07/17/2020
Great update on kids and Covid by my good friend and pediatrician, Dr. Steve Silvestro. Follow Dr. Silvestro’s “The Child Repair Guide” for great parent updates on navigating the challenges of raising happy, healthy kids.
***KIDS ARE AT RISK when communities can’t control COVID spread***
This is the latest data from Florida—10-15K new cases PER DAY over the past week.
Much more worrisome is this: 1/3 of all kids tested in Florida have been positive (17K positive of 54K tested).
Worse still, almost half of those kids who are positive are 9 years old and younger.
Why is that the worst part—at least in this pediatrician’s eyes?
Because we’ve recently been looking at other data that’s given the impression that kids under 10, *while not immune at all*, are theoretically less susceptible to COVID-19 AND less likely to spread it. I said as much in my recent article on kids & daycare (linked at the bottom). We’ve used the data we had from around the world—showing that kids under 18 were 2% of positive cases, and kids under 10 were only about 1%—with the idea that kids under 10 have less of the ACE-2 receptor the virus likes to use to get into cells…..and combined that info to theorize that kids under 10 are less susceptible to infection. Again, not immune, not impossible, but less likely to get it.
Yet here we have these numbers from Florida blowing a giant hole in how confident we can be in what we believed just a week ago.
What do I take from this?
1). We need to strongly—and repeatedly—emphasize that kids of any age CAN get COVID-19 and are NOT immune, as that misconception has spread too far and wide.
2). We still think that young kids are less likely to have severe symptoms. If they are as susceptible to infection as the Florida data implies, and if kids were very prone to severe symptoms, then we should be seeing many more kids hospitalized than we are. Like everything else with this disease, though, there is a qualifier—SOME kids do get severe disease or after-effects like MIS-C…this isn’t an all-or-nothing discussion. But for now, it does appear that kids are less likely to get severe symptoms.
3). Does this throw a wrench in the idea that kids under 10 are less susceptible to catching COVID-19? Possibly. It could be that the data showing kids under 18 making up just 2% of recognized infections is a result of us not recognizing that they’re sick in the first place. If kids are likely to have mild or no symptoms, they’re less likely to be suspected for COVID-19 and tested—unless they’re being tested because there are other people in the home or to whom they’ve been exposed who are sick. Now that testing capabilities have increased, it’s possible that places like Florida are testing more asymptomatic or mildly symptomatic kids as part of this contact tracing than others areas were earlier in the pandemic. This data from Florida doesn’t mention how many of these 17K positive children were symptomatic or tested because of exposure. Knowing that answer might not change anything we take from the Florida data, but it might lead us to look at the data that showed 1% or 2% incidence in kids more critically.
4). This doesn’t necessarily change the current thought that kids under 10 are less likely to spread COVID-19 than older teens and adults. The data we currently have still supports that idea—for now.
5). But this is the BIG TAKEAWAY—Kids are at risk as long as communities have poor control over the virus. Whether children are less susceptible to infection or not; whether children are less likely to spread it or not; no matter what, if the virus is running rampant in a community, kids are more exposed—and are therefore at a higher risk of infection than kids in communities with low prevalence.
As I mentioned in my daycare article, much of what we currently think about kids and this virus is up for grabs in areas where community transmission is high. And Florida, with daily infections drastically trending radically upward, is unfortunately proving that statement to be correct.
What does this mean for schools?
That’s the question everyone wants answered, right? For the moment, only one thing is clear—communities with rampant spread like Florida don’t currently have the luxury of thinking about in-person school. Whether young kids are spreaders or not, a state with up to 15,000 new cases per day and 1 in 3 kids tested turning up positive is a state in which there are much bigger fires to put out first.
But if your area has a low prevalence of infection, then the best way to get kids in school is to keep it that way.
Throughout this whole pandemic, it’s been challenging to build a straight, unwavering stance on almost anything. I do my best to build that solid case before I report anything to you—which is why the daycare article took me so long to publish, and why I’m even slightly hesitant to share this post with you, as there are a few questions about this Florida data I’d like to have answered. And yet, I am sharing this data despite those questions—in part for the transparency that in a “novel” event we learn as we go, and in part as a call to action:
The way through this is to know that it is real. To know that the simple acts of wearing a mask and being smart about distancing and where you go can have a massive impact. To accept that in a once-in-a-century global pandemic, you can’t always get what you want as an individual—but we can get what we need as a community if we collectively do the right things.
It’s time to rise above impatience, politics, and posturing, and focus on doing everything we can to beat this thing down—if not for ourselves, then for our kids.
___
My original daycare article:
https://www.drstevesilvestro.com/is-daycare-safe-during-covid-19
Florida data source:
http://ww11.doh.state.fl.us/comm/_partners/covid19_report_archive/pediatric_report_latest.pdf
Infection rate image:
https://www.nytimes.com/interactive/2020/us/florida-coronavirus-cases.html
