In his latest appearance on Fox News, Donald Trump declared that he thought testing for COVID-19 was “overrated,” though he grudgingly agreed that he would allow tests to continue. Jaw-dropping as that might seem, in a way Trump is right—since he’s completely surrendered any idea of responding to the pandemic, what’s the point in testing? There’s to be no national coordination of testing, no unified system of case tracing, no national mandate on masks, and no suggestion of providing states with any guidance on addressing the still-increasing number of cases. Once you’re content to drown, is there really any reason to measure the rising tide?
Of course, Trump doesn’t intend to go down alone. And his basic inflexibility means that once he has said something, he never even considers the option of changing his mind. So it’s perfectly understandable that in a Wednesday briefing, Trump absolutely declared his commitment to reopening schools and plopping children into closely-packed chairs. That includes his own son and his grandchildren, though of course, none of the above actually attend a public school. In expressing his commitment to experimenting on kids, Trump went through an entire set of talking points about children’s inability to catch COVID-19 or to transmit the disease to others—talking points that are 100% wrong.
As The Washington Post coverage of the event notes, Trump was insistent that schools “open to 100 percent.” This means no social distancing and no way to prevent spread to either students or teachers. It’s simply not possible when many classrooms are packed with 30-40 students in a space originally planned for half that number. Many schools even use trailers or other temporary facilities to cram in additional students. It’s utterly impossible to maintain any degree of safety in such a situation.
Of course, Trump doesn’t believe there’s any need. Because Trump has a very specific understanding about children and COVID-19. “A lot of people are saying they don’t transmit [...] They don’t catch it easily,” said Trump. “They don’t bring it home easily. And if they do catch it, they get better fast.”
Where would Trump get such an idea? Frankly, everywhere. For example, Vox ran an article on July 9, authored by Benjamin Linas, that contains this statement: “If any of us is ever going to send our kids to school again, we need a clear answer. Fortunately, I think we have one, at least for the children. Children are less likely than adults to be infected with Covid-19. There are multiple ways to study this question, and all the approaches arrive at this same conclusion.” Linas goes on to say that studies also show that children are unlikely to bring the disease home to parents. All of that may sound like just another article, except that Benjamin Linas is Doctor Benjamin Linas, an “infectious disease doctor and epidemiologist” who not only shares his assurances that it is safe to open the schools, but declares that he’s ready to send his own daughters back to the classroom. And hey … this is Vox. It’s not exactly sourcing courtesy of InfoWars or 4Chan. In fact, the title of Silas’ piece is “I’m an epidemiologist and a dad. Here’s why I think schools should reopen.” That’s a pretty solid bit of evidence for Trump or Betsy DeVos or anyone else who wants to pack children back into classrooms.
But as confident as Dr. Linas may be in the safety of reopening schools—and Linas is far from alone—this does not seem to square at all with the information we’ve seen on COVID-19.
There’s no study actually showing that children are less likely to contract COVID-19
Nueces County, Texas has reported 52 positive COVID-19 tests for children under the age of 1, and 33 additional tests for children between 1 and 2. Of course, over 9,500 people in Nueces County have tested positive for COVID-19, so it’s not as if babies make up a large cohort of cases. But there’s a reason for this that has nothing to do with susceptibility: contact rate.
One of the primary factors in calculating disease spread is average contact rate—the number of unique individuals that someone meets in a day. For the average adult, this number is around 13. That’s family, friends, the clerk at the grocery story, colleagues at work, and the folks who share the morning elevator. But babies and toddlers have a very, very low contact rate. Even those who are taken to day care are often in small, home-based settings. That reduced rate of contact means that infants are less likely than adults to be susceptible not because of innate resistance, but because they have far fewer opportunities to become infected.
In his article, Silas points out that “children under the age of 18 make up only 2 percent of cases in the US, even though they represent 22 percent of the total population.” This is true, or at least it was true. But then, those children have been out of school since the start of the pandemic. They have very specifically not been in the prolonged indoor conditions with close proximity to others that’s proven to be the best means of spreading the disease. The same is true in the other nations where Silas indicates that rates among children are low. Just two months ago, the same kind of claims were being made about people in their 20s and even 30s—that they were less likely to catch COVID-19. But in the latest surge of cases, these age ranges are now the most rapidly growing cohorts.
There remains no evidence that people of any age are gifted with some natural level of protection against COVID-19. As StatNews noted back in June, there is a very mixed bag of evidence, including much lower rates of testing among children. As the noted medical sage Donald Trump has pointed out many times: no testing, no cases.
There is an oft-cited June study from The Lancet showing that children under 9 “had a significantly lower risk” of returning a positive result in a study of a COVID-19 outbreak in Switzerland. But to draw any comfort from that statement means ignoring half the sentence, which actually says “individuals aged 5–9 years and those older than 65 years had a significantly lower risk of being seropositive than those aged 20–49 years.” Again, what seem to be measured here is the level of social contact, not the susceptibility to disease.
