31 July Children's conundrum and preterm babies

1. A very nice review by Joanna Merckx, a Flemish pediatrician in McGill (thanks Joanna for sharing with us). 

As you can see in the Tables, most published evidence, supports her conclusions:

• Despite limited evidence, the general pattern emerges that transmission from children occurs, but contributes much less to evolution of the epidemic than do contacts between adults, and school-reopenings have not lead to transmission spikes in low transmission countries

• Six months into the pandemic, children have not shown any evidence of being a significant factor in its propagation . As societies worldwide relax or reintroduce restrictions, pragmatic studies to measure changes in transmission in various groups, particularly children, are needed more than ever.

2. The data from Jerusalem and Israel, I referred to earlier have now been published in Eurosurveillance.  As you can see, reopening of schools and relaxing on preventive measures, including crowding and leaving off mouth/nose caps, presumably has resulted in a high prevalence of SARS-CoV-2 positivity, with quite some COVID-19 symptoms in high schools (see Table and Figures).  In Fig 3, you can also see that the children below 10 are a minority.  By the way, Israel (about 2 million inhabitants less than Belgium) has now a similar number of positive tests and is still at a peak of 2nd wave, but with far less deaths.  https://www.worldometers.info/coronavirus/country/israel/

3. However, then came this study in Chicago, on “145 patients with mild to moderate symptoms”, showing that the youngest children (<5) tended to have the highest viral load (see Fig in pp), the difference was significant.  This is in line with the earlier German data that in fact showed no difference across age groups.  Obviously, this is not a direct indication of prevalence in children, nor a direct proof of infectiousness, it is a selected symptomatic population.  But, in any case, it suggests that some young children may be as infectious or even more infectious as compared to older  children or adults.

4. As some of you may have seen there was an earlier press release that up to onr third of children in Florida tested positive: https://thehill.com/changing-america/well-being/prevention-cures/507442-almost-one-third-of-florida-children-tested-are

This has been revoked without explanation: https://news.yahoo.com/mistake-florida-child-covid-19-191800321.html

Computer and software problems leading to unreliable results.  Sounds like Belgium…

All in all, data on children remain somewhat difficult to interpret, as long as there are no really systematic prospective large-scale studies.  Is it possible that in most epidemiological conditions, where preventive measures are applied, children are relatively protected, while in uncontrolled epidemics, like in many parts of the US, they are more involved? Very difficult to say….

Unfortunately  all this uncertainty does not really help to decide whether and under which conditions schools can reopen during  the European “second wave”. 

5. Finally, some good news on lowering (very) premature and very low birth weighted babies during lockdwown in Ireland and Denmark suggests that various associated social and environmental factors, such as less stress, less exposure to infectious agents, less pollution may have a beneficial effect.