COVID-19 Transmission and Children: The Child Is Not to Blame - American Academy of Pediatrics
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COVID-19 Transmission and Children:
The Child Is Not to Blame
Benjamin Lee, MD, William V. Raszka, Jr, MD
Coronavirus disease (COVID-19) the child developed symptoms after or
presents arguably the greatest public concurrent with adult HHCs, suggesting
health crisis in living memory. One that the child was not the source of
surprising aspect of this pandemic is infection and that children most
that children appear to be infected by frequently acquire COVID-19 from adults,
severe acute respiratory syndrome rather than transmitting it to them.
coronavirus 2 (SARS-CoV-2), the
virus that causes COVID-19, far less These findings are consistent with
frequently than adults and, when other recently published HHC
infected, typically have mild investigations in China. Of 68 children
symptoms,1–3 although emerging with confirmed COVID-19 admitted to
reports of a novel Kawasaki Qingdao Women’s and Children’s
disease–like multisystem inflammatory Hospital from January 20 to February
syndrome necessitate continued 27, 2020, and with complete
Department of Pediatrics, Larner College of Medicine,
surveillance in pediatric patients.4,5 epidemiological data, 65 (95.59%) University of Vermont, Burlington, Vermont
However, a major question remains patients were HHCs of previously
infected adults.7 Of 10 children Opinions expressed in these commentaries are
unanswered: to what extent are
those of the authors and not necessarily those of the
children responsible for SARS-CoV-2 hospitalized outside Wuhan, China, in American Academy of Pediatrics or its Committees.
transmission? Resolving this issue is only 1 was there possible child to adult
DOI: https://doi.org/10.1542/peds.2020-004879
central to making informed public transmission, based on symptom
chronology.8 Similarly, transmission of Accepted for publication Mar 18, 2020
health decisions, ranging from how to
safely re-open schools, child care SARS-CoV-2 by children outside Address correspondence to William V. Raszka, Jr,
Department of Pediatrics, University of Vermont,
facilities, and summer camps down to household settings seems uncommon,
Larner College of Medicine, 89 Beaumont Ave, Given
the precautions needed to obtain although information is limited. In an Courtyard N210, Burlington, VT 05405.
a throat culture in an uncooperative intriguing study from France, a 9-year- E-mail: william.raszka@med.uvm.edu
child. To date, few published data are old boy with respiratory symptoms PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online,
available to help guide these decisions. associated with picornavirus, influenza 1098-4275).
A, and SARS-CoV-2 coinfection was Copyright © 2020 by the American Academy of
In this issue of Pediatrics, Posfay-Barbe found to have exposed over 80 Pediatrics
et al6 report on the dynamics of COVID- classmates at 3 schools; no secondary FINANCIAL DISCLOSURE: The authors have indicated
19 within families of children with contacts became infected, despite they have no financial relationships relevant to this
reverse-transcription polymerase numerous influenza infections within article to disclose.
chain reaction–confirmed SARS-CoV-2 the schools, suggesting an environment FUNDING: No external funding.
infection in Geneva, Switzerland. From conducive to respiratory virus POTENTIAL CONFLICT OF INTEREST: The authors have
March 10 to April 10, 2020, all children transmission.9 In New South Wales, indicated they have no potential conflicts of interest
,16 years of age diagnosed at Geneva Australia, 9 students and 9 staff to disclose.
University Hospital (N = 40) underwent infected with SARS-CoV-2 across 15 COMPANION PAPER: A companion to this article can
contact tracing to identify infected schools had close contact with a total of be found online at www.pediatrics.org/cgi/doi/10.
household contacts (HHCs). Of 39 735 students and 128 staff.10 Only 2 1542/peds.2020-1576.
