Are Kids Spreading SARS-CoV-2 in School and Daycare Centers

If kids aren’t spreading SARS-CoV-2, then why are three percent of the students at a high school in Texas sick with COVID-19?

Why are people starting to think that kids are spreading SARS-CoV-2, the virus that causing COVID-19, in school and daycare centers?

There have been over 500,000 cases of COVID-19 in children in the United States.
There have been over 500,000 cases of COVID-19 in children in the United States.

Probably because we are seeing more and more cases in kids, especially kids in daycare centers and schools in states with spiking cases.

SARS-CoV-2 in School and Daycare Centers

For example, let’s take a look at what’s going on in Texas…

“As of Friday, 410 total cases of coronavirus — 267 staff members and 143 children — had been reported at 318 licensed child care operations across the state, according to the Texas Health and Human Services Commission.”

Texas child care centers see sharp increase in coronavirus cases after months of relative calm

So far in Texas, 83% of child care centers (12,196 facilities are open) haven’t reported a COVID-19 case.

But 17% have…

Either in a child or adult.

Altogether, since March, there have been 1,271 cases in children and 2,416 cases in adults in 2,034 different daycare centers in Texas.

So far the largest cluster was in a Houston daycare, in which 17 adult staff members and 6 kids tested positive.

In another large cluster, in Pleasanton, 11 kids, but only 2 adult staff members tested positive.

COVID-19 has also already led to several school closures in Texas, just weeks after the start of the fall semester.

In one high school in East Texas, the number of active COVID-19 cases has already reached 3%. The school was only open for about three and a half weeks before having to move to online only education.

Are Kids Spreading SARS-CoV-2 in School and Daycare Centers?

A rise in cases in daycare centers doesn’t necessarily mean that it is the kids that are doing the spreading though.

Are staff members getting exposed and bringing SARS-CoV-2 to work with them, exposing the children? Or are the children acting as the spreaders?

A new study, Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020, provides some answers.

Children who likely got COVID-19 at two Utah daycare centers spread it to other family members at home.

These outbreaks all started with an infected staff member, but quickly spread to other staff members and children.

“Analysis of contact tracing data in Salt Lake County, Utah, identified outbreaks of COVID-19 in three small to large child care facilities linked to index cases in adults and associated with transmission from children to household and nonhousehold contacts. In these three outbreaks, 54% of the cases linked to the facilities occurred in children. Transmission likely occurred from children with confirmed COVID-19 in a child care facility to 25% of their nonfacility contacts.”

Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020

Not surprisingly, cases then spread outside the daycare centers, to some of the parents of these children and other family members at home.

Of course, that this study found evidence that children can spread SARS-CoV-2 isn’t surprising because it isn’t the first to make this claim.

“These findings demonstrate that SARS-CoV-2 spread efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission. Asymptomatic infection was common and potentially contributed to undetected transmission, as has been previously reported.”

SARS-CoV-2 Transmission and Infection Among Attendees of an Overnight Camp — Georgia, June 2020.

There is also the report about children at the overnight camp in Georgia in June, which found an overall attack rate of 44% among the campers.

And the report about the Rhode Island COVID-19 daycare outbreaks.

“A total of 101 possible child care–associated COVID-19 cases were reported during June 1–July 31. Among them, 49 (49%) symptomatic persons were excluded after receiving negative laboratory test results, 33 persons (33%) had confirmed cases, and 19 (19%) were classified as having probable cases.”

Limited Secondary Transmission of SARS-CoV-2 in Child Care Programs — Rhode Island, June 1–July 31, 2020

Fortunately, community transmission of SARS-CoV-2 was lower in Rhode Island than many other states at the time, which is likely why “possible secondary transmission was identified in four of the 666 programs that had been allowed to reopen,” and not more.

Of course, these results stand in contrast to early reports in other countries which found that children didn’t seem to be spreading SARS-CoV-2.

“These data all suggest that children are not significant drivers of the COVID-19 pandemic. It is unclear why documented SARS-CoV-2 transmission from children to other children or adults is so infrequent.”

COVID-19 Transmission and Children: The Child Is Not to Blame

Early reports that were maybe flawed because children simply weren’t being exposed to SARS-CoV-2 at the time because of school closures and other factors.

“Here, we report that replication of SARS-CoV-2 in older children leads to similar levels of viral nucleic acid as adults, but significantly greater amounts of viral nucleic acid are detected in children younger than 5 years.”

Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19)

So with conflicting reports, what are we to believe?

What to Know About Kids Spreading SARS-CoV-2

We will have to see more research, but with cases continuing to increase in daycare centers, schools, and colleges, it is very hard to believe that kids aren’t spreaders of SARS-CoV-2.

Not that they have to be…

There is an easy way to keep kids from spreading SARS-CoV-2 at daycare, school, and college.

