Researchers show children are silent spreaders of virus that causes
COVID-19
Comprehensive pediatric study examines viral load, immune response and hyperinflammation in pediatric COVID-19

Date:
August 20, 2020
Source:
Massachusetts General Hospital
Summary:
Researchers provide critical data showing that children play a
larger role in the community spread of COVID-19 than previously
thought.



FULL STORY ==========================================================================
In the most comprehensive study of COVID-19 pediatric patients to date, Massachusetts General Hospital (MGH) and Mass General Hospital for
Children (MGHfC) researchers provide critical data showing that children
play a larger role in the community spread of COVID-19 than previously
thought. In a study of 192 children ages 0-22, 49 children tested
positive for SARS-CoV-2, and an additional 18 children had late-onset, COVID-19-related illness. The infected children were shown to have a significantly higher level of virus in their airways than hospitalized
adults in ICUs for COVID-19 treatment.


==========================================================================
"I was surprised by the high levels of virus we found in children of
all ages, especially in the first two days of infection," says Lael
Yonker, MD, director of the MGH Cystic Fibrosis Center and lead author
of the study, "Pediatric SARS-CoV-2: Clinical Presentation, Infectivity,
and Immune Reponses," published in the Journal of Pediatrics. "I was
not expecting the viral load to be so high. You think of a hospital,
and of all of the precautions taken to treat severely ill adults, but
the viral loads of these hospitalized patients are significantly lower
than a 'healthy child' who is walking around with a high SARS-CoV-2
viral load." Transmissibility or risk of contagion is greater with
a high viral load. And even when children exhibit symptoms typical
of COVID-19, like fever, runny nose and cough, they often overlap with
common childhood illnesses, including influenza and the common cold. This confounds an accurate diagnosis of COVID- 19, the illness derived from the SARS-CoV-2 coronavirus, says Yonker. Along with viral load, researchers examined expression of the viral receptor and antibody response in healthy children, children with acute SARS-CoV-2 infection and a smaller number
of children with Multisystem Inflammatory Syndrome in Children (MIS-C).

Findings from nose and throat swabs and blood samples from the MGHfC
Pediatric COVID-19 Biorepository carry implications for the reopening
of schools, daycare centers and other locations with a high density of
children and close interaction with teachers and staff members. "Kids
are not immune from this infection, and their symptoms don't correlate
with exposure and infection," says Alessio Fasano, MD, director of the
Mucosal Immunology and Biology Research Center at MGH and senior author of
the manuscript. "During this COVID- 19 pandemic, we have mainly screened symptomatic subjects, so we have reached the erroneous conclusion that
the vast majority of people infected are adults.

However, our results show that kids are not protected against this
virus. We should not discount children as potential spreaders for this
virus." The researchers note that although children with COVID-19 are not
as likely to become as seriously ill as adults, as asymptomatic carriers
or carriers with few symptoms attending school, they can spread infection
and bring the virus into their homes. This is a particular concern for
families in certain socio- economic groups, which have been harder hit
in the pandemic, and multi- generational families with vulnerable older
adults in the same household. In the MGHfC study, 51 percent of children
with acute SARS-CoV-2 infection came from low-income communities compared
to 2 percent from high-income communities.

In another breakthrough finding from the study, the researchers challenge
the current hypothesis that because children have lower numbers of immune receptors for SARS-CoV2, this makes them less likely to become infected
or seriously ill.

Data from the group show that although younger children have lower
numbers of the virus receptor than older children and adults, this does
not correlate with a decreased viral load. According to the authors,
this finding suggests that children can carry a high viral load, meaning
they are more contagious, regardless of their susceptibility to developing COVID-19 infection.



==========================================================================
The researchers also studied immune response in MIS-C, a multi-organ,
systemic infection that can develop in children with COVID-19 several
weeks after infection. Complications from the accelerated immune response
seen in MIS-C can include severe cardiac problems, shock and acute heart failure. "This is a severe complication as a result of the immune response
to COVID-19 infection, and the number of these patients is growing," says Fasano, who is also a professor of Pediatrics at Harvard Medical School
(HMS). "And, as in adults with these very serious systemic complications,
the heart seems to be the favorite organ targeted by post-COVID-19 immune response," adds Fasano.

Understanding MIS-C and post-infectious immune responses from pediatric
COVID- 19 patients is critical for developing next steps in treatment and prevention strategies, according to the researchers. Early insights into
the immune dysfunction in MIS-C should prompt caution when developing
vaccine strategies, notes Yonker.

As MGHfC pediatricians, both Yonker and Fasano are constantly fielding questions from parents about the safe return of their children to school
and daycare. They agree that the most critical question is what steps the schools will implement "to keep the kids, teachers, and personnel safe." Recommendations from their study, which includes 30 co-authors from MGHfC,
MGH, HMS, Massachusetts Institute of Technology, Brigham and Women's
Hospital and Harvard T.H. Chan School of Public Health, include not
relying on body temperature or symptom monitoring to identify SARS-CoV-2 infection in the school setting.

The researchers emphasize infection control measures, including
social distancing, universal mask use (when implementable), effective hand-washing protocols and a combination of remote and in-person
learning. They consider routine and continued screening of all students
for SARS-CoV-2 infection with timely reporting of the results an
imperative part of a safe return-to-school policy.

"This study provides much-needed facts for policymakers to make the best decisions possible for schools, daycare centers and other institutions
that serve children," says Fasano. "Kids are a possible source of
spreading this virus, and this should be taken into account in the
planning stages for reopening schools." Fasano fears that a hurried
return to school without proper planning could result in an uptick in
cases of COVID-19 infections. "If schools were to reopen fully without necessary precautions, it is likely that children will play a larger
role in this pandemic," the authors conclude.

The research was supported by the National Heart, Lung, and Blood
Institute, the Cystic Fibrosis Foundation, the National Institute of
Child Health and Human Development, the National Institute of Diabetes
and Digestive and Kidney Diseases, the National Institute of Allergy and Infectious Disease, the Centers for Disease Control and Prevention, the
MGH Department of Pediatrics the MGH Department of Obstetrics/Gynecology
and private donors.


========================================================================== Story Source: Materials provided by Massachusetts_General_Hospital. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Lael M. Yonker, Anne M. Neilan, Yannic Bartsch, Ankit B. Patel,
James
Regan, Puneeta Arya, Elizabeth Gootkind, Grace Park, Margot
Hardcastle, Anita St. John, Lori Appleman, Michelle L. Chiu, Allison
Fialkowski, Denis De la Flor, Rosiane Lima, Evan A. Bordt, Laura
J. Yockey, Paolo D'Avino, Stephanie Fischinger, Jessica E. Shui,
Paul H. Lerou, Joseph V.

Bonventre, Xu G. Yu, Edward T. Ryan, Ingrid V. Bassett, Daniel
Irimia, Andrea G. Edlow, Galit Alter, Jonathan Z. Li, Alessio
Fasano. Pediatric SARS-CoV-2: Clinical Presentation, Infectivity,
and Immune Responses. The Journal of Pediatrics, 2020; DOI:
10.1016/j.jpeds.2020.08.037 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200820102442.htm

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