Researchers digging in to discover how novel coronavirus affects youngsters

covidkids2-charlesdeluvio-300x200Federal officials have launched what may be an aptly named, important, and reassuring study for kids, parents, families, and communities — the large-scale “Heros” investigation on Covid-19 and youngsters.

As the National Institutes of Health explains the “Human Epidemiology and Response to SARS-CoV-2” work:

“[It will] help determine the rate of novel coronavirus infection in children and their family members in the United States [and] will help determine what percentage of children infected with SARS-CoV-2, the virus that causes Covid-19, develop symptoms of the disease. In addition, the HEROS study will examine whether rates of SARS-CoV-2 infection differ between children who have asthma or other allergic conditions and children who do not.”

As the New York Times reported, the data and limited research on children and the novel coronavirus complicates crucial decisions — in households, states, and for the nation:

“Among the most important unanswered questions about Covid-19 is this: What role do children play in keeping the pandemic going? Fewer children seem to get infected by the coronavirus than adults, and most of those who do have mild symptoms, if any. But do they pass the virus on to adults and continue the chain of transmission? The answer is key to deciding whether and when to reopen schools … Two new studies offer compelling evidence that children can transmit the virus. Neither proved it, but the evidence was strong enough to suggest that schools should be kept closed for now, many epidemiologists who were not involved in the research said.”

The two stand-out studies on kids and the virus, thus far, were conducted in China and Germany, the newspaper reported:

“In one study, published … in the journal Science, a team analyzed data from two cities in China — Wuhan, where the virus first emerged, and Shanghai — and found that children were about a third as susceptible to coronavirus infection as adults were. But when schools were open, they found, children had about three times as many contacts as adults, and three times as many opportunities to become infected, essentially evening out their risk. Based on their data, the researchers estimated that closing schools is not enough on its own to stop an outbreak, but it can reduce the surge by about 40% to 60% and slow the epidemic’s course … The second study, by a group of German researchers, was more straightforward. The team tested children and adults and found that children who test positive harbor just as much virus as adults do — sometimes more — and so, presumably, are just as infectious.”

The new American study will “rapidly enroll 6,000 people from 2,000 U.S. families already participating in NIH-funded pediatric research studies in 11 cities. Study participants will include both healthy children and children with asthma or other allergic conditions. The study team will prospectively follow these children and their families for six months to determine who gets infected with SARS-CoV-2, whether the virus is transmitted to other family members, and which family members with the virus develop Covid-19.”

The agency noted important characteristics of the research:

“The study will be conducted completely remotely. Every two weeks, a caregiver in participating families will collect nasal swabs from the child who is the primary study participant and all other family members who are enrolled in the study and will mail the samples to a laboratory for analysis. On the same day as the nasal swab, the caregiver will complete online questionnaires about each participant’s current symptoms, social distancing practices, recent activities outside the home, and recent exposure to people who are sick. In addition, if any member of the household develops symptoms of a viral illness, the caregiver will fill out another online questionnaire designed to determine the likelihood that the illness is Covid-19. If Covid-19 is likely, the caregiver will collect nasal swabs from all study participants and a stool sample from the symptomatic participant within 24 hours. Laboratory analyses of nasal swabs will test for SARS-CoV-2 and assess gene expression in the collected airway-surface cells. Investigators hope that these gene expression studies will reveal patterns that correlate with higher or lower risk of infection, Covid-19 symptom development and SARS-CoV-2 transmission. A caregiver also will collect a blood sample from each study participant two weeks, 18 weeks and 24 weeks after enrollment as well as three weeks after the family’s first likely case of Covid-19, if there is one. The blood will be collected using a new, nearly painless device that extracts a small quantity of blood through the surface of the skin. The blood will be analyzed for antibodies to SARS-CoV-2 once an appropriate antibody test becomes available.”

The need grows — maybe in dire fashion — for evidence-based guidance about children and Covid-19, as grownups worry about not only the disease but the effects of strict public health measures on kids’ lives, studies, and development.

New concerns also are rising, as clinicians report “ a troubling new phenomenon: Some children are becoming seriously ill with symptoms that can involve inflammation in the skin, eyes, blood vessels and heart,” according to a separate article in the New York Times. “The condition, which doctors are calling ‘pediatric multisystem inflammatory syndrome,’ is so new that there are still many unanswered questions about how and why it affects children.”

