Just when COVID death rates are declining and recovery appears around the corner in most states, the latest fear is that children are getting sick and are at risk of dying.
New York Gov. Andrew Cuomo is one of those prominently pushing this inaccurate idea. He has emerged as the COVID-19 antihero due to his catastrophic policy of forcing nursing homes to accept infectious patients, which led to a surge in deaths. He has adopted a new tactic to stoke fear and justify his bad decisions: ratcheting up anxiety about the danger to children—the group by far least at risk from coronavirus.
Cuomo is focused on about 100 children in New York hospitalized for Kawasaki disease, an inflammatory condition that affects multiple organ systems of infants and children, and can cause cardiac damage. But the evidence in fact indicates that children are at very low risk of hospitalization or death from the novel coronavirus. The Center for Disease Control’s most recent report shows 12 pediatric COVID deaths total, compared to 174 pediatric flu deaths this season. In the 2018-2019 flu season there were 400 pediatric deaths, and the 2009 swine flu pandemic killed 2,000 children.
COVID deaths are overwhelmingly among the very old in a pronounced J-shaped age distribution, in marked contrast to the classic U-shape of the flu.
The CDC’s weekly COVIDView surveillance report says: “For children (0-17 years), COVID-19 hospitalization rates are much lower than influenza hospitalization rates at comparable time points during recent influenza seasons.” Children overwhelmingly get asymptomatic or mild COVID-19 infections, and recent papers suggest they may either have innate immunity or effective partial immunity from recent exposure to common cold coronaviruses.
International Evidence Finds Low Risk to Kids
There is also a body of evidence that supports this conclusion building internationally. Iceland has the most extensive testing program relative to total population in the world and reports: “Children under 10 are less likely to get infected than adults and if they get infected, they are less likely to get seriously ill. What is interesting is that even if children do get infected, they are less likely to transmit the disease to others than adults. We have not found a single instance of a child infecting parents.”
This adds to similar findings in Switzerland: “Even when children are tested positive for the virus, their viral load is often very low. Which would explain why they are bad vectors of the disease. It seems that it is adults who infect children, not the other way around.”
In The Netherlands, experience has found: “The decision to reopen schools is based on a wide range of research which shows that young children are unlikely to pass on the virus or develop serious symptoms themselves, according to Jaap van Dissel, head of the public health institute RIVM. ‘There are no clusters in which schools would appear to be a hot spot,’ Van Dissel said. ‘And the closure of the schools has had no impact on the spread.’”
Research in France has found that the coronavirus risk for children is “extremely low, we can say a thousand times lower than in adults. Children are weak carriers, poor transmitters, and when they are infected it is almost always adults in the family who have infected them.” The French study “completely confirms all of the scientific literature.”
Evidence from Australia finds the same: “When school closures were initially proposed to control an epidemic, planners had influenza in mind. Flu spreading within schools and children are the main source for transmission in the community. But COVID-19 is not the flu. Far fewer children are affected by COVID-19, and the number of transmissions from children to children and children to adults is far less.”
Here’s what they’re seeing in the United Kingdom: “Governments worldwide should allow all children back to school regardless of comorbidities…The media highlight of a possible rare new Kawasaki-like vasculitis that may or may not be due to SARS-CoV2 does not change the fact that severe COVID-19 is as rare as many other serious infection syndromes in children that do not cause schools to be closed.”
The one German study by Christian Drosten that tried to justify school closures by claiming children did not have lower viral loads arbitrarily binned age, a continuous variable, and still failed to support its predetermined conclusion. Re-analysis found the children in the study did have lower viral loads than adults. And Germany is opening schools, so the study didn’t convince the leadership of its own country.
Drosten’s conclusion was emphatically rejected in a joint statement from all of the leading German medical societies. In their statement, the German Society for Hospital Hygiene, the German Society for Pediatric Infectiology, the German Academy for Pediatric and Adolescent Medicine, and the Professional Association of Pediatricians in Germany say: “Day care centers, kindergartens and primary schools should be reopened as soon as possible,” and “unrestricted.”
As for Linking Coronavirus and Kawasaki
So the news for kids has been overwhelmingly positive, but just in time for camp season Cuomo fed the national media the fear fodder they wanted by saying Kawasaki disease will be “much more widespread than anyone thinks.” That is highly unlikely.
Kawasaki has as many as 5,000 hospitalizations annually in the United States, peaking in the winter and spring, and the cases being seen now are within the range of normal frequency. Moreover, the condition is considered unlikely to cause any lasting damage if properly treated.
The Kawasaki cases now being pointed to in New York, Boston, and other lockdown cities are a mix of SARS-CoV2-negative and -positive children, which makes the asserted COVID link tenuous. An American Academy of Pediatrics paper on the first U.S. child with Kawasaki to test positive for SARS-CoV2 in early April noted:
The cause of KD remains unknown, despite several decades of investigation. Some evidence suggests an infectious trigger, with winter-spring seasonality of the disease, and wave-like spread of Japanese epidemics of KD. Various studies have described an association between viral respiratory infections and KD, ranging from 9% to as high as 42% of patients with KD testing positive for a respiratory viral infection in the 30-days leading up to diagnosis of KD. Interestingly, Turnier et al. in 2015 described that 28% of positive results were attributable to rhinovirus/enterovirus, 8.7% due to parainfluenza, and the remaining pathogens: respiratory syncytial virus, influenza, adenovirus and human coronavirus (strains 229E, HKU1, NL63, OC43) were each positive less than 5% of the time.
