COVID-19 - message from the President, 22 May

There are many unanswered questions about children and COVID-19, including when and how we reopen schools, but, argues Russell in this week's weekly address to members, we must go back to the science.

This week we published our principles for recovering paediatric and child health services, now that we are past the peak of the COVID-19 pandemic. Thanks to those of you who joined the live Q&A on Wednesday.

For me, it’s been a week where my role in the RCPCH and my day job as a clinical academic blur. There are many unanswered questions about children and COVID-19, one of which has been the degree to which children and young people are susceptible to this virus (technically to the SARS-CoV-2 virus), and if they are infected, how much they transmit it to others. These questions are at the heart of issues about whether children are able to go back to school relatively safely and how much we should shield them when they do.

You will have heard a lot about this in the media, and one of the problems was doctors saying quite opposing things, quoting various studies. My belief is in this situation that you must go back to the science – and when studies are being quoted saying different things, a careful systematic review can be very helpful.

So, with a number of colleagues, many of them College members, we undertook and circulated a systematic review of susceptibility to and transmission of COVID-19 among children and adolescents. Given it is so central to issues around shielding of vulnerable children and schools, I thought I would summarise for you.

Most of the data available on children are from clinical series or national testing datasets. We know that children and young people make up only 1-4% of those who test positive for COVID-19. Children and teenagers make up an even smaller proportion of severe cases or deaths. This is good news for children and young people, and tells us that it is really very safe for the vast majority of them to attend school. 

But it doesn’t tell us much about susceptibility or transmission – as most children have few if any symptoms and therefore don’t present for testing or otherwise come to the attention of doctors. Disentangling these two concepts is important for the public and it’s vital that we are clear in our communications about the evidence and what it means (and what it doesn’t mean!).

We won’t get anywhere if [the debate about schools] is framed as opposing camps, not just because it’s very unhelpful but it’s also not an ‘either / or’ scenario

We reviewed 6,332 studies and winnowed these down to 18 studies. Nine were contact-tracing studies, eight were population-screening studies and one was a systematic review of small household cluster contact-screening studies. We showed that children and young people under 18-20 years of age had lower susceptibility to infection, with 56% lower odds of catching SARS-CoV-2 from an infected person, compared with adults (20 plus). Clearly if children are less susceptible, they have less chance of transmission at a population level, and this is supported by a small amount of data at population level. However, we found no useful data on the infectivity of individual children.

I’m writing about this partly because I’ve been immersed in it these last few days, and also because the evidence is relevant to how and when we open up our society. The debate about schools has become very difficult and polarised. We won’t get anywhere if it’s framed as opposing camps, not just because it’s very unhelpful but it’s also not an ‘either / or’ scenario. 

We can’t make any headway without a cool-headed discussion about balancing risk and mitigation. We know it’s safe for children to go back to school, but we know a lot less about whether they’ll then transmit back into the community. To bridge that gap we need to build a system, urgently, that mitigates the risk and builds confidence among teachers and parents. There is no magic date coming that will satisfy all of us, so there is no option but to come together and design a compromise that takes account of our shared needs, worries and responsibilities. This will be a difficult journey but I’m very optimistic, in part because necessity will get us there. We published a College statement on this issue today.

One issue I don’t believe is relevant to the discussion around schools is that of the newly-described inflammatory syndrome. We have anecdotal evidence of around 75-100 children who have been severely affected and we expect to see more cases – including a large number of mildly-affected children – when we have returns from the BPSU data collection. I know how busy you are but can I urge you to complete and return case reports so that we can increase our knowledge of this rare syndrome.

That’s all for now. I’m taking a few days off next week, so I’ll write again on 5 June. I hope it’s sunny where you are, and I hope you get a bit of rest over the weekend.

Best wishes,

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