This new virus is part of a well-known family of viruses, namely the coronaviruses responsible for the common cold. This new version of the virus is much more aggressive with an easier transmission, affects both the nose and throat like a cold in addition to potentially spreading to the lungs where it causes pneumonia. The new coronavirus has been named SARS-CoV-2 (Severe Acute Respiratory Syndrome with Corona virus number 2; number 1 being linked to a former episode identified in Toronto among other places in 2003). It is less deadly than the SARS-CoV1 (2003) or the Middle East Respiratory Syndrome Coronavirus, MERS-CoV, first detected in 2012. This new virus SARS-CoV-2 may cause a disease coined COVID-19 — Corona virus, year 2019.

SARS-CoV2 has some serious repercussions on some individuals, whereas roughly 80% of individuals exhibit symptoms of a simple cold or are simply symptom-free. Children may only come up with a runny nose with no reason to distrust; yet they could spread the disease to their surrounding, including their grandparents who are more vulnerable, as well as their parents. There is controversy on whether children are as much at risk for the infection and whether they may infect as much as adults. Most of the studies restricted throat swabs only to symptomatic children whereas when they are infected, they mostly do not exhibit symptoms. Yet we know that infected adults with no symptoms spread the disease. Younger children seem to be less likely to spread the disease if infected though older children seem to spread as much as adults.

We have 2 properly designed studies to answer whether children are at risk to be infected just as the adults are. In the Iceland study, younger children carried the virus half as often as older children or adults (NEJM Gudbjartsson 2020). Among children who had travelled or had been exposed with a known infected individual irrespective of the child’s respiratory symptoms, 1 child among 14 (7%) among those under 10 and 1 child among 7 (14%) above 10 years old carried the virus, similar to the 1 in 7 (13%) adults who had travelled or were exposed. In the 2nd study, Chinese children were just as much at risk to be infected as adults once exposed to a case, irrespective of age, estimated at 1 in 14 (7%) (Lancet infectious Disease Q Bi 2020 Epidemiology and transmission of COVID-19 in 391 cases and their 1286 of their close contacts in Shenzhen, China: a retrospective cohort study). Though the numbers may seem different, they do confirm that children do get infected.

Children are considered less likely to develop the most severe forms of the infection but are not always spared. Children with serious medical conditions are especially at heightened risk of severe COVID-19. Children may also manifest with unusual patterns of disease like red spots on the skin. There is an increase of a rare condition, Kawasaki disease, a disease of inflamed arteries that is currently suspected to be a late manifestation of a COVID-19 subclinical (subtle) infection, pediatric multisystem inflammatory syndrome with COVID toes, macrophage activation syndrome (a cytokine storm syndrome, an uncontrolled inflammation) CMAJ 2020. doi: 10.1503/cmaj.201600; early-released September 9, 2020 H Tam, Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 a spectrum of disease with many names.

On the question whether children may spread the disease as much as adults, for the longest part of this epidemic, it was though they were not spreading disease. In a German study, limited to those with respiratory symptoms suspected to be COVID-19 (Jones, Mühlemann, Drosten et al An analysis of SARS-CoV-2 viral load by patient age, 2020), the concentration of the virus (viral load) was just as intense among children as among adults, raising the question whether they may spread the disease or not. On the one hand, if they don’t cough as much, it decreases potentially the spread in addition to the fact that the volume of air in their lungs is smaller decreasing the spread of disease. On the other hand, as children, they may sing, shout and are more likely to hug their friends, be hugged and not respect social distancing hence increasing the potential to spread the disease. Adding to the uncertainty is the fact that schools have been closed in almost all countries limiting the data available. So, we do not know how much children may contribute to the dissemination of the disease but there are all reasons to believe that, as for other respiratory viral infections, they do, likely to a lesser degree than adults in the younger ones.

In order to limit the spread of the disease, even with mild symptoms; it is of the outmost importance for everyone to respect guidelines established by the health authorities. Anyone exhibiting symptoms that could be due to COVID-19 must stay in isolation for a period of 14 days and get in touch with authorities by dialing 1 877 644-4545 and follow their instructions.

Individuals free of respiratory symptoms are invited to restrict public contacts, remain quarantined when indicated, and respect guidelines established by the Public Health Authorities. Those free of respiratory symptoms who need to go for grocery or work outside their home, should cover their mouth and nose with a home-made mask, a bandana or piece of cloth or a procedure mask (dentist/surgeon mask) from the moment they exit their home until returning except to eat. In addition, all hygiene measures (frequent handwashing, coughing/sneezing in the elbow, not touching their face) must be applied. All those measures should continue to be applied until a vaccine is made available and has been received by a high proportion of the population or when authorities lift these requirements. Wearing a home-made mask helps decrease the likelihood of catching the disease as well as spreading the disease if you have it with or without symptoms yet.

This is something you can do and should do. Protect yourself. Protect everyone else too. Wear a mask. For more information on how to make your own masks, please check the information on the CDC website under Cloth face masks https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

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