Kids and Covid

26 May 2020

Interview with 

Jeremy Rossman, University of Kent

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Children working at school

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Earlier in the month, in his Sunday night TV “address to the nation”, Boris Johnson said the government’s “ambition” was for schools in England to re-open on the 1st of June. At first, the plan was for children in Nursery classes, Reception, Year One and Year Six to go back. But, since then, there’s been a great deal of push back, not least from teachers’ unions and many local authorities. The Prime Minister did say the reopening was conditional on the coronavirus being in retreat, but many are worried that children will catch the infection and spread it more widely, therefore putting us all back to square one. 

But some countries, like New Zealand for instance, have already slackend their lockdown measures and sent their children back into the classrooms. Indeed, it’s generally accepted that children seem to deal better with coronavirus and may even transmit it less. But in some exceptionally rare cases, there appears to be a link between COVID-19 and a severe inflammatory condition, which can have very serious consequences. So what’s the full picture in all this? To get a clearer idea, Adam Murphy spoke to Jeremy Rossman, Professor of Virology at the University of Kent.

Jeremy - Children seem to be able to be infected just as easy as adults do, but they don't seem to replicate the virus to quite as high levels as adults do. Which leads to some of the speculation that perhaps children don't spread the virus effectively. Although we don't know this for sure. What we do know, is that the majority of children that become infected with Covid-19 either have no symptoms whatsoever or have very mild illness.

Adam - Well, if it's the case that kids don't transmit or we can't prove they transmit it, does that mean it's safe to reopen the schools then in that regard?

Jeremy - There is this possibility, but unfortunately the issue is that we don't know for certain because we do know that children can be infected. And that they do produce virus in the respiratory tract and that once you produce virus in the respiratory tract, you can spread the virus. But there have been a few studies that have looked at transmission amongst households and what they've seen is that children don't seem to be the ones that bring an infection into the household. They can be infected by other members in the home, but they don't seem to be the primary ones that are bringing the infection in. And if schools were in full operation, maybe we would see more spread that is mediated by children. We just don't know yet. And so without knowing for sure, that is a fairly big risk, both for the health of the children as whole, but also for spread of Covid-19 amongst families and communities.

Adam - When children have the more severe version of the disease, what does it look like? How does it present?

Jeremy - In a subset of the children that have very severe disease, we're starting to see this new disease presentation, this multi-system hyper inflammatory disease. And that's something that is a little bit different from what we've seen in adults. And that doesn't seem to be associated with this pneumonia or respiratory distress. And this is sort of the new and concerning disease presentation that we're seeing in children.

Adam - If the symptoms are different, what symptoms would you be looking at for this kind of version?

Jeremy - The things that tend to occur are fever. Again, fever seems to be one of the most common disease symptoms in any form of Covid-19. So, what we're looking for is fever and a combination of other symptoms. So fever and perhaps a rash. Or fever and what seems to be the most common indicator is severe abdominal pain or any sort of gastrointestinal disease, diarrhea, vomiting, upset stomach. These together with fever are a really strong indicator that it's time to seek medical attention, because they could be, not necessarily, but they could be an early indicator of this multi-system hyper inflammation. And so it's important to really take action if you see these symptoms.

Adam - And what can it lead to? What problems can this inflammation cause, long term?

Jeremy - So this disease has a lot of similarities with two other diseases. This is Kawasaki disease and toxic shock syndrome. Now it's not either of those two diseases. It just has a lot in common. So Kawasaki disease, this is where you get inflammation of blood vessels. And we see inflammation of blood vessels in this new disease. And part of the problem with that is that first of all, if you get inflammation of the blood vessels, this can be very damaging to your body as a whole, but specifically it can be very damaging because you tend to get a lot of inflammation of blood vessels around the heart. And this can cause heart disease and is one of the reasons why it's so important to treat early. The other disease that it tends to be associated with is this toxic shock syndrome. And this is a massive, robust activation of the inflammatory system. Part of your immune system. Toxic shock is associated with bacterial disease and that's not what's causing this whatsoever. But what we are seeing is this hyper inflammation of the immune system, what we call a cytokine storm. This is just a cascade effect of reinforcing immune activation that can cause a lot of damage in and of itself.

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