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What do we know about SARS-Cov2 in children is it safe to go to school?

R Masekela

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What reduces transmission
• What are the typical symptoms in children
• What are the high risk group children
• Conclusion

What we know up to now?

• This is a new disease evidence base mostly non-peer reviewed
• Data from China mostly where disease originated
• European and US data emerging on impact in children
• Many countries once pandemic hit-schools were closed
• We are all still learning, can make some inferences from the data

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What reduces transmission
• What are the typical symptoms in children
• What are the high risk group children
• Conclusion

SA 24 264 and 5.5 million cases worldwide

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What reduces transmission
• What are the typical symptoms in children
• What are the high risk group children
• Conclusion

Current numbers in the population May 16

NICD data May 16 2020

Incidence risk for children SA

NICD data May 16 2020

Age-breakdown of infections

NICD data May 16 2020

• Study Vo Italy (86% population screened)
• Tests two time point (pre- and 2 weeks post

lockdown

• 2.6% population and no children infected under

10 years

Lavezzo C. MedRxiv 2020

Study family clusters children only responsible for 9.7% of cases

Zhu Y.SSRN 2020

Sungnak, W., Nat Med (2020).

ACE-2 Expression

Alanagreh L. Pathogens 2020

Proposed mechanisms

• Immature receptor system
• Specific regulatory mechanisms in the immune respiratory system
• Cross-protection by antibodies directed towards common viral

infections in infancy

• General antiviral defense mechanisms of the immune system
• Fewer with chronic diseases

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What reduces transmission
• What are the typical symptoms in children
• What are the high risk group children
• Conclusion

Flattening the curve

• Basic reproductive number: the average number of secondary

cases each case generates in a totally susceptible population

Slide courtesy of Dr Jeanette Dawa

Respiratory pathogen transmission

Transmission of SARS CoV2

Can children spread disease?

• Early data infection 2.1%

children affected with mild disease and asymptomatic infections.

• Characteristics of the virus
• Viral load: children vs. adults
• How efficient are children in

spreading the virus?

Mehta N. Systematic review Jones TC et al. Unpublished data

NB higher asymptomatic carriage and in children admitted also lower viral loads.

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What are the typical symptoms in children
• What reduces transmission
• What are the high risk group children
• Conclusion

Symptoms children

Uncommon

• Diarrhoea and vomiting
• Confusion
• Headache
• Runny nose
• Conjunctivitis
• Skin rashes
• Chest pain
• Coughing blood

Common

• Cough
• Fever
• Shortness of breath
• Loss of taste
• Loss of smell
• Muscle aches
• Sore throat or redness
• Lack of appetite

Symptoms children

Uncommon

• Diarrhoea and vomiting ( 17%)
• Confusion
• Headache
• Runny nose
• Conjunctivitis
• Skin rashes
• Chest pain
• Coughing blood

Common

• Cough (48%)
• Fever (41%)
• Shortness of breath
• Loss of taste
• Loss of smell
• Muscle aches
• Sore throat or redness (45%)
• Lack of appetite

UK data on admissions for Covid 19

Docherty AB et al. BMJ 2020

US CDC pediatric data (2,572 cases) : up to April 2, 2020

MMWR http://dx.doi.org/10.15585/mmwr.mm6914e4

• 1.7% of the 149,082 US cases
• 3 pediatric deaths, cause under investigations
• 2% of pediatric cases admitted to PICU
• Possibly more severe in < 1 yr of age

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What are the typical symptoms in children
• What reduces transmission
• What are the high risk group children
• Conclusion

Infection prevention control measures

How protective are masks?

Materials for masks and protection

• 1. Davies A. Dis Med Public Health Prep 2013
• 2. Rengansamy S. Ann Occ Hygiene 2010

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What reduces transmission
• What are the typical symptoms in children
• What are the high risk group children
• Conclusion

• Age below 5 years (more so infants under 1 year)
• Chronic lung disease (not asthma mild and moderate)
• Europe 45/655 asthmatic children admitted in survey, EAACI statement
• Cardiac disease and severe neurological disability
• Malignancy ( haematological > solid organ)
• New York 2.5% tested positive on screening and 5% of children in who tested positive

required admission. Bouland F. JAMA Oncology May 2020.

• Immunosuppression

Risk factors for severe disease in children

Multi-system inflammatory syndrome in children (MIS-C)

• Paediatric Multi-system Inflammatory Syndrome (PMIS)
• Paediatric Inflammatory Multisystem Syndrome (PIMS)
• Paediatric hyperinflammatory syndrome
• Paediatric hyperinflammatory shock

• In the UK and USA have a rising number of children presenting with a

multisystem inflammatory state and needing intensive care has been seen.

• Happens a few weeks post-infection
• Abdominal pain and gastrointestinal symptoms were also reported as

common features, as well as cardiac inflammation

• Rare complication unlikely to be KD but responds to same therapies

Multi- systemic inflammatory syndrome “Kawasaki-like disease”

• Shulman. JPID 2020

Unintended consequences

• Social isolation lack of peer support
• Lack of structure
• Home schooling?
• Anxiety and Depression
• 22% depression and 19% anxiety in a survey of over 2000 children. Xie BA. JAMA 2020
• Lack of nutritional support

Crawley E.BMJ Paediatrics 2020

Overview

• What are the numbers for SARS –Cov2 worldwide
• What are the numbers is South Africa
• What is the risk of spread of SARS-CoV2 from children
• What reduces transmission
• What are the typical symptoms in children
• What are the high risk group children
• Conclusion

Conclusion

• Children constitute a small proportion of cases
• Most children have mild symptoms or asymptomatic
• Majority of children will not require hospitalization
• Most children not efficient spreaders of disease
• Care should be taken in very young and those with co-morbidities

Questions ????

Asthma was not reported

Report characteristics of 23188 SARS-CoV-2 patients dying in Italy.

Swedish experience

• School premises are cleaned at least once a day, including cleaning

toilets, surfaces like doors and handrails, and wiping toys, computers, and textbooks.

• Limit large gatherings of students such as assemblies as much as

possible, and to space out tables and chairs.

• Staggering class, break, and lunch times to avoid large numbers of

students mixing at the same time.

• Look for opportunities to move activities outside, although close contact

sports and games should be avoided.