The role that children play in the spread of COVID-19 remains unclear. While it is largely consensus amongst the medical community that children are unlikely to become severely ill after infection with the virus, their infection rates and their likelihood of transmitting the virus to others is still not well understood.

As schools slowly reopen, students, parents, teachers, administrators, and other education stakeholders are grappling with how to provide kids with the benefits of schools without spurring the spread of COVID-19 within their communities. One outstanding question is which children should be tested for the virus. A new Letter to the Editor, authored by two physicians in Pediatric Annals calls for a consistent approach to testing children.

As the doctors point out in their letter, more than 15,000 children under the age of 18 have been reported to be diagnosed with 2019 in the U.S. This number represents less than 0.5% of all COVID-19 cases in our country. They point to a study that has shown that compared to the 69% of adults over the age of 70 who show symptoms when diagnosed with COVID-19, only about one out of five people between the ages of 10 and 19 who test positive for COVID-19 develop symptoms.

According to the authors, the question of which children to test for COVID-19 is complicated by recent data showing that some young people suffer a multisystem inflammatory syndrome in response to COVID-19 infection, as well as the fact that a high rate of asymptomatic youths may present significant risk of unknown transmissions. To address this question of which pediatric patients should be tested for the virus, an informal survey was distributed to U.S. pediatric emergency physicians and healthcare providers.

The results of the survey showed that hospitalization or undergoing surgery were the primary reasons for COVID-19 testing in children, with 95% of responders saying that they test in these conditions. Displaying symptoms consistent with COVID-19 was the next most likely reason for testing, as 85% of those surveyed said they test symptomatic pediatric patients.There was great variation, however, in the attitude toward testing children who had been exposed to the virus or who may be at higher risk for complications related to the virus. In these cases, 40% to 45% of providers said that they actively test patients.

While the best approach to testing is still not well-defined, the authors suggest that guidelines are needed to enable us to better understand several aspects of COVID-19, including its specific effects on children. This information is particularly critical at a time when children throughout the country are likely to begin interacting more and more through school and school-related activities.

Reference

Pyle, C. & Finkel, L. (2020). Which pediatric asymptomatic patients should be tested for COVID-19? Pediatric Annals, 49(8), e328.