evaluable households, in only 3 (8%) secondary infections were identified,
was a child the suspected index case, none in adult staff; 1 student in To cite: Lee B and Raszka WV. COVID-19
Transmission and Children: The Child Is Not to
with symptom onset preceding illness primary school was potentially infected
Blame. Pediatrics. 2020;146(2):e2020004879
in adult HHCs. In all other households, by a staff member, and 1 student in high
Downloaded from www.aappublications.org/news by guest on May 13, 2021
PEDIATRICS Volume 146, number 2, August 2020:e2020004879 COMMENTARYschool was potentially infected via infected in the community and SARS-CoV-2 epidemic: an observational
exposure to 2 infected schoolmates. present as index cases. cohort study [published online ahead of
print May 13, 2020]. Lancet. 2020. doi:
Almost 6 months into the pandemic, 10.1016/S0140-6736(20)31103-X
On the basis of these data, SARS-CoV-
accumulating evidence and collective
2 transmission in schools may be less 6. Posfay-Barbe K, Wagner N, Gauthey M,
experience argue that children,
important in community transmission et al. COVID-19 in children and the
particularly school-aged children, are
than initially feared. This would be dynamics of infection in families.
far less important drivers of SARS- Pediatrics. 2020;146(2):e20201576
another manner by which SARS-CoV-
CoV-2 transmission than adults.
2 differs drastically from influenza, 7. Wu Q, Xing Y, Shi L, et al. Co-infection
Therefore, serious consideration
for which school-based transmission and other clinical characteristics of
should be paid toward strategies that
is well recognized as a significant COVID-19 in children. Pediatrics. 2020;
allow schools to remain open, even
driver of epidemic disease and forms 146(1):e20200961
during periods of COVID-19 spread.
the basis for most evidence regarding 8. Cai J, Xu J, Lin D, et al. A case series of
In doing so, we could minimize the
school closures as public health children with 2019 novel coronavirus
potentially profound adverse social,
strategy.11,12 Although 2 reports are infection: clinical and epidemiological
developmental, and health costs that
far from definitive, the researchers features [published online ahead of
our children will continue to suffer until print February 28, 2020]. Clin Infect Dis.
provide early reassurance that
an effective treatment or vaccine can be 2020. doi:10.1093/cid/ciaa198
school-based transmission could be
developed and distributed or, failing
a manageable problem, and school 9. Danis K, Epaulard O, Bénet T, et al;
that, until we reach herd immunity.16,17
closures may not have to be Investigation Team. Cluster of coronavirus
a foregone conclusion, particularly for disease 2019 (Covid-19) in the French
elementary school–aged children who Alps, February 2020 [published online
ABBREVIATIONS ahead of print April 11, 2020]. Clin Infect
appear to be at the lowest risk of
COVID-19: coronavirus disease Dis. 2020. doi:10.1093/cid/ciaa424
infection. Additional support comes
from mathematical models, which HHC: household contact 10. National Centre for Immunisation Research
find that school closures alone may be SARS-CoV-2: severe acute and Surveillance. COVID-19 in Schools - The
respiratory Experience in NSW. New South Wales,
insufficient to halt epidemic spread13
syndrome Australia: National Centre for Immunisation
and have modest overall impacts
coronavirus 2 Research and Surveillance; 2020
compared with broader, community-
wide physical distancing measures.14 11. Cauchemez S, Valleron A, Boëlle P,
Flahault A, Ferguson N. Estimating the
These data all suggest that children impact of school closure on influenza
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PEDIATRICS Volume 146, number 2, August 2020 3COVID-19 Transmission and Children: The Child Is Not to Blame
Benjamin Lee and William V. Raszka Jr
Pediatrics 2020;146;
DOI: 10.1542/peds.2020-004879 originally published online May 26, 2020;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/146/2/e2020004879
References This article cites 14 articles, 5 of which you can access for free at:
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Downloaded from www.aappublications.org/news by guest on May 13, 2021COVID-19 Transmission and Children: The Child Is Not to Blame
Benjamin Lee and William V. Raszka Jr
Pediatrics 2020;146;
DOI: 10.1542/peds.2020-004879 originally published online May 26, 2020;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/146/2/e2020004879
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. Pediatrics is owned, published, and trademarked by
the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2020
by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.
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