Paediatric experts who serve on an advisory subcommittee to the Department of Basic Education, on May 29 discussed the risks for schoolgoing children to contract and spread Covid-19.
A virtual seminar hosted by the Human Sciences Research Council (HSRC) provided evidence-based information about the risk of children between 0 and 19 years old contracting and spreading Covid-19.
This comes as schools have been preparing to welcome back grade 7 and 12 pupils from June 1, with further grades expected to follow in a phased approach in the months ahead.
As at May 27, more than 4.9-million people have contracted Covid-19 globally, with South Africa having reported more than 27 000 confirmed cases. In South Africa, a third of the population consists of children.
South Africa has reported 260 confirmed cases of children aged between 0 and 4 years, 203 cases of children aged 5 to 9 years, 280 cases of children aged 10 to 14 years and about 390 positive Covid-19 cases for children aged between 15 and 19.
University of KwaZulu-Natal (UKZN) paediatrics and child health department head and paediatric pulmonologist Professor Refiloe Masekela says children continue to make up a very small portion in terms of total Covid-19 infections globally and in South Africa.
She says children are less susceptible to contracting Covid-19, explaining that although the coronavirus is an efficient one, it requires a specific receptor – the ACE-2 receptor – to allow entry into the body.
Masekela explains that children have significantly less of these receptors in their bodies, compared with adults, owing to their immature receptor systems.
Further, her research has found that children with allergies such as allergic rhinitis have even fewer of these receptors in their airways, placing them at an even lower risk of contracting Covid-19.
Additionally, children are less susceptible to contracting Covid-19 owing to them having a “virus soup” within their bodies and this competition between viruses helps to prevent the successful infection of Covid-19.
Masekela adds that children with co-morbidities and underlying conditions are more vulnerable to the virus, similar to adults with underlying conditions; however, a small proportion of children actually have these underlying conditions that put them at risk, compared with the number of adults with these conditions.
Masekela further notes that children are at risk for intensive care hospital admission – when contracting Covid-19 – if they have chronic lung disease (not mild to moderate asthma), cardiac disease, severe neurological disability, immunosuppression or malignancy (cancer).
She mentions that it is unclear how much higher a risk children are at for Covid-19 hospitalisation with tuberculosis and human immunodeficiency diseases, since there is simply not enough data from regions that have high rates of these diseases.
Moreover, Masekela highlights that children generally only make up between 1% and 5% of Covid-19 infections globally, and, of these, a very small proportion would need hospital care, and even fewer would need intensive care.
In the UK, out of 20 133 patients that were hospitalised for Covid-19, only 310 were children and none of them died.
She believes the unintended consequences of schools being closed, such as home schooling challenges, anxiety, social isolation and the absence of feeding schemes, outweigh the risks related to children and Covid-19.
Masakela reiterates that the virus is carried in people’s respiratory tract and therefore singing and speaking can leave droplets in the air or on services, infecting people within a meter around them or those that touch infected surfaces.
She finds in her research from US and European data that most children are not efficient spreaders of Covid-19.
“Although children often have a sufficient amount of viral load to get symptoms from contracting Covid-19, the viral load is often less compared with that of adults. Children are also more likely to be asymptomatic carriers of the disease.”
Should children contract Covid-19 and experience symptoms, these will likely be cough, fever, shortness of breath, sore throat, muscle aches, diarrhoea, vomiting and a runny nose.
Masakela says young children (up to ten years old) with Covid-19 typically experience less severe symptoms than older children, adults and elderly people.
Meanwhile, University of the Witwatersrand associate and paediatrics head at Chris Hani Baragwanath Academic Hospital Professor Sithembiso Velaphi says his research − based on experiences in Italy, Sweden and Iceland − confirms Masekela’s findings that the proportion of infected children is much lower than infected adults.
He agrees that children carry a lower viral load of coronavirus, making them less likely to spread the disease, compared with adults.
Velaphi conducted meta-analysis, compiling data from population survey-conducted studies and contact tracing-conducted studies, finding that children are less susceptible to contracting Covid-19.
He adds that there were 31 studies in the countries he included, looking at different age groups as spreaders of infection, and only three of these suggested that children are equal or greater spreaders of the infection than adults.
Additionally, Velaphi points out that children secrete or release fewer infected droplets into the air from coughing or speaking, compared with adults, which helps to contain the spread of Covid-19.
MAKING SCHOOLS SAFE
Nonetheless, schools still need to take as much precaution as possible to limit the spread of Covid-19 among pupils, especially since many of them live with high-risk elderly people.
UKZN affiliate and paediatric infectious disease specialist at King Edward VIII Hospital Dr Moherndran Archary says the majority of children are infected in their homes and, therefore, precaution must be taken to prevent transmission at schools.
“We are asking parents to screen children before they go to school and check for any symptoms of any disease, not just Covid-19. Staff should also complete self-checks before school to assess for any symptoms.
“Should a child, parent or staff member contract Covid-19, the school must be notified and accordingly start with a contact tracing exercise,” Archary states.
He adds that fever is quite variable for children with Covid-19, so screening alone is not enough of a precautionary measure. Rather, schools should create a full risk mitigating environment.
Archary says schools must ensure: adequate ventilation, space for physical distancing practices of 1.5 m between students, implementation and monitoring of physical distancing, available water and sanitation, implementation of hand hygiene awareness programmes and practices at school, screening and limited entry into school grounds, and frequent cleaning – twice a day for high-contact areas such as door handles.
He further recommends that schools arrange for staggered drop-off and collection times to allow for less crowding and queuing. Archary says large venues such as school halls and outside spaces must be used where classrooms do not allow for adequate physical distancing.
Lastly, he remarks that children over the age of two should be encouraged to wear cloth masks, as should staff members at schools.
“Schools should not be hosting any gatherings or assemblies, including prize-giving and sports events. Jungle gyms and sporting equipment must also be off-limits for the time being.
“These measures might need to stick for the next year or two, as long as the virus remains with us.”