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COVID-KIDS

July 22, 2020

 

A look at opening schools amidst the COVID-19 global pandemic

 

[Reminder: underlined phrases are hyperlinks to source materials]

 

Context

 

On July 6th, President Trump called for schools to fully open this fall. Secretary of Education Betsy DeVos, Governor of Florida Ron DeSantis, and House Minority Leader Kevin McCarthy have echoed the President’s stance.

 

President Trump also asked the CDC to ease its school opening safety guidelines. The CDC has declined, but they have also delayed the release of their supplemental guidelines – causing some uncertainty on the matter.

 

Meanwhile, Dr. Deborah Birx, the White House coronavirus response coordinator, has called for states to roll back their reopening statuses to Phase 1 due to record-breaking spikes in daily coronavirus activity.

 

On July 8th, Dr. Anthony Fauci, the Director of the NIAID, advised these states to “seriously look at shutting down.” A recent White House report suggest at least 18 states need to roll back their re-openings asap.

 

What are parents, teachers, and school superintendents supposed to do in light of these conflicting calls from within the White House Coronavirus Task Force?

 

 

MIS-C

 

The President recently stated that 99% of US COVID-19 cases are “totally harmless” going further to say that “the children aren’t affected” by the virus.

 

These statements are not accurate. Are they directionally correct? 

 

According to the World Health Organization, preliminary data out of China suggests there is a relatively low attack rate in children 18 and under (2.4% of all reported cases).

 

According to China’s CDC, as of February 11, 2020 87% of the cases in China were found in the 30-79 age group. Approximately only 2% of cases were found in those age 19 and under, with less than 1% of cases found in those age 9 and under. Fatality rates, according to China’s CDC, appear to be 0.2% in those aged 10-39.

 

However, this data does not appear to account for Western mutations of COVID-19.

 

There are currently greater than 30 strains of COVID-19 spreading globally. Scientists believe the Wuhan version was milder than the European strain. The Wuhan version spread to the West Coast of the US. Meanwhile, the European strain hit America via travel to the East Coast resulting in far more heinous outcomes. "The mutation Spike D614G is of urgent concern; it began spreading in Europe in early February, and when introduced to new regions it rapidly becomes the dominant form."

 

As the virus mutated and moved West, scientists noted that COVID-19 appeared to be affecting children and young adults in ways that were not previously observed in China. In late April, physicians in London put out a global alert that they were seeing infected children develop Kawaski-like symptoms. Kawasaki’s is an inflammatory condition that can attack the heart – usually in children who are 5 years old and younger. In early May, doctors in Europe and in New York began to see these symptoms in children. They referred to the condition as “multi-system inflammatory syndrome” or MIS-C for short.

 

 

Two new studies on MIS-C were recently published in the New England Journal of Medicine, which examined 300 cases of MIS-C in children. In the Boston Children’s Hospital study 80% of the children required ICU care, 20% were intubated, and 2% of the children (four children total) passed away. The New York study had similar results

 

 

Both observed that many of the children developed cardiac problems, clotting / vascular issues, GI symptoms, and skin rashes. These children were, on average, around 8-9 years old; 40% were Black and 36% were Hispanic (Kawasaki’s usually affects children of Asian descent).

 

 

Risk to children

 

What are the real-world practical risks from fully re-opening schools this fall? To answer we must ponder the following:

  • Can school age children get COVID-19?

  • Can school age children transmit COVID-19?

  • What is the risk of children developing chronic or serious health issues?

 

Can children get infected with COVID-19?

 

Yes. According to the CDC, 175,374 cases have been confirmed in kids aged 17 and under. As of July 17th, they account for roughly 6% of all confirmed cases.

 

Emblematic of the issue - Eighty-five babies under the age of 1 tested positive for COVID-19 in Nueces County, Texas.

 

Similarly, there is a 31.1% coronavirus positivity rate among children under 18 according to the Florida Department of Health’s most recent pediatric report – 46% in Lee County alone.

 

Can children transmit COVID-19?

 

Yes. A large new South Korean study shows that children between the ages of 10 and 19 can spread the virus at least as well as adults do. Younger children are half as likely as adults to spread the virus – but the risk is not zero.

 

Can children develop serious or chronic illness?

 

Yes. Dr. Alina Alonso, the director of the Department of Health Palm Beach County warns that there are hidden and possibly lasting consequences to children from being infected with COVID-19. “And while many of these especially younger children are asymptomatic when you take x-rays of their lungs, down in Miami and other places across the country, they’re seeing that there is damage to the lungs in these asymptomatic children.”

 

Dr. Bindu Mayi, a professor of microbiology at NSU’s College of Medical Sciences reminds us that we must consider the future long-term consequences to children who are infected with COVID-19. “We may have to deal with this virus for decades because of not just the survivors coming back with consequences, but also those who were the silent, infected individuals.”

 

According to MedPage Today, new-onset neurological symptoms turned up in four of 27 (14.8%) previously healthy children in a PIMS case series reported by Yael Hacohen, MD, PhD, of University College London, and colleagues in JAMA Neurology.

 

Those symptoms included encephalopathy and global muscle weakness in all four children along with:

  • Headache in three children

  • Brainstem signs with dysarthria or dysphagia in two children

  • Reduced reflexes in two children

  • Meningism in one child

  • Cerebellar ataxia in one child

     

According to the CDC, 228 children under the age of 17 have died thus far in the US.

 

 

The dangers of reopening schools too quickly

 

Can schools prevent outbreaks of COVID-19? Can they prevent transmissions between teachers and children and/or between children and their families?

 

According to the COVID-19 Emergency Response CRAFT Schools Briefing Packet fully reopening schools and universities remained the “highest risk” for the spread of the coronavirus.

 

This prediction appears to have been proven true in Israel.

 

Hagai Levine, an epidemiologist at the Braun School of Public Health and Community Medicine of the Hebrew University of Jerusalem, and chairman of the Israeli Association of Public Health Physicians, said: “contrary to our advice, the government decided to open the entire system all at once on May 17. What happened next was entirely predictable.” Just two weeks after schools had opened, more than 244 students and staff were found to test positive for COVID-19.

 

According to Israel’s education ministry, a total of 2,026 students, teachers, and staff have contracted COVID-19, and 28,147 are in quarantine due to possible contagion. Over the past few weeks, 393 summer school programs have been shuttered. 47 percent of all coronavirus cases in Israel in June were traced to schools. The reopening of schools in Israel erased the progress the country had made from its lockdown.

 

Will America’s fate be the same? The risk for children, teachers, and parents seems a high price to pay to find out.

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