Grade 1 learners from Summerwood Primary School. Picture Werner Hills
Grade 1 learners from Summerwood Primary School. Picture Werner Hills

As evidence mounts that children rarely get ill from Covid-19 and their role in passing on the virus is inconclusive, it may be that the greatest risk to children in SA are the adults who’re keeping schools closed and school feeding schemes on ice.

A group of paediatricians called “Don’t Forget the Bubbles” (DFTB), along with the UK Royal College of Paediatrics & Child Health, have reviewed 129 studies on children and Covid-19, and concluded that more than 99% of them aren’t at risk of developing severe illness and complications from the virus.

The DFTB review, published last week, said: “Deaths remain extremely rare in children from Covid-19, with only a handful of reported cases.”

Even children who have pre-existing conditions show “no significant increased risk”. One study considered five children with cancer, and three in an Italian hospital transplant ward who’d had transplants – and all had mild symptoms.

Of the 257,000 deaths globally up to now, a fraction have been children. There were no deaths of anyone younger than nine in China, for example. In the US, three children younger than 17 had died by April 14, all of whom had underlying health conditions.

Separately, the Royal College of Paediatrics & Child Health reported that deaths in children due to Covid-19 were extremely rare – “mortality seems to be consistent at around 0.01%” of cases found in children.

“The importance of children in transmitting the virus remains unclear, in particular given the number of asymptomatic cases. But there is some evidence that their role in transmitting the virus is fairly limited,” it said.

There is good news elsewhere too, as it seems children are also less likely to catch Covid-19 and, when they do, they’re less likely to transmit it.

A study in Iceland, in which antibodies of 9,000 people were tested, concluded that fewer children than adults had been infected. In an Italian study, where researchers tested 70% of the population of the northern town Vò, 2.6% of adults had been infected but no child under 10 had been. Chinese studies had similar findings.

Still, as SA considers opening schools again, fear is running rampant.

Prof Jonathan Jansen, the former vice-chancellor of the University of the Free State, said last month of the prospect of opening schools: “If one child tests positive under these conditions, it would be a tragedy.”

But the new science now shows that if one child tests positive, they’re likely to either have mild symptoms, or none at all.

In SA, this is a particularly fraught debate, since schools provide far more than just an education. Eight million children typically get at least one meal per day at school — something they’ve had to do without since the schools closed in March.

On April 7, a group of Belgian academics sent a letter to The Lancet journal calling school closures a “social crisis”.

“The summer holiday in most American schools is estimated to contribute to a loss in academic achievement equivalent to one month of education for children with low socioeconomic status,” the authors said. This effect was not seen among wealthier children, however.

The grandparent problem

In SA an estimated 350,000 children in grades 7 and 12 are set to return to school at the beginning of June.

Yet, it was a tough discussion, it seems. Trade unions and education authorities had no fewer than 50 virtual meetings, before agreeing to partially reopen schools, according to basic education minister Angie Motshekga.

One union official tells the FM they are particularly worried about teachers who are elderly or sick.

NGO Amnesty International was also up in arms about the initial school opening dates in May, asking: “What water and sanitation measures will be put in place to keep children safe?” Many schools still have dangerous pit latrines.

While the research says children who catch the virus are generally fine, the real question is whether they could carry Covid-19 home to grandparents, who are far more at risk. If so, you could argue that it’s wise to close schools, irrespective of other consequences.

As it stands, the jury is out on the extent to which children can spread the virus.

While the World Health Organisation (WHO) is adamant they can infect others, the DFTB paediatricians found little evidence that children pass on the disease. The paediatricians cited the WHO joint commission to China in February, in which staff said they “could not recall episodes during contact tracing where transmission occurred from a child to an adult”.

The Dutch National Institute for Public Health & the Environment is more explicit: it says it hasn’t yet found a case of a child passing on the virus.

In one ongoing study, the institute is looking at 54 Dutch households of 123 adults and 116 children between the ages of one and 16 to understand how the disease spreads in families. “There are no indications that children younger than 12 years were the first to be infected within the family,” the said.

The Dutch researchers add: “Children are less likely to be infected by adults. When this does happen, it turns out that it is mainly in the home situation. Patients under 20 years play a much smaller role in the spread than adults and the elderly.”

However, the Royal College of Paediatrics & Child Health points out that it’s not a settled debate. “The importance of children in transmitting the virus remains unclear, in particular given the number of asymptomatic cases. But there is some evidence that their role in transmitting the virus is fairly limited,” they say.

While single examples are not solid science, in one case cited by The Telegraph newspaper, a British boy who contracted Covid-19 in a group in the French Alps later came into contact with 170 people at school and did not pass it on to a single other person.

Does closing schools work?

A study by The Lancet in March looked at what role school closures might play in reducing the spread of Covid-19. Here, the researchers couldn’t find evidence to suggest that school closures had stopped the spread of similar diseases, including severe acute respiratory syndrome (SARS), which hit Asia in 2003.

The Lancet study concluded: “Currently, the evidence to support national closure of schools to combat Covid-19 is very weak … At the same time, the data also show that school closures can have profound economic and social consequences.”

In the US, the Center for Disease Control & Prevention (CDC) considered studies where schools were closed to stop the spread of flu, which is largely driven by children. In this case, the evidence was mixed: the incidence of flu wasn’t reduced, but one reason for this was that children still came into contact with other children, even while at home.

In SA, there are many factors at play in the government’s cautious approach — not least the fact that it is likely to still be some weeks before the country hits its peak number of infections.

But there is a clear concern about exposing elderly teachers to the virus at schools, through contact with other teachers – especially if they then come into contact with others on taxis and buses. Teachers with diabetes, obesity and hypertension are more at risk.

While there are still many unknown factors, at this point the science suggests that Covid-19 may pose less direct harm to SA’s youth than school closures.