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Coronavirus and children

How the virus behaves in children: infection, symptoms, and transmission risk

1. The risk of infection in children

1.1. Can children get infected?

Children can also get infected with the novel coronavirus (SARS-CoV-2). However, the risk of infection is often underestimated in children and teens because their symptoms are generally milder than those of adults. This is because children are less likely to have serious pre-existing conditions that put extra strain on their bodies when they have a coronavirus infection [1]. 

However, because they still carry the virus, are less able to comply with control measures, and are often in close contact with each other, children can spread the virus widely, both to each other and to adults [2].

Whether or not a child has symptoms is irrelevant: Even children with few symptoms spread the same quantity of virus through exhaled air as adults with more pronounced symptoms. The amount of virus in the nose and throat is also similar for infected children and adults. However, it has also been found that many children with coronavirus were infected by an adult contact [3]. 

Ultimately, children can be infected by adults or by other children who can pass on the virus even if they don’t have any symptoms [4]. 

1.2. Measures to prevent infection in everyday life

Course of the pandemic without countermeasures

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Proper ventilation is one of the best ways to protect children and yourself from infection because the coronavirus can linger for long periods in room air in the form of tiny particles known as aerosols. You can significantly reduce the risk of infection by regularly airing rooms with the windows wide open every 20 minutes or so [5]. 

The amount of time you need to air the room depends on the season. In summer, you should air the room for 20 to 30 minutes. In winter, shorter bursts of 5 to 10 minutes at a time may be enough. Children may need to put on warmer clothing while the room is being aired. If you can open windows on opposite sides of the room at the same time, this will speed the ventilation process up considerably. If many people are gathered together in a confined space, it may make sense to keep the windows open the whole time [6].

In schools and similar establishments, rooms should be aired during every break between lessons – or at least every 45 minutes if lessons last longer than this. It is a good idea to air rooms during lessons as well. In addition, the room should be aired immediately if somebody in the room repeatedly needs to cough or sneeze. Other measures such as physical distancing, good hygiene, and face masks are much more effective when combined with measures to ensure that there is enough fresh air indoors [6]. 

The feasibility of some measures depends on the age and motivation of the child. Whenever possible, an attempt should be made to ensure that children comply with contact and hygiene rules. These include staying 1.5 meters away from other people, regularly washing hands, and wearing a mask that covers both the mouth and nose [7]. 

Especially in the case of very young children, these measures can be difficult to implement and a workable balance will need to be struck. Measures such as washing hands thoroughly with soap and water, carefully cleaning frequently touched surfaces, and minimizing contact with others are all advisable and often easy to implement [8].

Children who are infected with coronavirus should not attend daycare, school, or other appointments and social events. The same applies in the case of a suspected infection, and children should only resume activities once a negative test result has ruled out the possibility of infection [9].

2. Clinical course in children

2.1. Typical symptoms

Most children with coronavirus have mild symptoms or no symptoms at all.  It’s impossible to say for certain based on existing symptoms whether a child is infected with coronavirus or with another virus or bacterium. The two most common symptoms of COVID-19, the disease caused by the SARS-CoV-2 coronavirus, are fever and cough. However, these occur in only one out of every five children infected with the coronavirus [10]. Even in children with clear respiratory symptoms caused by the coronavirus, only around half have fever and cough [11]. Other symptoms may include a stuffy or runny nose, headache, sore throat, loss of taste or smell, aching limbs, diarrhea, fatigue or drowsiness, nausea, vomiting, or a rash. All these symptoms are also seen with other common diseases, especially the common cold and flu [4]. 

Unfortunately, the temperature of a child with a fever doesn’t provide a reliable indication of whether it is a coronavirus infection either [11], which is why it is impossible to confidently diagnose a coronavirus infection in children based on symptoms and regular body temperature measurements alone [11].

2.2. Signs of a severe infection

Most coronavirus infections in children are mild. If the clinical course is severe, this is often because the child also has an underlying disease that existed before the infection, such as lung disease, diabetes, a heart abnormality, a weakened immune system, a genetic condition, obesity, or another underlying condition [4]. Pre-existing treatment that affects the child’s immune system may also be a reason for severe disease [3]. 

If a child shows clear symptoms of illness such as fever, cough, sore throat or ears, severe abdominal pain, vomiting, diarrhea, or an unexplained rash, they should not attend daycare or school under any circumstances and medical advice should be sought [7]. 

Symptoms such as increasing breathlessness, persistent chest pain or tightness, confusion, extreme and unusual drowsiness, bluish lips, and severe abdominal pain may be signs of a severe coronavirus infection and the child should be taken to an emergency room immediately [12].

Fortunately, severe illnesses and deaths from coronavirus infection in children are extremely rare [3].

3. Transmission from children to others

3.1. Likelihood of infecting others

The amount of coronavirus found in the lining of the nose and throat of infected children does not differ significantly from that of adults [13]. This means that children are also capable of passing the infection on to other children and adults. Infected children may also be contagious even if they don’t have any symptoms. The amount of virus found in the nose and throat is highest in the first two days after the onset of symptoms [11].

There are many reasons why children play only a minor role in the transmission and spread of the virus. It has been found that infections in families were transmitted mainly by adult family members – usually by the child’s parents. So far, there have been hardly any cases of households with infected children where the adults are not also sick.

In certain schools with high rates of coronavirus infection, children under the age of 15 years were not significantly affected or involved in the spread. According to a statement issued by several German expert associations, school closures have had little impact on the spread of the virus [3]. 

Nevertheless, some studies have found cases of infected children where the source of infection was outside the child’s immediate family [11]. The risk posed by infected children is therefore not yet entirely clear.

Course of the pandemic with countermeasures

orginal source

3.2. Measures to prevent the spread of infection

Since coronavirus infections in children are usually mild or even asymptomatic, it is often difficult to detect the disease early on and prevent transmission to others. In addition to observing the generally recommended measures (physical distancing, hygiene measures, and face masks) and ensuring adequate ventilation, you should also pay attention to the following [1]: 

  • Look for the symptoms mentioned above every day (see 2.1). 
  • Keep track of whom the child comes into contact with on a daily basis. 
  • Keep a journal in which any gatherings held in confined spaces are listed. This can make it much easier for health authorities to trace the chain of infection later. 
  • If relatives of a child or the child itself should fall ill, the school and the responsible health authority must be informed immediately.

Always reconsider whether or not to allow contact between children and people with pre-existing conditions, especially the elderly. If there is even the slightest suspicion that the child poses an infection risk, encounters of this type should not take place under any circumstances [8]. The same applies to contact with children who have cancer [14].

The contents of this article reflect the current, scientific status at the time of publication and were written to the best of our knowledge. Nevertheless, the article does not replace medical advice and diagnosis. If you have any questions, consult your general practitioner.

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