Children and Coronavirus: So Much Still Unknown as Schools Head for Reopening

Early talk said kids weren’t facing the same risks. Now, experts say they do — as well as lingering effects if they become ill
Credit: Gerd Altmann via Pixabay
Back to school with COVID-19

Despite some common misassumptions, research suggests young children do face certain risks with the novel coronavirus, and experts insist public health must remain the priority as New Jersey and other states consider how to reopen schools in the coming weeks.

“We started this with a myth that we’re having a hard time shaking, and that myth is that COVID spares kids,” said Dr. Lawrence Kleinman, a professor and population health expert in the pediatric department of Rutgers University’s Robert Wood Johnson Medical School, in New Brunswick. “And that desire to reassure creates harm,” he added.

Individuals under 18 make up a small percentage of the overall COVID-19 cases nationwide, and an even smaller fraction of the hospitalizations and deaths. But those that get sick can be severely impacted and suffer long-term consequences. Experts also acknowledge much remains unknown about the new disease. And many parents, educators and public health leaders are concerned that sending groups of children into the classroom could put them and their families in danger and exacerbate what appears to be a growing spread throughout communities in some states, including New Jersey.

Much more than meets the eye

In addition, while some studies indicate youngsters may be more likely to be asymptomatic, or not show outward signs of the disease, Kleinman said these patients can still spread the virus and may experience lung damage or other medical problems not evident to the naked eye.

“It’s a mistake to confuse asymptomatic with ‘It doesn’t matter’,” Kleinman said. “Asymptomatic doesn’t mean there’s not pathology or harm or later consequences, because we don’t know anything about the long-term consequences” of COVID-19, he added.

In addition, if a COVID-positive child somehow infects a grandparent or other vulnerable loved one, it could trigger feelings of guilt in addition to sadness, Kleinman explained. “There’s the potential for psychological trauma,” he said. “When we think about the impact on kids, we have to think about that as well.”

According to an analysis of federal data by the nonprofit Kaiser Family Foundation, minors make up roughly 7% of COVID-19 cases nationwide, 1% of the hospitalizations and less than 1% of the deaths. In New Jersey, the rates among those under 18 appear to be even lower, with this age group accounting for less than 3% of the total cases (or roughly 5,200), barely 1% of the hospitalizations (some 208 patients) and just 0.01% of the fatalities. Two children, both under age five, have died; nearly 14,000 deaths are said to be the result of the virus in New Jersey.

But the overall number of new cases spiked several days last week, and the state’s rate of transmission, or RT, had crept up to 1.35 by Friday, a level not seen since at least April, according to the state’s calculations of how successfully the disease is spreading. Gov. Phil Murphy suggested Friday that “alarms are going off” and additional restrictions may be reintroduced if people continue to flout state orders to wear a mask, and don’t avoid unnecessary outings, maintain at least 6 feet of distance from other people and frequently wash their hands.

Party like it’s COVID-19

While Murphy has recently focused his frustration on older teens and young adults who appear to be responsible for some transmission by attending large house parties, others worry that reopening schools and additional businesses — something currently on hold in New Jersey — could trigger a second wave of the pandemic statewide.

President Donald Trump has insisted children must return to classrooms this fall and federal guidelines have been revised to make it easier for local districts to comply. Murphy has called for some form of in-person instruction, and the state has issued initial guidance, although in late July he said parents could instead opt for remote-only lessons.

New Jersey school districts are crafting a variety of approaches in response, with many seeking to have specific groups of kids rotating through a mix of online and classroom days each week. Teachers unions are lobbying for additional protections for students and educators. And some lawmakers are urging the state to push back the start of school to the end of October. According to a Kaiser Family Foundation poll published in late July, at least six in 10 people — including parents — favor a delayed opening.

“Normalcy is not within our grasp right now,” Murphy said Friday in a warning to parents about the upcoming school year. “Know that we will do this as responsibly and humanely as possible. And that we’re going to go through this together.”

Murphy said the goal is to create as much flexibility for local districts as possible, so they can protect the health of students, staff and teachers, provide the best education possible and advance equity. An estimated 230,000 students have technical challenges when it comes to remote learning, according to the state, and Murphy has said it is critical they have access to quality education. “For some people, a plan B doesn’t exist, or it’s a poor substitute” for in-person schooling, he said Friday.

The price of keeping kids home

Kleinman, with Rutgers, concedes there are real downsides to keeping children at home for months longer, including new stresses on families that can result in domestic violence and nutritional gaps for those who depend on regular school-subsidized meals. There are also educational consequences, he said, although in some cases these learning gaps can be made up in the future.

“I am worried about the consequences of kids being isolated from social environments,” Kleinman said, adding that suspending in-person lessons for longer will likely further existing inequities. “But those benefits have to be balanced against the potential risk for safety,” he continued, “and there’s a lot of reasons not to do in-person school.”

For one, there are significant logistical challenges to providing safe facilities for small children, Kleinman explained. Ideally, teachers, staff and students would all be screened regularly for signs of the disease and those who positive, or were in contact with someone infected, would not be allowed inside the school building.

Proper hand washing and mask use are essential for everyone, he continued, and facilities need modern air-circulation systems. In addition, children and teachers would need to be kept in small groups that did not interact and provided with spaces large enough so they can maintain social distance. These parameters become additionally complicated for things like meal service or bus transportation, he noted.

In addition, community spread of the disease continues to grow with an RT above one. For Kleinman, that is an indicator it is too soon to continue to reopen the state or send pupils back into school buildings. “To crush the curve is to have the transmission rate close to zero, not just lower than one,” he said.

According to Kaiser, more than a dozen other countries have already reopened schools, but all had significantly lower rates of new infections over a seven-day average than the U.S. is now experiencing. Denmark was the second highest, but is still 5.5 times lower than the American rate. All but one nation — Japan — also had lower positivity rates, or the percentage of positive cases on a given day.