Even easier than making them wear masks.

A recent study in Germany found that child-to-child transmission of SARS-CoV-2 in schools/childcare facilities appeared very uncommon, but this was at a time of very low rates of community transmission.
A recent study in Germany found that child-to-child transmission of SARS-CoV-2 in schools/childcare facilities appeared very uncommon, but this was at a time of very low rates of community transmission.

Yes, that’s keeping the COVID-19 case count down in your community!

More on Kids Spreading COVID-19

What to Do if You Have Been Exposed to COVID-19

Folks need to understand that they should begin self-quarantine as soon as they learn that they have been exposed to someone with COVID-19.

Do you know what to do if you have been exposed to someone with COVID-19?

Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.
Because they could have been exposed to SARS-CoV-2, the virus that causes COVID-19, anyone who attended the party should self-isolate.

Hopefully you already know that you shouldn’t go to a party and expose lots of other folks…

What to Do if You Have Been Exposed to COVID-19

Unfortunately, lots of mistakes are being made that are causing COVID-19 cases to again rise.

“For COVID-19, a close contact is defined as anyone who was within 6 feet of an infected person for at least 15 minutes starting from 48 hours before the person began feeling sick until the time the patient was isolated.”

COVID-19 Frequently Asked Questions

One of them is that many people simply don’t understand the importance of self-quarantining themselves after they have been exposed to SARS-CoV-2.

In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention...
In addition to watching for symptoms, it is important to self-quarantine for 14 days after a COVID-19 exposure, the incubation period for SARS-CoV-2, something the Florida Department of Health forgets to mention…

What happens if you don’t self-quarantine?

You may expose others in the days before you start to show symptoms (presymptomatic transmission).

But can’t you just get tested after your exposure to see if you have it?

Sure, you can get tested, but if it is negative and you are early in your incubation period, it doesn’t mean that you still won’t become sick later on. For example, you could have a negative COVID-19 test four days after being exposed to the virus, but then develop symptoms of COVID-19 two days later.

“Yes, you are still considered a close contact even if you were wearing a cloth face covering while you were around someone with COVID-19. Cloth face coverings are meant to prevent someone from transmitting the disease to others, and not to protect someone from becoming infected.”

COVID-19 Frequently Asked Questions

What if you’re not sure if you have COVID-19 and you are waiting on your test results?

That should be a no-brainer.

Self-isolate yourself why you are waiting for your COVID-19 test results!

Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.
Ideally, folks would be getting this information to self-quarantine after their COVID-19 exposure from a contact tracing team.

And if you think you have COVID-19, be sure to tell all of your close contacts, which includes everyone who was within 6 feet of you for at least 15 minutes starting from 48 hours before you began feeling sick.

Of course, social distancing and wearing a mask are important too.

But folks need to understand that they should begin self-quarantine as soon as they learn that they have been exposed to someone with COVID-19. That’s the easiest way to limit the spread of SARS-CoV-2 and the size of outbreaks.

More on COVID-19

What to Know About Face Masks and COVID-19

Wearing a face mask is safe and may help slow the spread of COVID-19.

Why do some people still think they shouldn’t wear a mask to help control the COVID-19 pandemic?

A chain link fence won't keep out a mosquito, but it will keep out a dog covered in ticks...
A chain link fence won’t keep out a mosquito, but it will keep out a dog covered in ticks…

The usual suspects…

Confusion About Face Masks and COVID-19

Much of the confusion about face masks stems from the fact the initial guidance from the WHO and CDC said that wearing a mask wasn’t necessary for everyone.

“Wearing medical masks when not indicated may cause unnecessary cost, procurement burden and create a false sense of security that can lead to neglecting other essential measures such as hand hygiene practices. Furthermore, using a mask incorrectly may hamper its effectiveness to reduce the risk of transmission.”

Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak – WHO Interim guidance January 2020

Using a mask incorrectly?

If you are going to wear your mask under your chin or with your nose or mouth exposed and think you are protected and not social distance, then wearing a mask might actually get more people sick. With little information that masks were helpful, this fear that they would create a false sense of security likely influenced initial guidance.

Experts were likely also concerned about a limited supply of medical masks at the time.

Of course, as we have gotten more information about the SARS-CoV-2 virus and how it spreads, that guidance about face masks changed.

“CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.”

Use of Cloth Face Coverings to Help Slow the Spread of COVID-19 (April 2020)

We know that the best way to avoid getting COVID-19, at least until we get a vaccine, is going to be trying make sure you are never exposed to the SARS-CoV-2 virus. In addition to social distancing and washing your hands, wearing a face mask correctly will help to decrease your risk of exposing others. And if those around you are wearing a face mask, then they won’t expose you!

What to Know About Face Masks and COVID-19

But what about the idea that the pore size of the masks are too big to stop the small size of the SARS-CoV-2 virus?

