The hottest debate involving COVID-19 is the school re-opening status for the Fall. Empirically, 166 children died from flu and 30 children died from COVID-19 (from CDC, as of July 4, 2020). From this standpoint, no scientific argument exists against the opening of schools in the Fall. However, a number of government officials, public health officials, education officials, and the mass media have argued against the opening of schools because of safety to students and staff and surrounding communities. Let’s tackle each of these respective topics and see what the science tells us.
Safety for Students
The safety of students is of the greatest paramount, especially for parents. Empirically, the harm from COVID-19 to children is less than the harm from flu; there is at least five times greater risk of death from flu vs. COVID-19. This is without debate based on the data collected. But for most parents, they would like to have additional assurance because we are talking about the health of their children. Hearing the COVID-19 virus is completely new and its varied manifestations in patients do not bring the assurance desired, even in the face of “hard” numbers. By now, most people have heard that COVID-19 virus binds the receptor ACE2. And ACE2 is found along the nasal passage which is the primary first point of contact between COVID-19 virus and the human body. In a recent publication, researchers found the lowest amounts of ACE2 in the nasal passage were found in young children (<10) followed by teenagers (10-17). This translates into fewer ACE2 receptors for binding with COVID-19 virus.
In addition, we have a more clear mechanism-of-action on infection and disease progression of COVID-19. The severe outcomes including death from COVID-19 arise down-stream following ACE2 down-regulation. ACE2 plays a critical protective role in the Renin-Angiotensin-System (RAS) that is vital for cardio-pulmonary and vascular health. When ACE2 is produced less (down-regulated) because of COVID-19 infection, RAS imbalance on top of initial infection/inflammation leads to a downward spiral of more and more inflammation caused by destructive events of vasoconstriction, edema, thrombosis, etc. (see scheme below). Because children and teenagers have “pristine” RAS balance (assuming no pre-existing condition), they are able to withstand the ACE2 down-regulation and resultant RAS imbalance more effectively than adults. As adults age, a significant number of them develop chronic diseases such as hypertension, diabetes, heart failure, and neurodegeneration; these diseases have RAS imbalance. For adults with these pre-existing conditions, especially the elderly, they have significantly higher risk for severity of outcome from COVID-19 including death because of increased susceptibility to life-threatening, deep RAS imbalance.
The combination of fewer receptors for COVID-19 virus binding and “pristine” RAS balance gives children and teenagers a distinct protective advantage against harm from COVID-19 infection, as compared with adults.
Safety for Community
The second main concern is the safety for the Community from the seemingly probable spread of COVID-19 from infected students to the teaching staff, to their parents, and to their respective communities. In a recent commentary in Pediatrics–the official journal of the American Academy of Pediatrics–the authors surveyed the studies available on COVID-19 transmission data from students to others. Upon review of those studies, they concluded that children infrequently transmit COVID-19 to each other or to adults.[i] From a large study done by Institut Pasteur in France consisting of 1,340 people, the researchers found that the infected children in primary schools did not transmit COVID-19 virus to other children or to teachers or other school staff.[ii] From a large study in the German state of Saxony with 2,000 people (1,500 children aged between 14-18 and 500 teachers), there was no evidence of infection spread among school children.[iii] These are reassuring facts that COVID-19 transmission from children to other in a school setting is minimal.
“COVID-19 Transmission and Children: The Child is Not To Blame“
Benjamin Lee, MD, Wiliam V. Raszka, Jr. MD, Pediatrics. 2020;146(2):e2020004879
Overall, based on the science and data available, NO FACT-BASED ARGUMENT EXISTS AGAINST SCHOOL RE-OPENING IN THE FALL.
[i] https://doi.org/10.1542/peds.2020-004879
[ii] https://www.pasteur.fr/en/press-area/press-documents/covid-19-primary-schools-no-significant-transmission-among-children-students-teachers
[iii] https://www.theguardian.com/world/2020/jul/13/german-study-covid-19-infection-rate-schools-saxony