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You Might Not Know If Your Kid Has Covid-19

In a recent study, two-thirds of kids with Covid-19 didn’t have recognizable symptoms. That’s bad news for pandemic containment.

A child washes hands at an outdoor learning demonstration during the pandemic.
Spencer Platt/Getty Images
A child washes hands at an outdoor learning demonstration during the pandemic.

Yes, kids can get Covid-19. They can also spread it. They might even be better at spreading it than adults are. You wouldn’t know that from listening to the White House, though.

“It’s not just that children are not at risk at all from this disease. They also do not even transmit the disease,” Scott Atlas, President Trump’s controversial new coronavirus adviser—a radiologist and fellow at the conservative Hoover Institution—argued in June. He said it was “irrational” to close schools because there is “zero risk to the children.” The Trump administration immediately adopted this false argument, with Secretary of Education Betsy DeVos threatening to withhold funding from schools that did not reopen in-person classes.

A month later, the American Academy of Pediatrics and the Children’s Hospital Association released a report showing a 40 percent increase in infection among kids in the second half of July. Nearly 100,000 American children had gotten sick in those two weeks alone. By the end of the month, 338,000 children in the United States had tested positive for the virus—8.8 percent of all known cases in the country. Even so, a few days after the report’s release, Trump argued that children are “virtually immune” to the virus. More data published recently by the AAP shows the rate of children testing positive for the virus is rising rapidly, even as some states and districts resume in-person schooling.

The American debate about reopening schools was a touchstone for a country struggling its way through the pandemic. How much do we know about the virus, and how can we apply that information? How do partisan politics influence those decisions?

But the science is clear: Kids can get the virus, and they can pass it on to others. Simply asking whether kids can get sick isn’t the right question, experts say. Instead, we should be focusing on how children are getting sick, what their symptoms look like, which kids are most vulnerable, and what we can do to protect them and their communities.

“Kids are affected by Covid-19. Any suggestion that kids are unaffected is just untrue,” Dr. Rhea Boyd, a pediatrician and public health advocate, told me. Although they seem to be less affected than adults, they can still transmit the virus—and they can still suffer serious complications from the illness. A small percentage of children suffer from multisystem inflammatory syndrome in children, or MIS-C, a dangerous inflammation that can affect kids’ organs. Many more experience long-term symptoms, just as adults do—even if their illness was mild.

Most kids who get Covid-19 tend to have mild symptoms or no symptoms at all—but that is bad news, not good news, when it comes to containing the pandemic. New research from South Korea has found that the vast majority of kids who have the virus don’t show diagnostically useful symptoms. In a study of 91 children published in The Journal of the American Medical Association, only 8.5 percent of the kids who tested positive had recognizable symptoms. Two-thirds had symptoms so mild they were only recognized after a positive test, and 22 percent never developed any symptoms.

That means symptom screening like fever checks at school will fail to catch most cases, the researchers said. And with the U.S. Centers for Disease Control and Prevention now formally recommending against asymptomatic testing in some cases, that means more people with no symptoms or mild symptoms may slip through the cracks. Children are likely to fall into this gap. (Anthony Fauci, an immunologist and head of the National Institute of Allergy and Infectious Diseases who serves on the White House Coronavirus Task Force, told reporters he was under anesthesia when these new CDC recommendations were made and has expressed concerns about this protocol.)

Even if they never develop symptoms, children are very likely still contagious. In fact, a previous South Korean study published by JAMA found that asymptomatic people carry as much virus as those with symptoms and thus can spread the virus just as easily—but, because many of them don’t realize they have it, they may transmit the virus even more than people who stay home when they’re sick. Yet another JAMA report from Chicago revealed that younger kids carry just as much, if not more, virus in their noses and throats. Some kids under five had 100 times the amount of the virus that adults did.

Kids are at risk for the coronavirus, and it could affect the rest of their lives, from missed education to long-term health issues. But not all kids are at risk equally. A study in the journal Pediatrics found significant racial and socioeconomic disparities in the Washington, D.C., area. Black and Latino children were four to six times more likely than white children to test positive for the virus. And kids of color also have a higher chance of developing severe illness.

“Not all kids are the same, and the environments and conditions that all kids live in are not all equal,” Boyd told me. Black and Latino households are twice as likely as white households to lack access to clean water, while Indigenous households are 19 times less likely to have clean water. “In the pandemic, if handwashing is a way to prevent spread, these are populations who are structurally unable to engage in one of the simplest forms of prevention. And you also have to think about environmental pollution: Who lives in areas where there’s more air pollution?” Boyd asked. Air pollution can cause asthma and chronic lung disease, making Covid-19 complications worse. “And then who had access to health care? Whose parents are essential workers who have to work in conditions where they don’t have adequate protection?”

With all of these questions, Boyd points out, racism, not race, is the risk factor, although a lot of reporting and even study results conflate the two. Black communities, for instance, do bear a disproportionate burden of Covid-19 deaths, as headlines have pointed out, but it’s because those communities have been neglected and underserved for generations.

Dr. Maimuna Majumder, a member of faculty at the Computational Health Informatics Program, or CHIP, at Harvard Medical School and Boston Children’s Hospital, agreed. “Because kids of color are often more likely to live in places with air pollution or lack of clean water, sometimes researchers determine race to be a ‘risk factor’ for the myriad diseases that these circumstances can trigger,” Majumder told me in an email. “The reality, however, is that it’s air pollution and lack of clean water—not race—that’s actually a risk factor for these diseases, and I think that’s an important thing to remember when we discuss these issues.” Fixing underlying, systemic issues like air and water quality wouldn’t just protect against Covid-19, Majumder said, it would also improve many other health and developmental issues.

Another systemic form of discrimination is the de facto segregation of schools. If unchecked, the pandemic will only widen education gaps, Boyd said. “And we know the education gap is linked to key indicators for social and economic mobility in adulthood. If you widen the education gap for this generation of kids, I worry about the intergenerational impact that will have on economic mobility in communities of color.”

“Kids need their own federal relief package,” Boyd said. That means strengthening policies like in-home childcare for essential workers, paid sick leave, and income support for caregivers to stay home from work if their kids are sick. It also means tracking statistics on where and how kids get the virus, which has proven complicated as the Trump administration changes the rules and agencies overseeing data collection and management.

Finally, she pointed to a profound irony in the misunderstandings and misinformation about kids and Covid-19 as our evolving knowledge of the new virus has struggled to keep pace with soaring cases. “Some of what has given us the impression that younger kids are less affected may be being shaped by how proactive we were about closing school and childcare facilities early on in this pandemic,” Boyd added. “Which is also maybe an important reminder for the rest of our population: If that is what has protected kids, maybe that’s what we all need to do.”