The COVID-19 epidemic arrived with an important silver lining: Fewer children seemed to catch the disease, and with many who did, you could barely tell.
But as Georgia inches back to work, that is starting to pose a big problem.
The scarce tests have gone to the more seriously ill, most often meaning adults, and research on how the new virus works has just started. Gaping holes in knowledge mar the understanding of children’s role in the pandemic. As public officials chart the course forward to work and school, they don’t know for sure whether children are mostly clear of the virus, or mostly infected, or infected but not contagious — or if they pose a dangerous reservoir of infection ready to ignite once returned to group settings.
"We haven't been testing enough to know," said Dr. Evan Anderson, a pediatric infectious disease specialist at Emory University who is leading part of a national coronavirus vaccine study. As daycare starts back up and the next school year looms, "It'll be a huge challenge to identify those kids that need to get sent home" and avoid having those children infect other kids and staff, Anderson said.
» COMPLETE COVERAGE: Coronavirus in Georgia
“And there are not going to be any easy answers about how best that can be accomplished.”
In the absence of a vaccine and precise knowledge, the safe course may mean vast changes for children and families and the institutions that serve them.
“School is likely to look a lot different,” said Dr. Stephen Thacker, director of pediatric infectious diseases at Savannah’s Memorial Health University Medical Center. “This will really reshape American culture.”
Credit: JOHN SPINK / AJC
Credit: JOHN SPINK / AJC
The science
Fewer children than adults are seriously ill from the new coronavirus.
When they get sick from it, they may experience a fever and cold-like symptoms — a cough, maybe a runny nose. Parents can call their doctor just like they would if they suspect the flu; a reason to head to the hospital is shortness of breath.
One of the more serious questions to arise surrounds a set of symptoms that a small number of coronavirus-infected children have reported experiencing, resembling Kawasaki disease. That is an extremely rare inflammatory condition of the blood vessels in which children develop high fever, rashes on the back, chest and abdomen, bloodshot eyes, swollen hands and feet, swollen lymph glands and swelling around the mouth and lips.
On Friday, a New York City hospital confirmed that a child with COVID-19 died there after developing the inflammatory condition.
A team of infectious disease and cardiology experts are evaluating a few cases of children exhibiting Kawasaki-like symptoms and inflammation at Children's Healthcare of Atlanta, to determine if they could also have had COVID-19, and to determine if any link could exist, said Dr. James Fortenberry, chief physician officer there. In Savannah, one child at Memorial Health University Medical Center had COVID-19 and exhibited the Kawasaki-like symptoms, Thacker said.
Whether or not that connection exists, such serious symptoms among children are rare.
Credit: undefined
Credit: undefined
In Georgia, the Department of Public Health has recorded no child fatalities from COVID-19.
Children represent only 2% of the number of confirmed coronavirus cases in the state, according to the department.
But that doesn’t tell scientists as much as it seems.
There’s a chance, maybe a good chance, that the majority of infected children haven’t been tested, and so their families might not even know they have the disease.
There’s no way to know the number of asymptomatic infected children from the slim research evidence so far. One study from Germany looked at four dozen infected children and found the vast majority showed mostly no symptoms. But Fortenberry, of Children’s, said the health system has begun COVID-19 testing for a wide range of its patients who are getting time-sensitive procedures, such as ear tubes and tonsillectomies, and has found no asymptomatic cases.
Weeks of social distancing and a shelter-in-place order in Georgia have helped keep infection rates low in general. That is scaling back, though. Day care and school will be game changers. A study of Chinese children reported in The New York Times suggested that when children are in school, their frequent contact with other people may make them just as likely to be infected as the average adult.
“Children, when they gather in groups at schools and other places, they accelerate the spread of respiratory viruses, we know that,” Thacker said.
Credit: Curtis Compton
Credit: Curtis Compton
Making plans
Because scientists don’t know how contagious kids are, they advise planning for safety.
The American Academy of Pediatrics has released guidance. It advises every preschool, school and family to make their own plans, working with health officials. But some of its suggestions are eye-popping.
Schools need to prepare to put children at a distance from each other, it said. That will be challenging for packed classrooms and likely spur innovation, said Dr. Sally Goza, the academy’s president and a Fayetteville pediatrician. One way the academy suggests schools can do that is by staggering start times.
“We need to have some distance there,” she said. “That will be pretty critical.”
Athletic practice, with kids breathing hard and physically contacting each other, is a concern.
» RELATED: Confusion, scarcity lead to haphazard testing in state's virus response
» MORE: COVID-19 vaccine hunt heats up globally, still no guarantee
So are children at high risk of complications if they catch COVID-19. For them, school settings may have to be abandoned and distance learning or long-term home-bound schooling may be necessary, the academy has said.
Advocates for the disabled and for people with less access to high-speed internet have expressed concern about a possibly lesser education for those kids.
Then there are the mental health impacts of the epidemic. The academy strongly suggests ramped-up attention to therapy and mental health problems for the kids and their families.
They add that students, teachers and parents should not expect to make up all the lost education.
While schools and day cares will be considering drastic measures to minimize the risks for catching the coronavirus, they will be unable to eliminate all risk. And even a low risk for getting the coronavirus is too much for some families.
Credit: undefined
Credit: undefined
Amanda McCaskill’s middle child, Barrett, who is 4, suffers from moderate to severe asthma, which likely puts him at higher risk of complications from the coronavirus. That makes the Dunwoody family extremely cautious about Barrett or his siblings — 9-year-old sister Zoe, and 2-year-old sister Nora — going back to daycare and school.
The McCaskill family has been sheltering at their Dunwoody home for the past several weeks. And barring a new treatment or vaccine, or a steep decline in the number of COVID-19 cases circulating, Amanda McCaskill said they will likely hold off letting the children go back to school and day care. The thought of her youngest child returning to day care seems particularly tricky.
“With preschool-aged kids it’s hard because of surfaces and a lot of people touching them and rubbing their eyes,” said McCaskill. “And I just don’t see how a toddler could keep a mask on all day.”
So for now, the family is staying close to home and trying to make the most of it.
“It really is going to take pediatricians, school officials, public health officials and parents to figure it all out,” Dr. Goza said. “It’s a new normal.”
