In a new study, researchers provide critical results showing that children play a larger role in the community spread of COVID-19 than previously thought.
In a study of 192 children ages 0-22, 49 children tested positive for COVID-19, and an additional 18 children had late-onset, COVID-19-related illness.
The infected children were shown to have a much higher level of virus in their airways than hospitalized adults in ICUs for COVID-19 treatment.
This the most comprehensive study of COVID-19 pediatric patients to date.
The research was conducted by a team at Massachusetts General Hospital (MGH) and Mass General Hospital for Children (MGHfC).
Transmissibility or risk of contagion is greater with a high viral load.
And even when children exhibit symptoms typical of COVID-19, like fever, runny nose, and cough, they often overlap with common childhood illnesses, including influenza and the common cold.
This confounds an accurate diagnosis of COVID-19, the illness derived from the SARS-CoV-2 coronavirus.
Along with viral load, the researchers examined the expression of the viral receptor and antibody response in healthy children, children with COVID-19 infection, and a smaller number of children with Multisystem Inflammatory Syndrome in Children (MIS-C).
Findings from nose and throat swabs and blood samples carry implications for the reopening of schools, daycare centers, and other locations with a high density of children and close interaction with teachers and staff members.
The team says kids are not immune from this infection, and their symptoms don’t correlate with exposure and infection.
During this COVID-19 pandemic, doctors have mainly screened symptomatic subjects, so they have reached the erroneous conclusion that the vast majority of people infected are adults.
However, the current results show that kids are not protected against this virus. Doctors should not discount children as potential spreaders for this virus.
The researchers note that although children with COVID-19 are not as likely to become as seriously ill as adults, as asymptomatic carriers or carriers with few symptoms attending school, they can spread infection and bring the virus into their homes.
This is a particular concern for families in certain socio-economic groups, which have been harder hit in the pandemic, and multi-generational families with vulnerable older adults in the same household.
In another breakthrough finding from the study, the researchers challenge the current hypothesis that because children have lower numbers of immune receptors for SARS-CoV2, this makes them less likely to become infected or seriously ill.
Data from the group show that although younger children have lower numbers of the virus receptor than older children and adults, this does not correlate with a decreased viral load.
According to the team, this finding suggests that children can carry a high viral load, meaning they are more contagious, regardless of their susceptibility to developing COVID-19 infection.
The researchers also studied immune response in MIS-C, a multi-organ, systemic infection that can develop in children with COVID-19 several weeks after infection.
Complications from the accelerated immune response seen in MIS-C can include severe cardiac problems, shock, and acute heart failure.
Understanding MIS-C and post-infectious immune responses from pediatric COVID-19 patients is critical for developing the next steps in treatment and prevention strategies, according to the researchers.
One author of the study is Lael Yonker, MD, director of the MGH Cystic Fibrosis Center.
The study is published in the Journal of Pediatrics.
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