The article also reported:

“Symptoms can include fever, rash, reddish eyes, swollen lymph nodes and sharp abdominal pain. They do not usually include two common hallmarks of Covid-19: cough and shortness of breath. The syndrome can bear some resemblance to a rare childhood illness called Kawasaki disease, but as doctors learn more, they are emphasizing that the two conditions are not the same. Both involve a surge of inflammation in the body and can have serious effects on the heart. But Dr. Steven Kernie, chief of pediatric critical care medicine at Columbia University and NewYork-Presbyterian Morgan Stanley Children’s Hospital, said the new syndrome appears to affect the heart differently. While Kawasaki disease can produce coronary aneurysms when left untreated, the new syndrome seems to mostly involve inflammation of coronary arteries and other blood vessels. And though shock is a rare complication of Kawasaki disease, the new syndrome has sent many of the children into a kind of toxic shock with very low blood pressure and an inability of the blood to effectively circulate oxygen and nutrients to the body’s organs, Dr. Kernie said.”

Although this latest, puzzling, and problematic part of the novel coronavirus’ infection bears watching, the simpler and extremely stressful phenomenon of the disease’s forcing kids to be out of school and staying at home is creating untold anxiety about the well-being of youngsters, their parents, and families. Jennifer Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health, commented on the quandary about reopening schools, telling the newspaper:

“I think we have to take a holistic view of the impact of school closures on kids and our families. I do worry at some point, the accumulated harms from the measures may exceed the harm to the kids from the virus.”

As she pointed out about online learning classes:

“[They] temporarily may provide children with a routine, ‘but any parent will tell you it’s not really learning,’ she said. Children are known to backslide during summer months and adding several more months to that might permanently hurt them, and particularly those who are already struggling. Children also need the social aspects of school, and for some children, home may not even be a safe place, she said. ‘I’m not saying we need to absolutely rip off the Band-aid and reopen schools tomorrow,’ she said, “but we have to consider these other endpoints.’”

Parents are panicking about childcare as states start to re-open, and, with many households financially under big pressure and needing moms and dads and aunts and uncles and maybe even oldest siblings to return to work. (The grandparents, a stalwart source of support in raising kids in extended families, may be nixed now, of course, by infection concerns.) The stresses of confinement and close quarters are testing many families, and the possible respite for many of summer camps for kids seems to be dimming.

Even in households in which parents may be able to keep working remotely, and in families where there are older kids and not just the challenges of keeping little ones heading in good directions, the tussling with “quaranteenagers” is fraying nerves and testing tempers.

There also are alarming signs that grown-up diversions in homes — just as experts warned might occur — need to be better kept away from kids, with a reported 43% spike, for example, in March and April in deadly and unintentional shootings involving children.

In my practice, I see not only the harms patients suffer while seeking medical services but also the  benefits they can enjoy by staying healthy and out of the U.S. health care system. The coronavirus threatens to swamp our health resources, which, in their better times, already had notable problems with infections acquired in hospitalsnursing homes, and other medical care giving facilities, as well as major challenges with medical error and misdiagnoses. That said, at this difficult moment, we need to support doctors, hospitals, and public health officials as they marshal science, evidence, and facts to battle the global menace of Covid-19.

The rigorous public health measures may be getting tougher to bear, as the weather improves, the novelty wears thin, and critics question loudly and incorrectly in many ways the effectiveness of the battle against Covid-19. With more than 1 million infections and tens of thousands of deaths, the carnage would have been far greater without stringent responses. Boondoggles with testing and the provision of desperately needed medical supplies — including personal protective equipment for health care workers and many others — as well as the hyping of ineffective treatments has not been helpful in boosting public confidence.

Still, more Americans than not are sticking with the medical-scientific approaches, and they are showing how much they value above all else the health and safety of their lives and those of their loved ones, especially their kids. With all the mis- and dis-information and partisan falsehoods that are flying around, it may be an important consequence of studies on the coronavirus and the young that adults will take the research with the gravity it demands. Here’s hoping they read it, dig into it, and question it — exhaustively — so they better know how to safeguard themselves and their kids and how they might want to navigate with their families in difficult days that still lie ahead.

Photo credit: Tot plays as mom works at home, @Charles Deluvio, Unsplash
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