This 2009 photograph captured a sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth, thereby, dramatically illustrating the reason one needs to cover his/her mouth when coughing, or sneezing, in order to protect others from germ exposure. Photo courtesy CDC/James Gathany
A sneeze in progress, revealing the plume of salivary droplets as they are expelled in a large cone-shaped array from this man’s open mouth. Photo by James Gathany.

The thing is, the SARS-CoV-2 virus, while it is very small, isn’t just floating around in the air by itself! It gets carried in and on larger respiratory droplets.

And if the mask blocks those respiratory droplets, then it should keep you from exposing others to the SARS-CoV-2 virus.

What about the claim that face masks cause folks to breath their own carbon dioxide, even leading to breathing problems?

OSHA has issued guidance to protect workers from getting COVID-19, which includes that they wear face coverings.
OSHA has issued guidance to protect workers from getting COVID-19, which includes that they wear face coverings.

Most folks realize this isn’t a real problem, after all, health professionals wear face masks all of the time without any problems, right?

But just think about these arguments…

On the one hand, they are worried that the pore size of face masks won’t block out the SARS-CoV-2 virus, which is about 0.1 μm in diameter.

But then they think these very same face masks will block carbon dioxide? How big are carbon dioxide molecules???

They are about 1000 times smaller than the SARS-CoV-2 virus…

So a face mask is not going to affect your ability to breath well.

Who Should Not Wear a Face Mask

Not surprisingly, a face mask is even recommended for folks with asthma, as long as their asthma is well controlled.

“There is no evidence that wearing a face mask makes asthma worse.”

AAAI Recommendations on the use of face masks to reduce COVID-19 transmission

Infants and toddlers under age two years can skip wearing a face mask because of the risk of suffocation, as can “anyone who has trouble breathing, is unconscious, incapacitated or otherwise unable to remove the mask without assistance.”

If you have “trouble breathing” though, you likely have a severe respiratory condition and you aren’t simply someone who doesn’t want to wear a mask.

Flyers about the Americans with Disabilities Act (ADA) and the use of face masks due to the COVID-19 are fake.

And there are no face mask exemptions under the Americans with Disabilities Act (ADA).

People are selling fake face mask exemption cards.
People are selling fake face mask exemption cards.

Are you ready to put on a mask now?

Since we are seeing higher rates of COVID-19 in states that don’t have mask mandates, the only confusion should be over why anyone still won’t wear a mask when they are around other people.

More on Controlling COVID-19

Are One in a Billion Children Dying of COVID-19?

Paul Thomas doesn’t think parents should be concerned because he thinks only one in a billion children are dying of COVID-19.

Why do some people think that only one in a billion children are dying of COVID-19?

There were 7 deaths among the 7,780 children with COVID-19 in the study and Paul Thomas somehow translated that into a rate of one in a billion.
There were 7 deaths among the 7,780 children with COVID-19 in the study and Paul Thomas somehow translated that into a rate of one in a billion.

The usual suspects…

Are One in a Billion Children Dying of COVID-19?

In his video about face masks and face shields, Paul Thomas describes a study about pediatric patients with COVID-19.

“We identified 131 studies across 26 countries comprising 7780 pediatric patients.”

Hoang et al on COVID-19 in 7780 pediatric patients: A systematic review

What did they find?

They found that most of the kids in the study with COVID-19 recovered and had “overall excellent prognosis.”

“Seven deaths were reported (0·09%) and 11 children (0·14%) met inclusion for multisystem inflammatory syndrome in children.”

Hoang et al on COVID-19 in 7780 pediatric patients: A systematic review

Most, but not all…

“They looked at 131 studies that included over 7000 children from 26 different countries. There were only seven deaths out of the 6.4 million cases of COVID-19. Understand, that’s about one in a billion if you look at the world population. One in a billion children dying of COVID. Oh my gosh! No! You don’t need to be afraid for your child.”

Paul Thomas on FACE MASKS & FACE SHIELDS: Should We Wear Them?

One in a billion?

Even if you don’t know anything about statistics or epidemiology and haven’t looked at the study, you can guess that it wasn’t saying that only one in a billion children are dying of COVID-19!

Instead, most people will quickly see that there were seven deaths among 7,780 pediatric patients.

So among the children who got COVID-19, a relatively high percentage, at nearly 0.1%, died.

If only one in a billion children were truly dying of COVID-19, then only one child would have died! While the world population has indeed reached nearly eight billion people, keep in mind that they aren’t all children!

This North American Pediatric ICU database has recorded at least 39 pediatric COVID-19 deaths.

Anyway, so far, there have been over 70 pediatric COVID-19 deaths in the United States alone. So much for one in a billion children dying of COVID…

Should you be afraid for your child?

Are you getting advice about COVID-19 from Paul Thomas???

More on Kids Dying with COVID-19