New Study Suggests How Children Might be Persistently Spreading Coronavirus

By Rajaneesh K. Gopinath, Ph.D.

A collaborative study led by researchers from Guangzhou Medical University may have found the clue as to how young kids are serving as active carriers of COVID-19. Although children have been surprisingly able to evade the intensity of the SARS-CoV-2 pandemic, the report published in today’s issue of Nature Medicine suggests there is still “potential evidence” for the possibility of fecal-oral transmission. This discovery substantiates the decision taken by authorities to shut down schools, a move that might very well turn out to be the key to flatten the curve.

The Mystery and the Early Reports

It is quite evident why the elderly succumb to a viral outbreak of this proportion, but how children are at a very low risk has remained a mystery for long. A similar observation puzzled scientists during the 2003 global SARS outbreak where infected pediatric patients exhibited mild symptoms like fever, cough, nausea or vomiting but there was absolutely zero mortality. Especially, 12 years olds or younger patients were less likely than older children to be admitted to an ICU or put under a respiratory treatment.

An analysis of a study comprising of 44,672 confirmed COVID-19 cases in China found that children constitute only a lowly 1% with no deaths reported. But milder symptoms may not mean that children escape infection altogether. Although numbers are skewed towards adults and the elderly, a recent study clarifies that children are just as susceptible. Through contact tracing and closer inspection of victims and their families, the study reported that infection rates in children are on par with others. In fact, another report claimed a surge in the number of pediatric patients who contracted COVID-19 in recent times.

Meanwhile, experts have come up with several hypotheses to explain the phenomena. One popular suggestion is that the fledgling immune system of children might be the saving grace as defense mechanisms in adults might overreact to the incoming pathogen. A cytokine storm in adults, which is scientific jargon for the overproduction of immune cells is more harmful to the body. However, such speculations are debatable and only a detailed investigation would solve the conundrum. Uncovering the underlying mechanisms would prove extremely pivotal for developing therapeutic interventions for the disease.

Fecal-Oral, a Possible Route of Transmission

At this juncture, researchers of this new study have stumbled upon an important piece of this puzzle. Of the 745 children screened, they investigated ten COVID-19 positive patients (6 males, 4 females) belonging to the age bracket of 2 months and 15 years. Consistent with earlier observations, these children showed milder symptoms as opposed to adults and did not require ICU monitoring or respiratory care. Chest X rays revealed no signs of pneumonia and even the usual tests like blood count, urine and stool analyses and infection biomarkers among others turned out to be normal for most of them. However, despite negative nasopharyngeal swabs, they observed long term, positive, real-time RT–PCR results in rectal swabs in eight patients.

This suggests that fecal-oral transmission is possible in children and their gastrointestinal tract could be responsible for persistent viral shedding. Even though they may show signs of recovery, it is advisable to test rectal swabs before they are discharged from the hospital. That said, the study does not present any evidence that the viruses from fecal swabs are capable of replication. Further research with more candidates would certainly add validation to the claims.

Related Article: Takeda Initiates Development of Potential COVID-19 Therapy TAK-888

References

1. https://www.nature.com/articles/s41591-020-0817-4
2. https://jamanetwork.com/journals/jama/fullarticle/2762130
3. https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v1
4. https://wwwnc.cdc.gov/eid/article/26/6/20-0239_article
5. https://www.washingtonpost.com/health/2020/03/10/coronavirus-is-mysteriously-sparing-kids-killing-elderly-understanding-why-may-help-defeat-virus/
6. https://www.ncbi.nlm.nih.gov/pubmed/17195709

Author

Rajaneesh K. Gopinath