home, according to Fasano.
“During this COVID-19 pandemic, we have mainly screened symptomatic subjects, so we have reached the erroneous conclusion that the vast majority of people infected are adults,” said Fasano.
“However, our results show that kids are not protected against this virus. We should not discount children as potential spreaders for this virus,” he said.
In the study of 192 children age 0-22, 49 children tested positive for the virus that causes COVID-19, and an additional 18 children had late-onset, coronavirus-related illness.
The infected children were shown to have a significantly higher level of virus in their airways than hospitalized adults in intensive care units, especially in the first two days of infection — a finding that Fasano said came as a surprise.
Fasano said a lot of participants lived in hot-spot areas, had contact with a known coronavirus case or had flu-like symptoms. Many were asymptomatic or had few symptoms.
More than half of the kids in the study with acute coronavirus infection came from low-income communities compared to 2% from high-income communities.
Even when children did show symptoms such as fever, runny nose and cough, they often overlap with the flu or common cold, confounding an accurate COVID-19 diagnosis, said the study conducted by MGH and MassGeneral Hospital for Children.
The research comes as districts in Massachusetts prepare for the start of the school year and 70% plan for some kind of in-person instruction, Gov. Charlie Baker announced earlier this week.
Fasano said schools can reopen safely, but only with stringent infection control measures to keep kids and teachers safe, including social distancing, mask-wearing, hand-washing and routine screening of students for the virus.
“If we do not have that kind of approach, we will have another disaster here,” said Fasano. “Don’t give anything for granted, don’t just relax, I know we have been sick and tired of being home for months.”
Researchers said relying on body temperature and symptom monitoring to identify infection will not be sufficient.
Fasano said for families that live in hot spot areas, “You need to be really, really conservative when you send your kids to school.”