The burning question that all parents want an answer to is: How safe is it to send my child back to school? The short answer is that there is no scientific evidence that keeping children at home will help to curb the spread of COVID-19.

Worldwide, relatively few children have been reported with COVID-19. According to RIVM, the National Institute for Public Health and the Environment in the Netherlands, which has been conducting extensive ongoing studies on the role of children in the spread of the Coronavirus, international research shows that the percentage of children among confirmed COVID-19 patients is low, ranging from 1% in young children to 6% in older children. Worldwide, very few children with COVID-19 have died and, so far, there are no COVID-19 fatalities among children under the age of 18 in South Africa.

“For example, China, Korea, Italy, Spain and the United States have already conducted research on COVID-19 and children. International studies show that the disease in children is generally much milder than in adults. Children who were found to be infected with COVID-19 were also less likely to have symptoms than adults. Contact tracing shows that none of the children have infected other people.”

RIVM’s findings confirm that COVID-19 patients under 20 years play a much smaller role in the spread of the disease than adults and the elderly. “The virus is mainly spread between adults and from adult family members to children. Cases of children infecting one another or children infecting adults are less common. Children are also less likely to be infected by adults.”

Dr Kritzinger, a paediatric pulmonologist at Christiaan Barnard Memorial Hospital, agrees that evidence from across the world points to the fact that children are in fact not ‘super spreaders’ of COVID-19. “We’ve learnt a lot over the last two months and the data suggests that our initial assumption – based on previous influenza outbreaks – that children could be ‘super spreaders’ of the disease, was wrong. The majority of children who become infected do so within a family cluster or household and are very rarely responsible for the spread of infection within a household or a school environment.

“If you look at the scientific data, and also bear in mind that there is no winter without the risk of children contracting the flu and other viral infections, I honestly don’t think there is an exceptionally high risk now that is completely different to previous winters.”

Dr Kritzinger went on to say if the schools have prepared adequately and have all the necessary protocols in place, such as screening, sanitising, frequent hand-washing and maintaining social distancing, there’s “every reason to allow children back to school in a strategic fashion. A lot can be done practically to allow children to return to school safely, especially if there’s constant monitoring and awareness, and parents don’t send their children to school when they have symptoms. We are in uncharted territory and do not have hard facts, but the risks can be managed and minimised.”

For parents of school-going children with comorbidities, Dr Kritzinger shared encouraging information during the interview. While advising them to set up an appointment with the child’s doctor or specialist in cases of serious cardiac disease, lung disease, diabetes, obesity or immune suppression to discuss the possible risks of sending the child back to school, she said there was no evidence to suggest that asthma sufferers should stay at home.

“There is reassuring data from Europe and North America that they have not seen more cases of COVID-19 in children with asthma or even with serious lung conditions such as cystic fibrosis. Even patients undergoing chemotherapy or who’ve had bone marrow transplants only had mild disease.”

She emphasised that parents should make rational decisions based on individual circumstances and risks. “There’s a lot of information (and misinformation) out there, but what is often lacking in insight and context – you have to apply the available information to a specific context, otherwise fear takes over everything and we no longer make rational decisions. And if there is a case, rather close down a specific class or school than resort to a blanket decision that all children should stay at home.”

Schools in several European countries have reopened and children in the UK will also be returning to their classrooms on 1 June. Mark Woolhouse, Professor of Infectious Disease Epidemiology at the University of Edinburgh was quoted in The Guardian last week as saying that under 2% of hospital admissions for COVID-19 in the UK were children under the age of 18. He said other considerations in reopening schools were that there had been few recorded cases of adults catching the disease from children, and no outbreaks had occurred in schools around the world. He did caution, however, “that teachers may be at risk from other teachers – as is the case between workers in other jobs”.

The Guardian also reported that the reopening of schools in 22 European countries had, as yet, not led to any significant increase in Coronavirus infections among children, parents or staff. In France, however, 70 cases of COVID-19 were diagnosed within days of the reopening of 40 000 pre-schools and primary schools on 11 May. France’s Minister of Education, Jean-Michel Blanquer commented, “It’s inevitable this sort of thing will happen, but it’s a minority. In almost all the cases, this (infection) happened outside of the school.” He described the number as a very small proportion of the 1.4 million children who had gone back to school.

Inflammatory Syndrome linked to COVID-19

Parents have also been put on edge by reports of a small number of cases around the world of children with a potentially deadly inflammatory syndrome that has been linked to COVID-19. However experts have stressed it is rare, affecting only one in 1 000 children exposed to the virus.

With this new illness, dubbed Multisystem Inflammatory Syndrome in Children (MIS-C), patients tend to have symptoms similar to those found in Kawasaki disease, a rare childhood illness that causes inflammation in blood vessel walls, and in serious cases can cause heart damage. According to the Centers for Disease Control and Prevention (CDC) in the US, symptoms can include fever, fatigue, abdominal pain, vomiting, diarrhoea, neck pain, rash, bloodshot eyes, and swollen hands and feet.

The syndrome has a relatively wide age range and has been detected in babies of a few months old, young children and adolescents up to 20 years old. Cases have appeared in the US, Italy and Spain. According to the CDC, the disease is not directly caused by the Coronavirus, but the weakened immune system following infection can make children more susceptible to getting MIS-C, sometimes weeks later.

Although much is still unknown about this new illness, experts have said that the cases are too rare to affect policy decisions and should not be a factor in the reopening of schools.

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