So if the viral theory is true, it is possible that a SARS-CoV2 infection could trigger Kawasaki, but given the ubiquity of other potential viral triggers, it’s likely that most children disposed to developing the disease will encounter multiple potential triggers. A trigger is not a cause.
‘Fewer Cases Are Being Seen, Not More’
Cuomo is hyping the small number of cases in New York as portending something widespread, but as the research-compilation website ExplainCovid points out: “First, some of the increase in cases reflects looking back at past cases which might not have been recognized as PMIS at the time. Second, and probably more important, when parents hear about this, some of them get scared and more of them are likely to show up at the hospital with their children, not all of whom will actually have the disease. The symptoms to watch out for — fever, rash — show up in kids for lots of reasons. When media outlets report ‘possible’ cases, this number may be inflated by care seeking.”
Some press accounts point to London, too, to bolster the theory of a COVID-Kawasaki connection, but there the Kawasaki Society has taken a firm stance against the claim:
The cases being referred to have been reported in approximately 20 children in the UK (out of 11.5 million U.K. children) – of whom half have tested *negative* for Covid-19 according to their doctors.
There is no current evidence of any increased incidence or greater susceptibility to Covid-19 infection for children who had Kawasaki Disease in the past…Fewer cases of Kawasaki Disease than would be normally expected at this time of year are currently being seen – not more.
Then there is The Lancet, which published a mess of a paper trying to make a statistical case that Kawasaki risk went up significantly—based on a study done on eight children. Newman Nahas took it apart on Twitter.
The math is a disaster. Two of the children tested negative by both PCR and serological tests, and two others were double counted because they were positive on both tests. These eight children, counted as ten, presented over a period from February 18 to April 20.
The study authors inexplicably define this two-month period as one month. Then they compared their overstated frequency over a two-month “month” to the average of the previous 50 continuous calendar months of Kawasaki cases at their hospital. That averaged in a lot of off-season months of a highly seasonal condition, constructing a useless control.
Despite such shaky evidence, the U.S. Centers for Disease Control rushed headlong into creating a new notifiable condition that amounts to, essentially, Kawasaki in the presence of coronavirus. They call it Multisystem Inflammatory Syndrome in Children Associated with Coronavirus Disease 2019, asserting by way of definition an association not proven to exist.
Bizarrely, the first sentence of the CDC background section on the newly defined condition refers to the debunked press accounts from London: “clinicians in the United Kingdom (UK) recognized increased reports of previously healthy children presenting with a severe inflammatory syndrome with Kawasaki disease-like features.”
Even the World Health Organization (WHO) is skeptical. WHO chief scientist Dr. Soumya Swaminathan recently said: “Now, it’s not very clear what the links are between Covid-19 and this syndrome. There are some children who tested positive for the virus and some who haven’t… But again to re-emphasise the risks to children are extremely low with this infection, and there have not been many cases.”
If Your Child Needs Help, Get It Quick
Some research suggests lockdowns may make Kawasaki more common by reducing immune system stimulation, like a 2018 study from Canada that found, “Patients with KD were generally less exposed to environmental allergens in many aspects of their daily lives,” and were “less likely to live in an area with dense tree coverage, near a park, body of water or a farm.”
But the more likely cause of severe cases presenting recently in cities with hard lockdowns is that lockdowns discourage (or even prevent, by closing pediatricians) parents from seeking treatment earlier in the disease. The American Heart Association issued a release to reassure parents: “‘While Kawasaki disease can damage the heart or blood vessels, the heart problems usually go away in five or six weeks, and most children fully recover,’ said Dr. Jane Newburger, director of the Kawasaki Program at Boston Children’s Hospital. ‘Rarely, but sometimes, the coronary artery damage persists. Because of this, Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. Prompt treatment is critical to prevent significant heart problems.’”
The key takeaway for Kawasaki or any other malady is that if you or your child needs medical care, don’t delay treatment over COVID panic. And the bottom line on COVID risk to children, overall, is that it is much less than ordinary everyday risks we live with like the flu or car accidents.
David Spiegelhalter is chair of the Winton Centre for Risk and Evidence Communication at Cambridge and is widely considered the world’s top expert in understanding and communicating risk. He told the BBC: “There have been based on the data so far extremely low risk to children… It is an unbelievably low risk. This group of kids are staggeringly safe in general. Nobody has ever been safer in the history of humanity than these kids.”
Don’t let politicians like Cuomo use dozens of kids with a treatable condition tenuously connected to COVID-19 to justify lockdowns and school closures for millions—and to distract from their failure to protect the truly vulnerable, particularly seniors in nursing homes.