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.