Children do not get sick with COVID-19 as often as adults do (but they still do), however, they appear to spread the coronavirus easily. Maidu California health coaches assess the risks in and out of school.

Mask-wearing is a fundamental way to keep kids from spreading the coronavirus.

As students start to head back to school across the United States, adults are legitimately concerned about the COVID-19 risk this may pose, both to children and to the community at large.

Although our knowledge about the novel coronavirus keeps evolving, available information shows that children are only slightly less likely than adults to develop COVID-19 and less likely to get very sick when they do become infected.  The American Academy of Pediatrics (AAP) estimates that as of August 6, children represented about 9.1 percent of all COVID-19 cases in states reporting cases by age.

That number appears to be on the rise.  The AAP reported that almost 100,000 kids tested positive for COVID-19 in the last two weeks of July – a 40 percent increase in all child cases.  For the month of July, nearly one in three coronavirus tests of children in Florida came back positive, according to South Florida Sun Sentinel.

A Small Percentage Get Very Sick

The Mayo Clinic says that children with COVID-19 tend to develop mild cold-like symptoms such as fever, runny nose, cough, fatigue, muscle aches, vomiting, and diarrhea; many have no symptoms at all.  The latest figures from the Centers for Disease Control and Prevention (CDC) suggest that 40 percent of all coronavirus patients are asymptomatic.

While severe COVID-19 among kids is very rare, some infected children can get seriously sick and even die.  As of August 6, the CDC has received reports of 570 confirmed cases of a potentially fatal illness associated with COVID-19 called multisystem inflammatory syndrome in children (MIS-C).  More than 70 percent of these cases involved children who are Hispanic or Latino or non-Hispanic Black.

In addition to fever, children with MIS-C may experience abdominal (gut) pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or extreme fatigue.

Thomas McDonagh, MD, a pediatrician with Northwell Health’s Huntington Hospital in Long Island, New York, stresses that although MIS-C is rare, parents have genuine cause for alarm about their child’s health if he or she gets COVID-19.

“Some healthy children who don’t have any particular underlying risk factors can become severely ill,” he warns.

Dr. McDonagh has treated several children with COVID-19 and a couple who developed MIS-C, but says “Luckily, none of them have had significant long-term consequences to their health.”

Why are most children able to do so well?  McDonagh suggests there may be a physiological explanation.  “The receptors on their cells may not accept viral infection from this particular novel virus quite so easily,” he says.  “There is also a hypothesis that children may be less susceptible because they have some innate cell protection against
coronavirus related to being infected more recently and more frequently with the normal cold virus.”

For now, these remain theories, and more study is needed to understand how the virus affects kids.

How Easily Do Children Spread the Virus? 

Although children have made up a lower proportion of those who test positive for COVID-19, evidence increasingly suggests they are effective transmitters who not only pass the virus along to each other but to adults as well.

Studies have found that young people between the ages of 10 and 19 can spread the virus at least as well as adults do, although children under the age of 10 appear to transmit the virus somewhat less frequently compared with adults.

A paper presented in JAMA Pediatrics at the end of July, however, suggested that very young children could be absolutely brimming with the virus.  Researchers discovered that children under age 5 may host as much as 100 times the amount of the virus carried by adults.

“Certainly, one could be tempted to correlate a high amount of viral load to an ability to spread the virus rather efficiently,” says McDonagh.  “But there might not be enough data yet to say that children are ‘super spreaders.’”