To slow the spread of the coronavirus, society is becoming much less social. Public areas are emptying, businesses are shutting down, and schools and day cares are closing. Parents are struggling to navigate this new way of isolated family life, often with imperfect information.
Here’s what we do know: The virus behind the pandemic, SARS-CoV-2, can infect children. Kids under 10 are just as likely as adults to become infected from a person in the home, a study of transmission in Shenzhen, China suggests.
For reasons that remain mysterious, kids carrying the virus are less likely to get sick than adults. Of about 2,500 U.S. COVID-19 cases reported as of March 16, only 5 percent were in people aged 19 and younger. None died, but children aren’t out of the woods.
“Kids do better than adults, but they can still get sick,” says Sean O’Leary, a pediatric infectious disease specialist and spokesperson for the American Academy of Pediatrics. And COVID-19, the disease that the coronavirus causes, can be severe, particularly for babies and preschoolers, an analysis of 2,143 children in China suggests. That study, published March 16 in Pediatrics, found that the 5 and under crowd suffered more severe symptoms, including breathing trouble, than older children.
In addition to possibly getting sick themselves, children can spread the virus. A study of children in Wuhan posted March 18 at medRxiv.org concludes that although children account for a sliver of the confirmed illnesses, they are “nonnegligible invisible infection sources.” Put another way, kids are huge germ bags.
What’s more, people are highly contagious before they show symptoms (SN: 3/13/20), which means they unwittingly spread the virus (SN: 3/17/20). Although scientists are still missing key details about this spread, upper airways are known to be packed with virus early in the illness. And young children are terrible at covering coughs and wiping their noses.
As scientists scramble to answer basic questions about COVID-19, parents are left with practical questions about how to keep their children — and the more vulnerable members of their wider community — healthy. Here, infectious disease experts offer their thoughts on how parents can navigate these questions in the face of great uncertainty.
Are playdates ok? Should I ground my teenager?
Others say the answer isn’t clear-cut. “Everyone wants a binary answer — do this, do that, yes or no,” says John Swartzberg, an infectious disease specialist at the University of California, Berkeley. “This is not a binary condition.”
The best answer, Swartzberg says, is highly individual. Factors like whether you’re in an area with lots of virus circulating, whether you live with an older person, or whether you yourself are at high risk of exposure through your job could all change the answer.
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Parents ought to ask themselves, “Am I doing my best to keep the spread of this virus from happening?” O’Leary says. “That means changing a lot of behaviors, but not necessarily never leaving your house.”
Some parents have teamed up with another family to create a small circle that interacts, but limits exposure to other people. This imperfect solution also accounts for the fact that we may be in this scenario for a long time. “People can do anything for a short time,” Swartzberg says. But families will struggle to keep their children isolated for a long stretch of time, he says. “On the other hand, if we stop [distancing] too soon, we might as well not have started it.”
For both young children and teenagers, the same principles apply: Small numbers of people are better, outside is better than inside, no one with symptoms should be present, and no face touching (an impossible expectation for young children). And, of course, lots of handwashing.
One more tip from Swartzberg: Wash the toys kids touch, and their clothes — a lot.
Should I take my children to playgrounds?
That’s not a good idea. The virus is known to linger on hard surfaces (SN: 3/4/20), though it’s not clear how much that scenario might contribute to infections. The virus remains viable longest on plastic and stainless steel, where it can be detected for two to three days, though infectivity drops substantially after 48 hours, researchers report March 17 in the New England Journal of Medicine.
“You can imagine young kids playing on a playground, and they cough on a piece, then another child crawls on that, and then they rub their eye,” O’Leary says. “That’s potentially a pretty easy way to spread it.”
Bottom line: Take a family hike or bike ride instead of a trip to the playground.
Schools and day cares are closed. Can my parents watch my kids?
Contact between grandparents and grandchildren is particularly risky with this coronavirus. That’s because people aged 60 and older are at the highest risk of death from the disease. Of about 2,500 U.S. COVID-19 cases reported as of March 16, adults 65 and older accounted for 53 percent of intensive care unit admissions, and 80 percent of deaths. In stark contrast, no ICU admissions or deaths have been reported for people 19 and under, the U.S. Centers for Disease Control and Prevention reports March 18.
“If parents have the option to stay home with their kids and not infect the grandparents, that’s obviously something they should seriously consider,” says Valerie Reyna, a risk and decision-making expert at Cornell University.
That may not be realistic. Normally, an estimated 40 percent of grandparents in the United States babysit their grandchildren. That percentage is likely to go up as schools close around the country, according to the CDC.
For parents at high risk of COVID-19, such as medical staff and service workers, the best option is to stay away from older loved ones, says epidemiologist Jennifer Horney of the University of Delaware in Newark. Other families might be able to hunker down together, forming intergenerational, closed groups.
Swartzberg, a grandpa himself, has been asked to keep his distance from his grandchildren, whose parents are doctors who treat COVID-19 patients. Their new protocol involves walks outside, at a distance, but no babysitting or hugs. This new way of life is “very reasonable, and very painful,” he says.
My kid just spiked a fever. Should we go to the doctor for a test?
No. Chances are high that a test wouldn’t happen, given the still limited testing going on in the country, and even if it did, clinical care wouldn’t change.
“There’s no specific treatment that we’re going to give,” O’Leary says. Children who might carry the virus ought to be cared for at home, unless they’re showing signs of distress such as trouble breathing. Unnecessary trips to the doctors would add to already burdened health care facilities and potentially risk exposing health care workers, O’Leary says.
“There are still a lot of people who are thinking this is not a big deal,” O’Leary says. “This is a big deal. The sooner we recognize that, the better off we’ll be.”