As schools reopen, scientists say some children could spread COVID-19 even if they already have the antibodies


As schools and colleges reopen across the country, scientists say social distancing remains a critical public-health response to COVID-19. New research released Thursday sheds more light on children who test positive for COVID-19, and the contagiousness of coronavirus. Children often remain asymptomatic or display very few symptoms, and the research also offers insights into the course of the disease at an important time for families and communities.

A study published in the latest edition of the Journal of Pediatrics finds that the virus and antibodies can coexist in young patients. “With most viruses, when you start to detect antibodies, you won’t detect the virus anymore. But with COVID-19, we’re seeing both,” says Burak Bahar, lead author of the study and director of Laboratory Informatics at Children’s National Hospital in Washington, D.C. “This means children still have the potential to transmit the virus even if antibodies are detected.”


‘Children still have the potential to transmit the virus even if antibodies are detected.’


— Burak Bahar, director of Laboratory Informatics at Children’s National Hospital in Washington, D.C.

The researchers reviewed an analysis of 6,369 children tested for SARS-CoV-2, the virus that causes COVID-19, and 215 patients who underwent antibody testing at Children’s National between March 2020 and June 2020. Out of these 215 young patients, 33 tested positive for both the virus and antibodies during the course of the disease. Nine of those 33 also showed presence of antibodies in their blood while also later testing positive for the virus.

What’s more, researchers found that patients aged 6 years through 15 years old took a longer time (a median time of 32 days) to clear the virus, meaning that it had left their systems, versus patients aged 16 years through 22 years old (a median of 18 days). Females in the 6 to 15 age group also took longer to clear the virus than males: A median of 44 days for females versus 25.5 days for males. “We can’t let our guard down just because a child has antibodies or is no longer showing symptoms,” Bahar said.

The study also found that 25 days was the median time from viral positivity to negativity — the moment when the virus can no longer be detected; it took 18 days to go from viral positivity to seropositivity — or the presence of antibodies in the blood — and it took 36 days to reach adequate levels of neutralizing antibodies. These “neutralizing antibodies” are important in potentially protecting a person from reinfection of the same virus, the researchers wrote.

Four important caveats: Firstly, the study looked at a relatively small number of children. Secondly, the next phase of research will be to test whether coronavirus that is present along with the antibodies for the disease can be transmitted to other people. Thirdly, scientists need to explore whether antibodies correlate with immunity and, fourthly, they need to establish how long antibodies and potential protection from reinfection actually lasts. As such, Bahar reiterates the need for social distancing.

Related:Dr. Fauci: It’s ‘conceivable’ we’ll know by November if a safe, effective vaccine is coming

A separate study published this week in JAMA Pediatrics suggests that children can spread SARS-CoV-2, even if they never develop symptoms or even long after symptoms have cleared. It found a significant variation in how long children continued to “shed” the virus through their respiratory tract and, therefore, could potentially remain infectious. The researchers also found that the duration of COVID-19 symptoms also varied widely, from three days to nearly three weeks.

A recent systematic review estimated that 16% of children with a SARS-CoV-2 infection are asymptomatic, but evidence suggests that as many as 45% of pediatric infections are asymptomatic, according to the U. S. Centers for Disease Control and Prevention. The signs and symptoms of COVID-19 in children are similar to other infections and noninfectious processes, including influenza, according to the CDC.


A separate study in JAMA Pediatrics said children may spread SARS-CoV-2, even if they never develop symptoms or even long after symptoms have cleared.

Under pressure from the teachers union to delay the start of the school year, New York City Mayor Bill de Blasio announced Tuesday that in-person classes will be pushed back until Sept. 21, 11 days later than planned. Remote learning, also originally slated to start on Sept. 10, will now commence on Sept. 16. Other countries have not fared so well with school reopenings. Israel, which also reopened schools this week, experienced outbreaks when it reopened schools on May 17.

Bahar also advised teachers and students to wear masks. To reduce the risk of spreading COVID-19, it may be preferable to use high-quality cloth or surgical masks that are of a plain design instead of face shields and masks equipped with exhale valves, according to an experiment published Wednesday by Physics of Fluids, a monthly peer-reviewed scientific journal covering fluid dynamics that was first established by the American Institute of Physics in 1958.

As of Sunday, the U.S. still has the world’s highest number of COVID-19 cases (6,262,989), followed by Brazil (4,123,000), India (4,113,811) and Russia (1,022,228), according to data aggregated by Johns Hopkins University. California became the first state in the country to surpass 700,000 confirmed cases. COVID has killed 188,711 people in the U.S. Worldwide, cases are near 27 million.

AstraZeneca
AZN,
-1.07%

, in combination with Oxford University; BioNTech SE
BNTX,
-1.19%

and partner Pfizer
PFE,
-0.11%

; GlaxoSmithKline
GSK,
-1.38%

; Johnson & Johnson
JNJ,
-0.64%

; Merck & Co.
MERK,
-0.95%

; Moderna
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-3.45%

; and Sanofi
SAN,
+5.09%

are among those currently working toward COVID-19 vaccines.

