Children and coronavirus: Should I send my child to school with a cold?
They are the least likely group to become fatally ill with the virus, but in many ways the young have been the most profoundly affected by the fallout from Covid-19, missing months of school and having their social lives curtailed.
Now, as schools have finally reopened, concerns that sending kids back to class could trigger a catastrophic second wave are beginning to grow.
Authors of a report released by the University College London and the London School of Hygiene and Tropical Medicine this week warned that without improvements in testing it would be “absolutely essential” to introduce other measures in September to “mitigate” the effects of schools opening.
Getting children back into classrooms has been held up by the prime minister as a “national priority”. But the chief medical officer in August admitted the UK may have reached the “outer edge” for how far we can emerge from lockdown without leading to a resurgence of the virus.
There has been much debate since the very beginning of the pandemic around whether or not children can get the virus, or be carriers, and there are still significant gaps in our understanding of the impact of Covid-19 on the young. Here’s everything we know so far.
Can children get coronavirus?
The short answer is yes, children can get coronavirus. However, Great Ormond Street Hospital (GOSH) said last month that the evidence (as of July 22) suggests that although children do develop Covid-19, “very few” develop severe symptoms, even if they have an underlying health condition.
Dr Sanjay Patel, a consultant in pediatric infectious diseases and immunology at Southampton Children’s Hospital, says the data on children with Covid is “still pretty flimsy”. “We know children are infected. We know they have a far milder disease than adults. We know that the older you are the more likely you are to get sick.
“Data from Iceland and other Chinese data showed that rates of infection in children were about half that in adults, but the truth is that until they're doing population level serology [diagnostic examination of blood serum], it's really hard to know who has been infected and who hasn't.
"I think we take all of it with a bit of a pinch of salt. All you can say for sure is that children are getting milder illness.”
Can children pass it on?
A topic that has generated much research and debate. An exclusive report by The Telegraph in May revealed that the Royal College of Pediatrics had found that there have been no cases where a child had passed coronavirus to an adult. Similarly, major studies into the impact of Covid-19 on young children suggest they "do not play a significant role" in spreading the virus. Experts note that there has not been a single case of a child under 10 transmitting the virus, even in contact tracing carried out by the World Health Organisation (WHO).
However, these reports tend to come with the disclaimer that more research is needed. To give one example, Germany's chief virologist Christian Drosten had said there is insufficient data to say conclusively that young children could not transmit the virus. He told Austrian broadcaster ORF that the question of whether children contracted the virus, and if so how they might pass it on, was answered differently in different studies.
Dr Patel points out that the data on children not transmitting it is “very very weak indeed”. “It is hazardous to draw firm conclusions when we know that when we test children they are positive,” he says. “We know that other respiratory infections are readily transmitted by children. I would not have my children hugging my parents who are both over 70 at the moment. Nothing in the literature has convinced me that children cannot transmit Covid.”
There remains a possibility that the age of a child has a bearing on his or her ability to catch and pass on the disease. Findings from a study carried out by a university in Italy in April suggested that children under the age of 11 could be less at risk of contracting the virus than 11-20 year olds. Another study, this time from South Korea, found that children younger than 10 transmit to others much less often than adults do, but the risk is not zero. It found that kids between the ages of 10 and 19 could spread the virus at least as easily as adults.
The findings suggest that as schools reopen, communities may see clusters of infection take root that include children of all ages.
Michael Osterholm, an infectious diseases expert at the University of Minnesota, told the New York Times “I fear that there has been this sense that kids just won’t get infected or don’t get infected in the same way as adults and that, therefore, they’re almost like a bubbled population.
“There will be transmission. What we have to do is accept that now and include that in our plans.”
Should I send my child to school with a cold?
If they had a cold, it would be safe to go to school - but these are uncertain times. However, as demand for testing rises, experts have now said children who have a runny nose do not have coronavirus - which would make their attendance safe.
Prof Tim Spector, who developed the Covid-19 symptom tracker app, revealed that children under 18 displayed a completely different array of symptoms to adults and that if they had a cough or congestion were almost certainly suffering from the common cold that is sweeping through schools.
However, if you're genuinely uncertain about your child, keeping them at home may be the safest precaution.
What is Kawasaki Disease, the new coronavirus-related 'syndrome' which a small number of children have presented with?
In April, NHS doctors were told to look out for a rare but dangerous reaction in children.
