The novel coronavirus, SARS-CoV-2, (and the disease it causes, COVID-19) has the entire world on edge, but perhaps nobody is as concerned as parents. It can seem impossible to shield children from illnesses when germs are unpredictable and omnipresent. And the fact that the coronavirus is spreading in America—where it’s caused 188,247 illnesses and 3,921 deaths so far—also doesn’t help parental anxiety.
But here’s a bit of optimistic news for moms and dads: The coronavirus doesn’t seem to impact babies and children as severely. A World Health Organization (WHO) - China Joint Mission report on the coronavirus, published in mid-February 2020, found that children aged 18 or younger accounted for only 2.4 percent of all coronavirus cases in China. On top of that, a new study by the American Academy of Pediatrics (AAP) of pediatric cases of the coronavirus in China confirms what the WHO found, adding that "over 90 percent of all patients were asymptomatic, mild, or moderate cases."
And while the first infant death related to COVID-19 in the U.S. was reported in Illinois on March 28, the limited research available suggests “that children with confirmed COVID-19 have generally presented with mild symptoms,” says the Centers of Disease Control and Prevention (CDC). Severe complications seem to be exceptionally rare in kids.
Here's what parents need to know about the coronavirus and children, plus tips for preventing the respiratory illness that originated in Wuhan, China.
What are Coronavirus Symptoms in Children?
Most children with the coronavirus have mild cold-like symptoms, such as fever, runny nose, and cough, according to the CDC. Gastrointestinal issues, like vomiting and diarrhea, may also occur. Some children have no symptoms whatsoever.
The coronavirus complications appear to be uncommon for those under 18 years old—even in small infants. In fact, the WHO-China Joint Mission report states that only 2.5 percent of children diagnosed with the coronavirus had “severe” symptoms, and 0.2 percent were considered "critical." The recorded complications include acute respiratory distress syndrome and septic shock, according to the CDC.
How Are Babies and Infants Being Affected?
Since babies don't have fully formed immune systems, it would make sense that they'd be severely affected by the virus. According to the 2020 AAP study of those affected in China, while kids of all ages are susceptible, young children might be more vulnerable. The proportion of severe and critical cases was 10.6 percent for infants under 1 and 7.3 percent for kids ages 1 to 5, compared to 3 percent for 15- to 18-year-olds. Like older children, however, babies display mild symptoms in most cases, but might also be asymptomatic.
In China, for example, only nine infants had confirmed coronavirus cases between December 8 and February 6, according to a February 14 report published in JAMA. The infants were between 1 month and 11 months old, but none required intensive care. No severe complications were reported either.
But while this is great news, it might lead to another problem: Babies might unknowingly spread coronavirus to their parents or caregivers. Take this case in Singapore published in the journal Clinical Infectious Diseases, which involves a 6-month-old baby. After a mother and nanny were hospitalized with pneumonia—and the father came down with a fever and sore throat—hospital staff found the baby had high levels of the coronavirus in his "throat, blood, and stool," according to the Los Angeles Times. The baby was asymptomatic, which caused the coronavirus to spread easily to caregivers. He didn't develop any symptoms during a subsequent hospital stay (with the exception of a very short-lived fever).
These "silent cases" could help spread the coronavirus even further, which is particularly worrisome for grandparents and caregivers with compromised immune systems.
Why is the Coronavirus so Mild for Children?
Since the coronavirus is a novel disease, experts still don’t know many things about it—including why children have lower transmission rates and milder symptoms. “We don’t definitively know the reason,” says K.C. Rondello, M.D., MPH, CEM, clinical associate professor at the College of Nursing and Public Health at Adelphi University. “Everyone from virologists to epidemiologists to infectious disease doctors are completely stymied as to why we’re seeing this phenomenon.”
Here are a few theories, however, within the medical community:
Kids Have a Better Immune Response
One theory is that children have better immune responses than adults, which helps them fight off the coronavirus. “Children’s immune systems are not fully functional until later in their development. As a result, they have a considerably stronger and more robust immune response to pathogens than adults,” explains Dr. Rondello.
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What’s more, “The death rate for COVID-19 is higher among individuals with certain pre-existing conditions, such as cardiovascular disease, diabetes, and cancer. This may help explain why many children seem to be at lower risk, since they are less likely to have these types of preexisting conditions,” says Aimee Ferraro, Ph.D., faculty member for Walden University’s Master of Public Health (MPH) program.
Many experts tentatively support the hypothesis, but there’s also a hitch: The coronavirus seems to spare most infants even though their immune systems aren’t fully formed yet.
Experts Might Not Be Identifying All Coronavirus Cases
Robert Frenck, M.D., medical director of the Division of Infectious Diseases at Cincinnati Children’s Hospital, says that a reporting bias might be to blame. When the coronavirus first emerged, doctors in America and China were only testing people with severe symptoms. But they’ve since found that milder, cold-like symptoms may also occur.
“It’s possible that the coronavirus causes a spectrum of illnesses, and that medical organizations are only identifying the more serious ones,” summarizes Dr. Frenck. Children might not be getting diagnosed if they’re only experiencing mild symptoms—which means the coronavirus may be affecting more children (and people in general) than reported.
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Kids Could Have "Immunological Cross-Protection"
According to Dr. Rondello, a number of different viruses could give you the common cold—including milder forms of coronavirus. “Children get colds a lot, so they’re already being exposed to more benign, less intense coronaviruses. They could have potentially built immunity to them,” he says. Dr. Rondello calls this “immunological cross-protection.”
Kids Could Have Less Exposure
Other experts say kids might simply have less exposure to the coronavirus, since infected adults are more careful to prevent the spread of sickness, according to Business Insider. Plus, the article adds, more adults probably visited the presumed source of the coronavirus: the seafood and live animal market in Wuhan, China.
Smoking is a Potential Risk Factor
An earlier theory suggested that smoking might be a risk factor for COVID-19, since smokers tend to have greater SARS-COV receptors. “And since children do not smoke, they would be less susceptible to lower respiratory tract infections like COVID-19,” says Dr. Ferraro. This hypothesis has fallen out of favor, though, since experts found that the coronavirus transmission was comparable in counties with both high levels and low levels of smoking.
How to Prevent Coronavirus in Children
Like the cold and flu, the coronavirus is a respiratory illness that spreads through contaminated droplets. These droplets enter the body through the eyes, nose, and mouth, says Miryam Wahrman, PhD, biology professor and director of the microbiology research lab at William Paterson University in Wayne, New Jersey, and author of The Hand Book: Surviving in a Germ-Filled World.
The absolute best coronavirus prevention method, says Dr. Wahrman, is washing your hands with soap and water for at least 20 seconds. Alcohol-based hand sanitizer can also work in a pinch. Washing your hands is especially important before eating or touching your face. Parents should also disinfect common surfaces like doorknobs and countertops often.
Send your children to school like normal, but watch for updates from the school board or health organizations. The CDC has said that a coronavirus outbreak in America is “imminent,” and that parents should prepare for potential school closures. Indeed, schools have been shut down in Seattle, New York, and many other areas impacted by the disease.
“You can also give children disposable wipes so they can clean commonly used surfaces like keyboards at school,” adds Dr. Ferraro. “Parents should keep their children home from daycare or school if they are sick, and call their health care provider early to discuss the best approach for treatment.”