High levels of virus in children could make them silent spreaders of disease, study shows

Medical Watch

A troubling study just released by the Journal of the American Medical Association Pediatrics may give pause to parents and educators considering whether to reopen schools.

The study looked at SARS-COv-2 viral levels in children. That’s the virus that causes COVID-19. The younger the child or baby, the higher the viral loads in their nose which means even if they are not sick, they could spread disease to at-risk family members.

Dr. Taylor Heald-Sargent is Lurie Children’s infectious disease specialist.

“We can’t take for granted that they might also not be spreading this virus,” Heald-Sargent said.

Children have largely been spared from severe illness when it comes to COVID-19, but are they silent spreaders?

“People have been thinking maybe kids don’t spread,” Heald-Sargent said. “But schools were shut down fairly early, so you have to remember that adults were the only ones that could be spreading early on because they were the only ones going into the community, bringing it into the household.”

Heald-Sargent and her colleagues analyzed 145 cases of mild to moderate COVID-19 within the first week of symptom onset. They looked at viral load in those younger than five years old, then compared the numbers to different age groups, including five to 17-year-olds and 18 to 65-year-olds.

“Everyone was swabbed the same way and sent to the lab as part of their routine clinical care,” Heald-Sargent said. “And then we just happened to notice that our babies and our young kids under 5 seemed to have very high levels. And when we did the math they definitely did.”

Unlike what has been found in adults, the higher viral loads did not correlate with severity of illness.

“It’s pleasantly surprising that kids are not getting very ill despite having so much virus in their nose and in their upper airway,” Dr Heald-Sargent said. “Maybe it’s because it’s not getting into their lower airway, where it starts to cause pneumonias. I don’t know, that’s something everyone is looking in to, why don’t kids get as sick? But it’s nice that it’s not happening.”

But doctors do know from studying other infections the more virus a patient carries, the more easily it can be spread.

“Combining that with the behavioral habits of young children, I have two at home, they are not the best at washing their hands and not touching their face and then touching everyone else and all of their things,” Dr Heald-Sargent said. “So, it would make sense that these kids that have a lot of virus might be able to transmit at least as well as adults if not better.”

Dr Heald-Sargent said the underrecognized finding has implications, especially as daycare facilities and schools prepare to reopen.

 “I think that school districts and daycares and the community can’t assume that kids aren’t going to be spreading the virus,” Dr Heald-Sargent said.

Dr Heald-Sargent said as kids re-emerge in the community, we may see an uptick in pediatric cases. There has been a rise in the southern states.

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