Are the concerns over heading back to school valid?

DR DANIEL ISRAEL

Large studies out of China and the United Kingdom in The Lancet and in MedRxiv, respectively, have recently demonstrated mortality rates of 0.01% in children compared to roughly 2% in broader age groups. In South Africa, we have, questionably, had one COVID-19 child death out of 524 total deaths to date. I have seen eight international papers that have described COVID-19 as having a “far milder course” – or even an asymptomatic course – in children, compared to adults.

A study undertaken in the city of Vo, Italy, confirmed that children are able to transmit COVID-19. But as this pandemic progresses, far greater data seems to emerge that defines SARS-CoV-2 as a virus that is transmitted between adults, and at most, transmitted to children and not by children. This is in sharp contradiction to the original untested hypotheses that COVID-19 would be spread widely by children, even if they are asymptomatic carriers.

For many a parent, the emergence of this new “safety data” on coronavirus in children is swallowed as a well-earned tranquiliser during this lockdown of corona-parenting responsibility. The nagging question still niggles the logical mind though: why do children not develop COVID-19 similarly to adults? Are we simply adapting evidence to solve the educational crisis that we have created for ourselves?

There are three logical theories as to why children’s immune systems don’t respond with the same systemic inflammatory response as adults’ immune systems when exposed to COVID-19.

The first theory is that babies are born with a complete repertoire of immune cells called T-cells, millions of them. Each T-cell has a unique receptor so that this entire pool of T-cells can recognise almost any new hypothetical virus. Over time, these T-cells are replaced by “memory T-cells”, which offer immunity only to viruses previously encountered by the specific individual.

Logically then, children will easily mount an immediate effective response to the SARS-CoV-2 (the virus that causes the COVID-19 disease) because of their complete entity of T-cells, versus adults who could only achieve such a response to an infection that they had been exposed to previously.

The second theory is that children are frequently exposed to other older strains of coronavirus. I have encountered this in the respiratory swabs I have performed on the paediatric patients in my own practice prior to 2020. “Coronavirus” was a common pathogen that I would pick up on children’s respiratory swabs. Therefore, because of the structural similarities these viruses have with COVID-19, children already have latent protection inferred upon them.

Lastly, there is a special receptor on the cell wall called an ACE2 receptor. This is the receptor – or gateway – the virus uses to enter the cell. As you get older, the number of ACE receptors in your lungs becomes fewer. One may wonder why a greater number of receptors in children would make them contract the virus less severely? This is largely still unknown. But we do know that more ACE receptors mean less inflammation and less lung scarring, and therefore less severe disease.

We have indeed seen undeniable evidence of COVID-19 leading to Kawasaki disease, COVID toes, and other complications in children. But all of the studies describing these phenomena make clear that these are rare complications, not mainstream pathology.

The take-home message is this: there is evidence that while COVID-19 affects children too, it’s not a severe disease entity in children. COVID-19 can be likened to a common cold or upper respiratory infection in children.

There are several logical pathways to explain this with no suspicion that the facts are being manipulated to suit societal agendas currently. The literature furthermore does indeed show little risk of children being vectors of viral spread between adults.

The evidence changes in this pandemic weekly. Let’s hope that it continues to emerge in this positive light so we may soon send our children back to school with increased confidence.

• Dr Daniel Israel is a family general practitioner in private practice in Johannesburg.