A potentially more valuable study appeared in Nature Medicine on June 16. That analysis, which looked at data across multiple countries, indicated that children may be roughly half as likely to catch COVID-19 in any encounter with an infected individual as someone in their 20s. However, as people in their 20s are on their way to being the most populous cohort of COVID-19 cases, and it would be hard to find a more perfect setting for the spread of the disease than the average classroom, it is difficult to find any comfort in these results.
The average kid out of school in 2020 may meet a dozen people a day … in Animal Crossing and Minecraft. In no sense does extrapolating the current rate of infection among children indicate their susceptibility in a school environment.
Children can very definitely pass COVID-19 to other children and to adults
Just as with the possibility of children catching COVID-19, Dr. Silas found comfort in a pre-print Chinese study indicating that “only 5 percent of household clusters were found to have a child as the index case.” However, this data looked at information from the port city of Guangzhou at a time when schools were closed.
In contrast, a paper published in the most recent Emerging Infectious Diseases Journal at the Centers for Disease Control and Prevention (CDC) draws starkly different conclusions. When adjusted for rates of contact, risk of transmission was found to be higher for children than for adults. In fact, school-aged children were the most likely source of infections in a household.
We also found the highest COVID-19 rate (18.6%) for household contacts of school-aged children and the lowest (5.3%) for household contacts of children 0–9 years in the middle of school closure.
That same study reinforces the information that other studies showing low rates of transmission among children “showed that school closure and social distancing significantly reduced the rate of COVID-19 among contacts of school-aged children.” In other words, the low rates of transmission by children cited by Dr. Silas and other was explicitly because of school closures and the resulting reduced rate of contacts by children.
While these are not controlled studies, there are plenty of real-world examples. Like in Kansas City, where resuming summertime sport activities and teen parties has driven a spike in cases not just among teenagers, but in their families. And in Cincinnati, where rates of positive tests for teenagers are up to 7% after just a few weeks of relaxed guidelines. Even kids under 10 are seeing 5% positive results.
All the evidence indicates that teenagers can spread the disease just as well as adults, and there is really absolutely no reason to think the same thing is not true of younger children.
Children are in no sense immune to the effects of COVID-19
Because kids have, to this point, seen lower rates of infection from COVID-19, there’s been a steady impression that kids are guaranteed mild or asymptomatic cases with no lasting effects. This is absolutely not true.
While devastating multisystem inflammatory syndrome (MIS-C) thankfully remains rare, it seems to be much less rare than originally thought. As a letter in the latest Contemporary Pediatrics notes: “In the early days of COVID-19, it seemed like the disease rarely infected children and when it did the disease course was mild. Then in late April, pediatricians in the United Kingdom and New York were discovering children who seemed to have something similar to Kawasaki disease (KD) and testing positive for COVID-19.” The CDC has so far identified 186 cases of this potentially devastating condition.
But MIS-C is just a “bonus,” because kids can definitely catch COVID-19 just like adults. In Texas, hospitals are seeing an increase in pediatric COVID-19 cases along with rising numbers in adults. The number of fatalities among children remains low—but low is far from zero. Five children under 10-years-old have died from the disease in Florida alone. And that’s with schools still closed.
In addition, hundreds of children have now faced prolonged intubation and ICU care, opening them to the same kind of lasting health effects seen in infected adults. As the chief medical officer at Methodist Children’s Hospital in San Antonio notes, “I am hesitant to be too comfortable in saying it’s a lesser disease for children, especially with us not seeing the long-term effects.”
Opening the schools in advance of an effective COVID-19 vaccine is begging for disaster
As discussed above, the relatively low rate of infection among children has far more to do with their reduced rate of social contact. We do not live in a Leave it to Beaver world where every moment out of school means kids are gathering for sandlot kickball. Without the forced closeness of school, most children in the United States, Europe, and many other places have a very low rate of social contact.
It is absolutely impossible at this point to make any firm indication about the rate at which children contract COVID-19, the ease with which they transmit the disease to others, or the potential for lifelong damaging health effects. The only thing that can be said with certainty is that they are all far too high to open schools.
Opening the schools is inviting not just thousands of deaths among children, but tens of thousands of deaths among teachers and families. More than that, it means exposing millions of children to an infection that can leave them gasping for breath for the rest of their lives, or living with damage to their heart, kidneys, or most any other organ.
Donald Trump’s demand for “100%” opening of schools is an invitation to a real lost generation. No matter how willing he, or anyone else, may be to sacrifice the health and safety of their children, that does not mean you should be forced to do the same.
Posted with permission from Daily Kos.