Coronavirus Cases Among Children on the Rise as Schools Gear Up For Reopening

New data shows that a growing number of children across the country are testing positive for the coronavirus as many schools prepare to resume in-person classes this fall.

Over the last two weeks of July, the U.S. reported 97,078 new cases of COVID-19 among children, according to a study by Children’s Hospital Association and the American Academy of Pediatrics.

That’s a 40% jump in juvenile cases, bringing the cumulative number of infections to 338,982 — 8.8% of all cases — since states started reporting data. Overall, the study found there were 447 cases per 100,000 children.

Aaron Milstone, an expert in pediatric infectious diseases at the Johns Hopkins University School of Medicine, says the increase isn’t surprising, and can be traced back to a greater willingness to test younger patients.

“Early on, when there was limited testing capacity, it was not encouraged to test children,” says Milstone. “Testing was more reserved for health care workers, first responders, people that were hospitalized. I think we’re now testing children more.”

Milstone says that kids may also be socializing more than they were at the onset of the pandemic, when information about the virus was scarce and parents were more cautious. 

“I think what we’ve all seen over the summer is that there’s been a lot more interaction of kids, either through camps or neighborhood get-togethers, you name it,” he says.

The mortality rate remains relatively low for children: only about  0%-0.4% of cases have resulted in death, and 20 states have yet to report a child death from COVID-19. 

Still, Milstone says that children aren’t immune to the virus. “It definitely does not mean there’s no risk there,” he says. 

Typically, children who contract COVID-19 have milder symptoms than adults, but some may develop a rare condition called multisystem inflammatory syndrome.

Milstone says that MIS-C has become more common among children, and can be life-threatening. “The initial infection may be unrecognized and then weeks later kids can present this very severe inflammatory syndrome that can put them in the intensive care unit, requiring very aggressive support,” he says.

In July, Colorado health officials reported the death of two children due to the rare syndrome, though they declined to release the ages of the patients out of privacy concerns. 

Last week, Georgia reported the death of a seven-year old from COVID-19, the state’s youngest victim so far.

Meanwhile, students in some school districts are already back in the classroom, and many major public school systems are set to reopen in the next few weeks. Officials in New York City are devising a plan to partially reopen schools to the city’s 1.1 million public school students.

As children return to in-person learning, the concern is that the virus will spread beyond school walls and into the community, Milstone says. “The challenge with kids is kids are a reservoir for viruses,” he says. “When kids get back into school, the concern is that they will propagate the spread of the virus through the school.” 

“Those kids will potentially spread it to their teachers, other staff members of the school, their families, their neighbors,” he adds.

In Georgia, a high school has already temporarily shut down just one week after reopening due to a cluster of coronavirus cases that broke out after students posted photos of school hallways packed with maskless children.

To prevent the spread of the virus, some schools have floated the idea of testing all students before the start of classes. But Milstone says that universal testing may not be the most practical solution given limited resources.

“I would never say it shouldn’t be done,” he says. “I just think that when administrators make the decision to try to do this, they need to be really thoughtful about whether or not it’s feasible.”

Officially, the Centers for Disease Control does not recommend universal testing for students and staff in K-12 schools. Instead, the agency suggests focusing testing efforts on individuals who exhibit virus symptoms.

“Implementation of a universal approach to testing in schools may pose challenges, such as the lack of infrastructure to support routine testing and follow up in the school setting, unknown acceptability of this testing approach among students, parents, and staff, lack of dedicated resources, practical considerations related to testing minors and potential disruption in the educational environment,” the agency said in guidance released last month.

Milstone says testing students before the first day of classes doesn’t prevent them from contracting the virus later on. Moreover, long turnaround times for test results may render testing ineffective. 

“Testing will always be imperfect,” he says. “We need to really focus on the basic preventative strategies, which are hand washing, social distancing, masking, doing good screening to keep kids out when they’re sick.”