Children Not Super Spreaders of SARS-CoV-2

Letting “science” guide the pandemic response sounds great, and it makes sense, of course.

So, it’s understandable most (right-thinking, anyway) public and public health officials make it a point of emphasis.

However, given that SARS-CoV-2, is still a relatively new “bug,” the science we have at our disposal is continuing evolving. Which means that our response initiatives need to evolve with it as well.

To wit: The issue of whether to keep schools and daycare centers open even as the virus spreads in the surrounding community.

At least initially, conventional wisdom, and even the US Centers for Disease Control and Prevention’s pandemic infectious disease plan (built around the H1N1 flu), indicated that schools should be closed, and students transitioned to online learning. The logic: Children are typically prime spreads of respiratory viruses.

Interestingly, though, as the pandemic rages on, the science is telling us that young people may actually play less of a role in the transmission of SARS-CoV-2, calling into question the need to shutter schools at childcare facilities, as least once teachers and staff have been vaccinated.

The latest study to find a minimal role for children in the spread of the coronavirus was published in The Lancet. In it, the authors observe that cases of SARS-CoV-2 among young children attending daycare centers in France were (relatively) rare and that “intrafamily transmission seemed more plausible than transmission within daycare centers.”

As the researchers, affiliated with several hospitals and academic centers in and around Paris, wrote, “The seroprevalence rate among children was lower than that reported by various investigators for the general population in the same period in the Paris region while the seroprevalence rate among the adult participants in our study was similar to that in the general population. The present results indicate that young children are not super-spreaders of SARS-CoV-2 and that daycare centers are not major foci of viral contagion.”

Indeed, among 327 children attending 22 daycare centers between June 4th and July 3rd of last year, 3.7% were positive for the coronavirus, while 6.8% of staff were infected. This latter figure is slightly than that for a comparator group of adults included in the study (5%) but lower than infection rates for the Paris region during the same period (9% to 10%), according to the researchers. In addition, nearly half of all the children who tested positive for the virus were known to have been exposed to infected family members while at home.

Most of the infected children experienced mild illness, and many were asymptomatic, making symptom-based screening and contact tracing protocols potentially ineffective, the researchers said.

“Our exploratory comparison of seropositive and seronegative children suggested that clinical signs are not good decision criteria for PCR testing and that the main criterion should be a suspected or laboratory-confirmed COVID-19 case in an adult household member, [though] further epidemiological studies are needed to confirm this hypothesis,” they wrote. “The detection of a PCR-positive or seropositive child in a daycare center does not mean that all the children should be tested. Contact tracing and screening tests must start with parents, other adult household members, and staff at the daycare center. Further sero-epidemiological studies are needed to determine the extent of SARS-CoV-2 infection among children and to define the role of children in viral transmission.”

All of which doesn’t mean that officials should rush to open schools and daycare centers—at least not until community spread in their areas has been contained. However, it once again highlights the need to remain open-minded as new data emerge—and the importance of being able to pivot as needed.