COVID-19 in Children: Looking Forward, Not Back.

Abstract

* Abbreviations: COVID-19 — : coronavirus disease 2019 SARS-CoV-2 — : severe acute respiratory syndrome coronavirus 2 In the fall of 2020, some of the fiercest debates waged in both academic and public arenas concern the relative ability of children to acquire and transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19): rightfully so, because there are enormous implications for children, parents, and schools. To date, much of the data have come from studies of COVID-19 within household clusters early during the pandemic. In this issue of Pediatrics , Laws et al1 add to this body of literature with a secondary analysis of a previously reported household contact study.2 They describe infection rates, transmission dynamics, and symptom profiles in a cohort of US children with household SARS-CoV-2 exposure between March and May 2020 in Milwaukee, Wisconsin, and Salt Lake City, Utah.1 The authors found that secondary infection rates in household contacts were similar in children (19 of 68 contacts; 28%) and adults (36 of 120 contacts; 30%). Having an infected parent was associated with a marked increase in risk for secondary infection in a child. Possible child-to-adult or child-to-child transmission was observed in 2 of 10 and 1 of 6 households, respectively, with potential for such events. Infected children generally had mild symptoms and were less likely than adults to report lower respiratory tract symptoms or loss of taste or smell. With their findings, the researchers provide additional confirmation that the overwhelming majority of children with SARS-CoV-2 infection develop mild symptoms3,4 but question whether children are less susceptible to infection or less likely to transmit SARS-CoV-2. Limitations of the study include convenience sampling and a relatively small sample size because … Address correspondence to William V. Raszka Jr, MD, Department of Pediatrics, The Robert Larner, MD College of Medicine, The University of Vermont, 89 Beaumont Ave, Given Courtyard N210, Burlington, VT 05405. E-mail: william.raszka{at}med.uvm.edu