Children and COVID-19: How Should We Consider the Risks?

Medical experts urge mask use and outdoor play dates as the public awaits vaccine permission for young people.

By Carina Woudenberg
Oct 11, 2021 9:00 PMOct 12, 2021 1:04 PM
child school covid-19 mask thermometer
(Credit: MIA Studio/Shutterstock)


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With school back in full swing amid a pandemic, this year’s cold and flu season is a more freaky prospect for parents than any Halloween horror flick — especially given the sheer number of viruses that seem to be circulating around. 

“[My daughter] keeps bringing home new colds and I swear to Christ I'm buying a homestead and not having any other human contact for 10 years,” a friend texted me recently. “It's enough to make me start considering essential oils, crystals and praying to whatever deity might be listening.”

Meanwhile, a family member recently lamented that she appreciated how her son’s elementary school takes precautions meant to keep everyone safe, but the administration doesn’t allow students back on campus until 72 hours after their last cough. This means her kindergartner has been in and out of school repeatedly since classes started just two months earlier. 

How Schools Are Managing COVID-19

Before the pandemic upended life as we know it, cold and flu season was more or less an accepted part of life. Now, other respiratory viruses are spreading rampantly despite COVID-19 precautions, including masking and social distancing. This begs the question of whether schools and daycares are just as vulnerable to these outbreaks as they are to the common cold. It’s especially relevant as parents continue to wait on COVID-19 vaccine approval for children younger than 12.

Zachary Hoy, a pediatric infectious disease specialist at Nashville Pediatric Infectious Disease in Tennessee, says he doesn't think schools are to blame for the current jump in virus spread. Hoy notes that families face an onslaught of annual viruses, from the common cold to respiratory syncytial virus (RSV), which ramps up as the weather cools and children and staff move indoors and into small spaces.

“I do not think this represents a failure of preventative measures of schools and daycares and do not think it's related to the mechanism or spread of virus,” Hoy said. “We have also seen strains of COVID-19 that are more transmissible in general, so that likely contributes to the increased spread we have seen recently.”

And while novel coronavirus cases are cropping up in schools across the country, masks have proven their worth. The Centers for Disease Control and Prevention recently reported that schools without mask mandates were 3.5 times more likely to experience COVID-10 outbreaks than those without them.

Coupled with the fact that children are still considered less likely to experience serious complications from the disease compared to adults, parents can breathe a little easier. Medical experts say this decreased risk may occur because children are less likely to have underlying conditions, such as high blood pressure or heart disease, which are known to exacerbate symptoms.

Experts have put forward other theories, too. A lack of a mature immune system may actually work in children's favor, says Sharis M. Simonian, a pediatric care coordinator at medical concierge Sollis Health in Los Angeles. 

“[Children] may not develop strong immune responses that adults more commonly form against COVID-19, known as a cytokine storm,” Simonian noted. “Cytokine storms allow the virus to damage several organ systems on a broader scale, leading to more complications in adults.”

Young people’s constant exposure to viruses — including other coronaviruses— at schools and daycares may offer relatively strong protection as well, Simonian adds.

The disparity could also be explained by differences in lung anatomy, says Hoy. “Children may respond differently to COVID than adults due to different amounts of receptors present in the lungs where COVID is able to enter the body,” he said.

Staying Vigilant

Regardless, health officials are still urging parents to take precautions because some children can (and do) get very sick from COVID-19. These include keeping masks on when indoors with people outside of your household, receiving the flu shot (to ward off another potentially harmful pathogen), and giving young people the COVID vaccine when they're eligible. 

On Thursday, Pfizer sought Food and Drug Administration approval for use of its vaccine in children aged 5 to 11, and federal regulators are expected to consider it in late October.

Letting our guards down may partly explain a recent jump in children's cases: These comprised about 16 percent of all regularly reported U.S. cases since the pandemic's start, but jumped to over 26 percent in late September. 

“As vaccinations have become more widely available, many have become less stringent about mask use, despite [the] lack of a fully vaccinated family, which is likely also contributing to the increased cases,” says Simonian.

Ashlesha Kaushik, medical director at UnityPoint Clinic Pediatric Infectious Diseases in Sioux City, Iowa, has done extensive research on a COVID-19 complication in children known as multi-system inflammatory syndrome. Although rare — roughly 500 children in the United States were diagnosed with MIS-C in 2020, Kaushik says — MIS-C can lead to severe disease in children. It causes damaging inflammation in various organs such as the heart, lungs, brain, eyes and intestines. 

Treatment options vary but can include intravenous immunoglobulin therapies and mechanical ventilation. Although most children eventually recover from the ordeal, it can be fatal. It’s ultimately a severe manifestation of disease with a constellation of symptoms and not a lot of understanding behind why it occurs. “Perfectly healthy children have developed MIS-C,” she said.

Taking on The Holidays

So how should parents think about risks when planning the upcoming holidays and potential indoor gatherings as temperatures drop? Checking COVID-19 rates in your area might be a good place to start, suggests Simonian. However, with the virus so widespread it's safest to minimize indoor playdates or sleepovers. You could even form “pandemic pods,” with other families in which you agree to socialize exclusively with each other throughout the pandemic, she said. Still, some experts have criticized pods' efficacy, and it can be difficult to track every member’s social interactions.

As for holiday travel, Simonian suggests looking up infection rates in your destination and giving special thought to how exactly you'll get there. "Mode of transportation needs to be considered, and the level of exposure that would entail,” she said. “It would be prudent to research local COVID-19 precautions in the areas the families are traveling.”

Kaushik suggests using the pandemic as an opportunity to think creatively about celebrating the holidays. For example, parents could hide Halloween treats in the backyard for their children rather than going out to trick-or-treat.

“We have lost more than 680,000 American lives; it’s not just some virus,” the doctor noted just days before COVID deaths in the U.S. topped the 700,000 mark. “If wearing a mask can add that extra layer of protection, then why not? Just do it. You don’t want to suffer and be on a ventilator.”

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