Immunity and COVID

Education is essential for the overall growth and development of any child. Children are the future of the world and the nation’s development depends on their development. COVID-19 pandemic since Dec 2019 has impacted the education system globally, changing the in-person education system to digitalized system. Besides providing basic education, many remote places schools, early care and different education programs also provide meal programs and social, physical, behavioural, mental health services and initiate different vaccination drives. Also, they provide employment to teachers, other staff and other caretakers. COVID-19 has put all these activities at a standstill, hampering the overall growth of society. To reduce the transmission, restriction in movement, gatherings have hampered the Team sports or other types of group extracurricular activities which has also impacted the mental health of all.^1,2

To date children infected with SARS-CoV-2 suffered from only mild symptoms, but incidences of the hyper-inflammatory syndrome in children associated with SARS-CoV-2 infection are being reported in many countries. Studies reveal that children have lower seropositivity compared to adults, hence are less susceptible to the infection and mostly get the infection from their household contacts.³

Recent reports from the US, state that during the early stages of the pandemic, children accounted for only 2% of total COVID -19 cases, which increased to 13% % of diagnosed cases in the US. To prevent the spread of kindergarten to 12th-grade schools were closed affecting a large number of students having an adverse impact on the social, psychological and educational status of different communities.²

A study by Chung et al stated that among 37 000 nasal swab samples tested, 123 children and 432 adults had SARS-CoV-2 infection. They concluded that children had less frequently symptomatic (61.8% ) compared to adults (92.8%), had fewer symptoms compared to adults, and had a shorter duration of symptoms (mean [SD], 3.8 compared to 4.9 among adults. Symptomatic children who had lower SARS-CoV-2 cycle threshold (Ct) values means had higher viral RNA levels compared to asymptomatic individuals,  Also, there was no difference in Ct values between symptomatic children and symptomatic adults, nor between asymptomatic children and asymptomatic adults.²

Another meta-analysis showed that the risk of asymptomatic transmission is significantly lower than that of symptomatic transmission (relative risk, 0.58; 95% CI, 0.34-0.99; P = .047).⁹ Thus these studies conclude that children may be transmitting SARS-CoV-2 less.²

Reports from a study in South Korea, suggest that children older than 10 years could transmit COVID-19 infection more. In a Meta-analysis of household transmission dynamics 3.8% of transmission, clusters had a pediatric index case, While the secondary infection rate was lower than adult household contacts (relative risk, 0.62; 95% CI, 0.42-0.91).⁴ 

It was observed from recent data that children who attended school in person had a greater risk of getting COVID-19 infection, but this could be reduced by following the preventive measures.⁵ 

The US Centers for Disease Control and Prevention has put emphasis on re-opening the kindergarten through 12th-grade schools and resuming in-person learning phase wise, and prioritization of the correct and consistent use of masks and physical distancing. Prevention measures such as, teacher masking, daily symptom screens, and appropriate isolation and quarantine, further can reduce transmission risk in schools. Future care should be taken to monitor and check that symptomatic children stay at home, which would help in prevention not only of SARS-CoV-2, but also of influenza, respiratory syncytial virus, and other infectious pathogens. Additionally, extracurricular activities are important in SARS-CoV-2 transmission, and measures to prevent transmission should be used.¹

Keeping in view the results of the discussed studies, it seems that children may be less likely to transmit SARS-CoV-2 due to less frequency and severity of symptoms, because of reduced viral load. To bring back the normal phase of life, it is necessary to vaccinate all who are eligible including children, children, teachers, non-teaching staff and caretakers, maintaining physical distance, improving the ventilation in schools, encouraging the consistent and correct use of masks, hand washing, frequent screening tests to be conducted, staying at home if sick and maintaining self-discipline and being alert can reduce risk of transmission and help the children enjoy their learning in a safe and best manner.

References:

1. CDC. Science Brief: Transmission of SARS-CoV-2 in K-12 Schools and Early Care and Education Programs – Updated. 2021, Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Accessed on 7-Aug-21
2. Rostad, C. A.; Kamidani, S.; Anderson, E. J. Implications of SARS-CoV-2 Viral Load in Children: Getting Back to School and Normal. JAMA Pediatrics 2021.
3. Spielberger, B. D.; Goerne, T.; Geweniger, A.; Henneke, P.; Elling, R. Intra-Household and Close-Contact SARS-CoV-2 Transmission Among Children – a Systematic Review. Frontiers in Pediatrics 2021, 9.
4. Zhu Y, Bloxham CJ, Hulme KD, Sinclair JE, Tong ZWM, Steele LE, Noye EC, Lu J, Xia Y, Chew KY, Pickering J, Gilks C, Bowen AC, Short KR. A Meta-analysis on the Role of Children in Severe Acute Respiratory Syndrome Coronavirus 2 in Household Transmission Clusters. Clin Infect Dis. 2021; 72(12):e1146-e1153.
5. Lessler J, Grabowski MK, Grantz KH, Badillo-Goicoechea E, Metcalf CJE, Lupton-Smith C, Azman AS, Stuart EA. Household COVID-19 risk and in-person schooling. Science. 2021;372(6546):1092-1097.