The issue of COVID-19 in children

The AHPPC has been asked to consider the issue of COVID-19 in children and management of Early Childhood and Learning Centres (ECLC) in relation to the community transmission of COVID‑19.


Emerging epidemiology reports on COVID-19 in children show that, while they are less likely than adults to be infected and have severe illness, they are still vulnerable to the pandemic corona-virus.

Epidemiology

The European CDC published a summary of the latest evidence on 25 March 2020. Currently, there is not enough evidence to indicate how likely children are to be infected compared to adults, but they do generally experience mild clinical manifestations.


  • Data shows no difference between age groups in the order of most common symptoms but fever was slightly less commonly reported among those aged 10–19 years of age (39%, compared to 47% for all ages) and sore throat was less common among those aged <10 years (10%, compared to 16% for all ages).

  • Exposure to COVID-19 among children is likely to occur within the family or in a household context. The data showed that children made up a very small proportion of the 50,068 cases reported as of 24 March (with known age (<10 years (1%), 10–19 years (4%)).


There continues to be limited information on the contribution of children to transmission of COVID-19. The WHO-China Joint Mission also noted the primary role of household transmission and observed that children tended to be infected by adults in the household.


The clinical picture in pediatric patients infected with SARS-CoV-2 contrasts distinctly with the severity pattern observed with other respiratory viruses, where young children are particularly at risk of severe disease.


The health evidences on school closures from previous respiratory epidemics remains that the costs are often underestimated and the benefits are overestimated. The best available modelling supports the hypothesis that children are infected but relatively asymptomatic. If asymptomatic people are less likely to transmit, the modelling indicates that school closures will have minimal impact on the overall epidemiology of COVID-19 in the Australian setting.


Recommendations

AHPPC considers ECLC are essential services and should continue at this time, but with risk mitigation measures in place. These should include:

  • Exclusion of unwell staff, children, and visitors.

  • Reduce mixing of children by separating cohorts (including the staggering of meal and play times).

  • Enhanced personal hygiene for children, staff, and parents.

  • Full adherence to the NHMRC childcare cleaning guidelines.

  • Excursions other than to local parks should be discouraged, public playground equipment should not be used.

  • Influenza vaccination for children, staff and parents.

Alternative care arrangements should be considered for those children highly vulnerable to adverse outcomes should they be infected with COVID-19. AHPPC recommends parents seek medical advice for these children.


Restrictions on entry into ECLC

The following visitors and staff (including visiting workers) should not be permitted to enter the facility:

  • Those who have returned from overseas in the last 14 days.

  • Those who have been in contact with a confirmed case of COVID-19 in the last 14 days.

  • A contact is defined as anyone who has been in contact with a known case, including the 24 hours before the case became symptomatic.

  • Those with fever or symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath) symptoms.

  • Those who have not been vaccinated against influenza (after 1 May 2020).

There has been an absence of outbreaks in ECLC globally, however there is clear evidence that children are susceptible to SARS-COV-2 infection. The role that children play in transmission and amplification of COVID-19 remains largely unknown and AHPPC will continue to closely monitor the evidence as it emerges to inform public health policy.


MORE INFORMATION:

For the latest advice, information and resources, go to https://www.health.gov.au/

Feel free to contact us at office@gordondu-associates.com.au or (08) 9345 0499.

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