This was prompted by eight children in London becoming ill, including a 14-year-old who died. They were hospitalised with similar symptoms (including a high fever, rash, red eyes, swelling and general pain) that initially looked like sepsis. Some of those patients tested positive for Covid-19, prompting conversations in the medical community about whether there might be a new inflammatory syndrome which could be an extreme reaction to Covid among very young patients.
Some of these cases have been likened to a rare inflammatory heart condition called Kawasaki, for which the symptoms are similar to sepsis and toxic shock.
“For doctors looking after these children, they present as if they’ve got sepsis,” explains Dr Patel. “They’ve got a fever and abnormal blood tests, but when further investigation is done they recognise that there’s also an inflammatory component that is affecting bits of the body – you can get a rash, or red eyes, or cardiac inflammation.”
These symptoms have been likened to the overactive immune response known as a "cytokine storm" which has been seen in adults with Covid-19. In these cases, it seems it is the body's immune response rather than the virus itself that proves life-threatening.
Dr Patel says there are some similarities between these pediatric cases and what has been observed in a number of adult cases, but it’s too early to say for sure. “The timing and dynamics are not exactly the same. So in adults, you often have seven days of Covid symptoms and then you potentially get worse and that’s when the cytokine storm happens.
“The timelines are not quite so clear with this. It may be a similar phenomenon but at the moment it’s just too early to say, we’ve got too few patients with this to draw any firm conclusions.”
It's important to note that these cases are very rare events.
Is this only happening in the UK?
At the start of May, three children in the US were also being treated for inflammatory symptoms thought to relate to coronavirus. All three – who range in age from six months to eight years – had fevers and inflammation of the heart and the gut.
Dr Patel says a small number of these new cases have been identified in Europe too. “We’ve been talking to Italian and Spanish colleagues and they have had extremely small numbers of something similar – this inflammatory presentation in children. But still we haven’t been clear if it’s due to Covid.
“Half the children have tested negative for Covid on our viral testing, so there’s still so much to learn.”
How worried should parents be about coronavirus and Kawasaki Disease?
Experts stress that very few children become severely ill with coronavirus. Evidence from around the world suggests they are the group least affected by the disease.
Children are thought to make up just 1-2pc of all cases of coronavirus infection, accounting for less than 500 admissions to hospital in Britain.
The Royal College of Paediatrics and Child Health (RCPCH) say parents should be reassured by this, but stress that if they are concerned about their children's health for any reason, they should seek help.
Dr Patel says he has “very little concern or fear” that children are getting sick from Covid. “I think children are definitely the lowest risk group. The inflammatory syndrome is exquisitely rare. And parents should just be looking out for the normal red, amber, green criteria that is on the NHS website and ensuring their kids don’t have close contact with vulnerable people.”
When should I dial 999?
The RCPCH advises you should go straight to the nearest A&E department or call 999 if your child...
Becomes pale, mottled and feels abnormally cold to the touch.
Has pauses in their breathing (apnoeas), has an irregular breathing pattern or starts grunting
Experiences severe difficulty in breathing, becoming agitated or unresponsive.
Is going blue around the lips.
Has a fit or seizure.
Becomes extremely distressed (crying inconsolably despite distraction), confused, very lethargic (difficult to wake) or unresponsive.
Develops a rash that does not disappear with pressure (employ the ‘Glass test’).
Has testicular pain, especially in teenage boys.
How can I treat my child’s mild coronavirus symptoms at home?
If your child is well enough to be looked after at home, experts at RCPCH recommend that parents treat symptoms of fever or pain related to Covid-19 with either paracetamol or ibuprofen.
The Commission on Human Medicines’ Expert Working Group on coronavirus has now concluded that there is insufficient evidence to establish a link between use of ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs), and the worsening of covid-19. Catrin Barker, Chair of the RCPCH Medicines Committee and Chief Pharmacist at Alder Hey Children’s Hospital, says: “Our advice to parents is that either paracetamol or ibuprofen can be used to treat their child if they have symptoms of COVID-19, such as fever and headache, and should follow NHS advice if they have any questions or if symptoms get worse.”
What happens if my child becomes ill with something else at the moment?
It is, of course, highly possible your little ones may come down with something else entirely during lockdown or once they return to school.
Dr Patel says that far from being overly worried about children getting Covid, he is more worried about non-Covid health incidents. He says: “I think the real harms that have been generated from lockdown on families has been very palpable, and for me that’s where the greater long term harm will lie - children not being immunised, issues with child protection, especially in some of the most vulnerable families where you’ve lost that oversight through school.”
Prof Simon Kenny, NHS national clinical director for children and young people, told the BBC: "The advice to parents remains the same: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital."
