Child Health and COVID-19 in New Zealand

Russell Wills FRACP, MPH
Paediatrician, Hawke’s Bay District Health Board and Former Children’s Commissioner

30 April 2020

Is it really safe for children to return to school and early childhood education? And what about the recent reports of Kawasaki Disease in children with COVID in the UK?

Epidemiology of COVID-19 in children

The science of COVID-19 is moving fast, including the epidemiology. When the Centres for Disease Control released its first report on COVID in children on 2 April,1 there had been more than 239,000 cases of COVID and 5,400 deaths in the USA. In the analysis of 149,760 laboratory-confirmed COVID cases in the United States in February and April, 2,572 (1.7 percent) were children aged under 18 years. Due to the high workload of clinicians, clinical data was only available for a small proportion of affected children, so we should be careful about extrapolating.

However, most (73 percent) paediatric patients presented with fever, cough, or shortness of breath, compared to 93 percent of adults aged between 18–64 years. 5.7 percent of paediatric patients were hospitalised, compared to 10 percent for adults aged 18–64 years. In this case series, three children died. The paper suggested that infected children “do not always have fever or cough”, “clinicians should maintain a high index of suspicion for COVID-19 infection in children”, and “persons with asymptomatic and mild disease, including children, are likely playing a role in transmission and spread of COVID-19 in the community”, suggesting that children may be more likely to transmit the virus while asymptomatic, and asymptomatic transmission by children could be an important part of disease transmission. 

A study by the National Centre for Immunisation Research and Surveillance (NCIRS) in New South Wales released on 26 April directly assessed risk of transmission of infected children and staff in school2

The New Zealand data from  April 1-28 are shown in Table 1 below. Of 1124 people with positive COVID swabs, 32 (2.9 percent) were children 0-14 years, the ages permitted to return to ECE/school under  Alert Level 3. None of these children have required hospital admission. In fact, children’s wards are the quietest we can remember in Autumn, mostly because there are very few children with winter viruses such as RSV. It is fair to say that for New Zealand children right now, their chance of catching any serious virus at school or ECE is the lowest it has ever been.

So – is it safe for children to be in school? Yes.

Table 1. Numbers of people (by age band) with COVID19-positive swabs, Aoteoroa New Zealand, February 28 to April 28, 2020.

This is not to say that we should not take COVID seriously – we just need to look at the UK, US and Europe to see the costs of failing to adequately control this virus. Elimination is a process, not a destination. While COVID is rare in the community, one case that is allowed to infect others could undo weeks of hard work by the country. This is why we need to continue to quarantine all new arrivals, physically (not socially) distance, not go to work (or send our kids to school) if sick, and continue to wash our hands. 

 

What about Kawasaki Disease? 

On 27 April, NHS England emailed child health staff alerting them to a small rise (about 12 cases) in children presenting with features of COVID, Kawasaki Syndrome and Toxic Shock Syndrome. Some patients tested negative for COVID. The alert was widely reported all over the world and was followed by a statement by the Paediatric Intensive Care Society 3. The statement notes that serious complications from COVID in children remain rare and there are too few cases to be a “typical” clinical picture of the syndrome. UK clinicians are advised to be alert for children with toxic shock, atypical Kawasaki Disease and respiratory infection. It should be noted that the UK has had over 157,000 cases and 21,000 deaths from COVID to date but no COVID deaths in children aged between 0-144. There are no such reported cases in Australasia.

What does this mean for our advice to parents?

We support the Government’s Level 3 alert rules because they are based on good science and they are working. We should all continue to physically distance, wash our hands and stay home when we are sick. This means working from home and keeping our kids home with us, if we can. If we have to return to work it is safe for children to return to school. Their chance of getting a COVID infection from an infected child or teacher are extremely low, both because the virus is now rare and because an infected child is very unlikely to infect other children, or infect adults. 

 

References 

  1. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep 2020;69:422–426. https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm?s_cid=mm6914e4_w
  2.  National Centre for Immunisation Research and Surveillance. COVID-19 in schools – the experience in NSW. Sydney, New South Wales Government. http://ncirs.org.au/sites/default/files/2020 04/NCIRS%20NSW%20Schools%20COVID_Summary_FINAL%20public_26%20April%202020.pdf
  3.  PICS Statement: Increased number of reported cases of novel presentation of multisystem inflammatory disease. London, Paediatric Intensive Care Society.  https://picsociety.uk/wp-content/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdf
  4.  Office for National Statistics. Deaths Registered Weekly in England and Wales, Provisional: Week Ending 10 April 2020.  https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending10april2020