COVID-19 Interest Group

                                         August 6, 2020

                                                       CIG Bulletin #17 from Berkeley Rotary Club

                                             "Children and COVID Risks”
                                          Comments by Arlin Peters, Eva Gero, Rick Betts, Pate Thomson, and O’Neil Dillon

Disclaimer: The opinions expressed were based on data derived from public sources. However, these are our opinions and our attempt to assimilate multiple viewpoints. We do not pretend to be experts in the infectious disease field but bring our expertise from our prior training in science, engineering and medical fields to these issues as interested viewers.

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At the July 29th CIG meeting, members of this interest group discussed the risk of interactions with our grandchildren and the potential transmission of COVID-19. Since then there was the startling news of a coronavirus outbreak at a sleep-away summer camp in Georgia. In this incident, 260 children and staffers (out of 344 tested) contracted the virus. The median age the children was 12 years old. All had tested negative before attending the camp. What can we make of this data?
 

From Arlin Peters:

The current patterns of most children's family life and typical social behavior aren't conducive to the spread of Covid-19 to or among them - and that's good. It makes it much less likely that interactions with our grandchildren will result in a mutual spread on infection. I think the patterns of us old folks life and social behaviors (at least for the Rotarians I know) also makes us less likely to be infected, so we won't infect our grandchildren either. 

There is some data that indicates to me that more than just children's family life and behavior patterns are involved. In today's East Bay Times Coronavirus Tracker section, it shows that California children under 5 have had 1.9% of California's 460,000 cases to date; and 5-18 have had 7%. There have been no, zero California deaths for these age groups.

 Who are the parents of these children still living in a family group? Well mostly people aged 18-50. This group has had a whopping 60% of the California cases so far (and only 7% of the deaths). To me this means that while parents have un-avoidably exposed their children to Covid-19 when they have had it, their children have had few cases of Covid-19 or have had cases where their immune systems have prevailed so well against the virus that their symptoms have been mild or non-existent. I believe that for children to have been tested means that either they were exhibiting symptoms or lived in a family where another member had tested positive.

 I feel that this also means that children under 10 do not easily transmit Covid-19, as we discussed on July 28th.
 

From Eva Gero:

The outbreak in the children's camp is a very serious warning that if people, adults or children, congregate for extended periods of time, even for hours, it may become a super-spreader event. One infected person can infect many who can transfer it to many others. It took only a week - actually, 2-3 days for the staff to spend with an asymptomatic infected adolescent, and then the staff kept infecting the children - the longer the children stayed, the infection rates increased.

 We need more data before we could draw conclusions on how to keep schools safe but it is obvious: as long as we have a high rate of infection, any congregation, including participation in school classes, must be completely avoided. A different situation is a closed group (hub), such as a family setting with all members having close contacts exclusively with one another and each with good Covid habits. 

Some of the unknowns in the case are:

> Case number of any transmission by children to their family members and contacts after returning home from the camp.

> Statistics by sleeping units and activity to assess if there was child-to-child transmission

> Time of clinical manifestations, if any

> Severity of the disease

> Follow-up on all children and staff members in the camp

Research study with cell culture on different age groups with asymptomatic adults and children to assess the live virus load and live virus shedding, thus the potential of infectivity, of PCR-positive cases.

 Regarding the biology and pathophysiology of Covid-19 in children, it is obvious that children, when exposed to the virus are also infected. Their infection does not progress to manifested disease and death nearly as often as in adults. Even adults show a clear age-dependence; increasing 2.6-fold per 10 year increments of age.

 The milder outcome in children is attributed to their better innate immune response that may eliminate the virus within hours provided that the dose of the virus at infection was not very high. Additionally, they also have some antigen-specific response but that develops slower (across days). Young adults are known to have better specific (antibody and killer-T-cell) immune response than older folks; it is a tug-a-war between the immune response and virus replication.

 To be fully informed, we need more data, and continue to stay careful, practice good behaviors and be vigilant. 

From Rick Betts

A physician with the COVID unit at Children’s Hospital in Oakland said:
“We (fortunately) have not had any kid-to-adult or kid-to-health-care-provider transmissions, despite having over 225 infected kids, of whom about 30 have had admissions. There is very LITTLE data about transmission to adults and lots of data suggesting the opposite.”

 From Pate Thomson

From my reading it seems that child to child transmission of Covid-19 infection has been well demonstrated. Child to adult is less than expected in the under 10 age group (infants are another matter). In infected children, viral loads from the nasopharyx have been shown to be substantial. Mechanisms that would inhibit transfer to adults with intimate contact seem illusive. That leaves me with with a suspicion that child to adult transfer can occur, like so many other respiratory viruses.
 

I know this is under intense study and more data may clarify this important question. I choose to reserve my final interpretation until we have more information. 

From O’Neil Dillon

O'Neil Dillon reminds us that this data is based on what we have learned during the current focus on social distancing, “bubbles”, with serious personal and societal control measures being practiced. All bets are off with major “opening up” and with explosive pandemic spread.

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