Focus on how children transmit Covid-19
• National Institutes of Health researchers will track US youngsters to determine what percentage of those infected with coronavirus show symptoms
Children with Covid-19 threaten recovery from the pandemic — sparking increased scrutiny of their cases from scientists and policymakers seeking clues about the new coronavirus’s spread and virulence.
While infections of those under 18 compose a small portion of the worldwide total, they number in the thousands, and in recent days have become the subject of a National Institutes of Health study.
There have also been reports in the US, UK and Europe of a mysterious condition among children.
In Italy, one model being used to guide recovery decisions has underscored the danger presented by children, who often show no symptoms and have many more daily social contacts than adults.
It predicts that opening schools alone would blow out the reproduction factor — known as R0 and pronounced R naught — to about 1.3, above its current level below 1, which is needed to curb the outbreak.
“Opening the schools is a solution that’s absolutely worrying,” said Stefano Merler, a researcher at the Trento-based Fondazione Bruno Kessler who built the models with Italy’s Superior Institute of Health. “It would bring very serious problems in a very short time,” he said at an April 30 briefing.
By contrast, opening only businesses would keep the level below 1, according to the model. An R0 rate of 1 means that for every person infected, another contracts the virus; a rate less than 1 implies the pandemic is shrinking.
But more than just being vectors of infection, children around the globe have been sickened by, and in some cases died from, Covid-19.
While their numbers pale compared with the tens of thousands of dead elderly people, there are now enough children with Covid-19 that hospitals have dedicated spaces for them — including in Milan, near Rome, and in New York, where at least six children have died from the disease, according to the city’s health department.
Italy has counted 1,478 children aged nine and younger as infected, according to state data up until April 28. Two died: a girl and a boy.
Rome’s Bambino Gesu paediatric hospital, which has set up an isolated Covid-19 ward at a satellite facility outside the city centre, last week had two children in intensive care, of a total 16 coronavirus patients. They included four mothers, according to Corriere della Sera newspaper.
As governments weigh reopening economies — along with their schools — the new research points to a risk that virus transmission via children could worsen the pandemic. One such study, from Germany, found that children with the coronavirus may be as infectious as adults, and recommended caution against unlimited school openings.
The New England Journal of Medicine on May 1 published a study of Italian children with Covid-19 that showed more than half contracted the disease outside their families or from unknown sources, and hypothesised that this was the result of Italy’s not locking down sooner.
Other researchers have questioned how much children can spread the virus. A recent analysis of global studies compiled by the Don’t Forget the Bubbles paediatric blog found limited evidence that children pass the disease to others in significant numbers.
The National Institutes of Health said on Monday that US researchers will track children from 2,000 families to learn how the virus is transmitted and determine what percentage of those infected show symptoms.
And in the UK, Spain, Italy and US, health authorities and doctors are warning of a growing number of children with a “multi-system inflammatory state” that could be linked to the coronavirus.
In New York state alone, authorities have identified 64 potential cases.
The New York state department of health on Wednesday issued an advisory to health-care providers. “Thankfully most children with Covid-19 only experience mild symptoms, but in some, a dangerous inflammatory syndrome can develop,” said Howard Zucker, the health commissioner.
Among children with Covid19, the youngest have borne a disproportionate burden. In Italy, those one year old and under compose 37% of the 134 coronavirus admissions to hospitals of children through April 28.
Among the reported 49 babies in hospital in Italy was a two-month-old from a small town south of Milan. Her ordeal began on March 15 when she ran a high temperature and was vomiting, said her mother, Francesca, who asked that her surname not be published to protect medical privacy.
Francesca drove the two of them to a Milan hospital that specialises in infants, not knowing it would be the last time they would see the baby’s father and two older siblings for three weeks. She had with her only a few nappies, a phone charger and her purse. At worst, she suspected bronchitis, and said she had no idea babies could contract Covid-19.
Doctors, however, had a hunch and isolated the two, testing mother and daughter. The next morning, Francesca learnt from a phone call to the room that they each had the novel coronavirus.
“I had a panic attack,” she said. “I thought I’d die or the baby wouldn’t make it. I prayed it would be me, not her. ”
The local hospital transferred Francesca and her daughter to the paediatric ward of Milan’s Sacco hospital, which has more than 15 beds, five of which are for infective isolation, and one isolation room for babies.
ISOLATION ROOM
In a room of their own, the duo were each other’s only company as they fought the virus. Their conditions never turned serious enough to require invasive procedures or machines to assist breathing.
However, their isolation — and doctors and nurses who entered only in full protective gear — meant they did not see another human face the entire time they were there.
Even after they recovered from the Covid-19 symptoms, Francesca and her daughter had to wait days until they both tested negative before they could go home, on April 6.
“The day we got out, and I finally saw the face of the ward’s doctor, I started crying,” Francesca said.
Back at home, however, there are still lingering questions about her two other children’s health — and by extension the rest of Italy’s — as the country heads towards a slow reopening: despite her time in hospital, the other members of her family, having never shown symptoms, have been unable to get a coronavirus test.
I HAD A PANIC ATTACK. I THOUGHT I’D DIE OR THE BABY WOULDN’T MAKE IT. I PRAYED IT WOULD BE ME, NOT HER