COVID-19 in Kids Too Young for School
We’ve heard a lot about the risk of COVID-19 spread in school-aged children, but what about younger kids?
Originally published on August 18, 2020
When our city confirmed their first COVID-19 case, my family of three – two career scientists and our 7-month-old son – locked down, motivated by a nefarious encounter with an “every man down” flu-lapalooza a few weeks earlier. After nearly five months, we – like so many families – are wrestling with the long-term costs and benefits of routine decisions, namely childcare.
This discussion is separate from the question of how to open schools safely. It isn’t generally acceptable for school-aged children to crawl around on the floor swapping chew toys all day, but this has been my son’s favorite pastime for at least half his life. In an environment with predictable spit sharing and diaper changes, how at-risk is my 1-year-old son for contracting COVID?
As a scientist, I like to make data-driven, evidence-supported decisions, so I dove into the literature to find answers to my questions:
1. How likely is my child to contract COVID-19 and to spread it to me or someone else?
2. What symptoms and disease severity should I expect for his age group?
3. What is unknown about COVID-19 that hinders my ability to make a “eyes wide open” decision?
This first thing to note is that, because COVID-19 is a relatively new disease, there isn’t a lot of data to drive my decision. The most informative studies reflect cases from early in the pandemic and mainly report on patients in Italy and China.
Will My Kid Catch COVID? If They Do, How Likely are They to Give It to Me or Someone Else?
The CDC reports that COVID is mainly spread from an exchange of respiratory droplets: an infected person breathes (through their mouth and nose), releasing virus-infected liquid that an uninfected person then inhales (through their mouth and nose). This is why masks are so important! We protect others – especially more vulnerable populations, like young children – when we wear them.
The CDC also issued this guiding principle, “the more people children interact with, and the longer that interaction, the higher the risk of COVID-19 spread.” Children too young for school are generally not appropriate for masks, are more likely than other age groups to directly exchange saliva (their closest competition likely being love-ravenous teens), and spend 8+ hours together at daycare in a classroom with about 9 other peers and caregivers. That combination of factors suggests that daycare is a high-risk environment for COVID-19 spread.
We Will Know More Tomorrow
At first, COVID-19 symptoms were reported to be “flu-like,” but as time passes, we discover more and more about this disease that adds to the mystery: survivors report symptoms – including neurological complications, such as decreased alertness – that progress for months, and autopsies of the deceased provide evidence that COVID-19 affects the heart and brain. Profound lingering symptoms do not necessarily correlate with initial respiratory disease severity. How will I evaluate the presence of some of these symptoms in my son who hasn’t started talking and won’t have the vocabulary to explain symptoms for several years to come. How could lingering neurological symptoms affect his development?
Listen to the Expert
I firmly believe in trusting the trained experts around you, so I asked my son's pediatrician – a weathered, stoic physician with decades of experience and a well-established practice – what he thought about COVID-19 risk and daycare. He focused on the positive. “The protective measures that daycares are taking will probably mean there is less overall disease spread [in daycares] this year than in previous years” was his basic message. He also reminded me that comparatively, there are many other diseases children pick up at daycare that are potentially much more serious.
Prioritizing Isn’t Simple
Family priorities and flexibility further complicate the decision process, positioning us between a rock and a hard place: do we choose socialization or sanitation? Mental or physical health? Can we accommodate a 2-week quarantine (or multiple quarantines) if a child in the classroom tests positive for COVID-19? Can we function without childcare? Each family’s answer to these questions will look different.
The Decision Continuum
While I’m still uncertain about the best childcare solution for us, this process has made me feel a little more comfortable encouraging social interactions for my son, especially now that he is one year old. We implement a few guiding principles for those interactions: we maximize outdoor social opportunities and avoid high traffic situations. Friends join us at the neighborhood pool (first thing in the morning to avoid crowds) or for a walk at the botanical gardens. Our playdates involve one friend at a time, instead of groups.
The right answer will look different for everyone, and the initial solution doesn’t have to be permanent. I have a feeling "the right choice" will evolve over time, creating a decision continuum, where our solutions reflect expanded knowledge, understanding, and opportunities. In these uncertain times, embracing flexibility is key.