The Dow Jones Industrial Index
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-0.56%
,
the S&P 500
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-0.81%

and the Nasdaq Composite
COMP,
-1.26%

ended lower Friday. Doubts about traction for further fiscal stimulus from Washington may be one factor discouraging investors who have been betting on Republicans and Democrats striking a deal to offer additional relief to consumers and businesses.



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Asymptomatic children who contract COVID-19 may ‘shed’ coronavirus for weeks


Should families double down on social distancing now that their kids are going back to school?

A new study published in JAMA Pediatrics suggests that children can spread SARS-CoV-2, the virus that causes COVID-19, even if they never develop symptoms or even long after symptoms have cleared. It found a significant variation in how long children continued to “shed” the virus through their respiratory tract and, therefore, could potentially remain infectious. 

While the virus was detectable for an average of about 2.5 weeks in the entire group, a significant portion of the children —about a fifth of the asymptomatic patients and about half of the symptomatic ones — were still shedding virus at three weeks, meaning they were releasing it into the environment. The researchers also found that the duration of COVID-19 symptoms also varied widely, from three days to nearly three weeks. 

A recent systematic review estimated that 16% of children with a SARS-CoV-2 infection are asymptomatic, but evidence suggests that as many as 45% of pediatric infections are asymptomatic, according to the U. S. Centers for Disease Control and Prevention. The signs and symptoms of COVID-19 in children are similar to other infections and noninfectious processes, including influenza, according to the CDC

Such research comes at an important time for communities. Under pressure from the teachers union to delay the start of the school year.

While children infected with SARS-CoV-2 are less likely than adults to develop severe illness or complications, they are still at risk of becoming ill. “Recent COVID-19 hospitalization surveillance data shows that the rate of hospitalization among children is low (8 per 100,000 population) compared with that in adults (164.5 per 100,000 population),” the CDC said.

Such research comes at an important time for families and communities. Under pressure from the teachers union to delay the start of the school year, New York City Mayor Bill de Blasio announced Tuesday that in-person classes will be pushed back until Sept. 21, 11 days later than planned. Remote learning, also originally slated to start on Sept. 10, will now commence on Sept. 16.

Other countries have not fared so well with school reopenings. Israel, which also reopened schools this week, had less success when it reopened schools on May 17 amid high temperatures that made it difficult for students to wear masks, full classrooms that made social distancing near-impossible and, perhaps, the illusion that the virus had been vanquished, creating a false sense of security.

The risk, as Israel discovered, is providing an environment where children unwittingly spread the virus to each other, which can lead to community transmission. That’s particularly worrying for those who have underlying conditions, and the elderly, who are more vulnerable to the most severe effects of the virus. Community transmission also makes contact tracing more difficult.

A school outbreak can lead to community spread, hence the need for staggered school reopenings, social distancing and reduced class sizes. “If we find a certain number of symptomatic people testing positive, we expect the same number of asymptomatic carriers that are much more difficult to identify and isolate,” said Enrico Lavezzo, a professor in the University of Padua’s department of molecular medicine, who coauthored a study released in June of a quarantined town in Italy.

Children may shed virus for weeks

The latest study in the peer-reviewed JAMA Pediatrics focused on 91 pediatric patients at 22 hospitals in South Korea. “Unlike in the American health system, those who test positive for COVID-19 in South Korea stay at the hospital until they clear their infections even if they aren’t symptomatic,” said Roberta DeBiasi, chief of the Division of Infectious Disease at the Children’s Hospital in Washington, D.C.

The patients were identified for testing through contact tracing or after developing symptoms. About 22% never developed symptoms, 20% were initially asymptomatic but developed symptoms later, and 58% were symptomatic at their initial test. The hospital staff tested them every three days on average, providing a picture of how long viral shedding continues over many weeks.

Among the important findings from the study: Children, a group widely thought to develop mostly mild disease that quickly passes, can shed virus for weeks, DeBiasi and Meghan Delaney, chief of the Division of Pathology and Lab Medicine at the Children’s National Hospital in Washington, D.C., wrote in a commentary piece to accompany the study in JAMA Pediatrics. 

There were a large number of asymptomatic children: About one-fifth of the group of children studied across 22 South Korean hospitals.

Other key points: Even asymptomatic children continued to shed coronavirus after testing positive, making them potential key vectors. In this study at least, there were a large number of asymptomatic patients: About one-fifth of the group in South Korean hospitals. Researchers said the study provides important insight on the role children might play in the spread of COVID-19.

But the study also had obvious limitations. One of these relates to the link between testing and transmission. A “positive” or “negative” result may not necessarily mean that a child is infectious, “with some positives reflecting bits of genetic material that may not be able to make someone sick,” or, on the other hand, “negatives reflecting low levels of virus that may still be infectious.”

Researchers may have tested different parts of the respiratory tract and different testers may yield different results. It’s unclear whether symptomatic children shed different quantities of virus than symptomatic patients. They tested for the active virus — not antibodies — excluding those who may have had and cleared an asymptomatic or mild infection, an important factor for understanding herd immunity.

However, DeBiasi said studies such as these can add to the knowledge of public-health efforts being developed and refined to bring COVID-19 under control. “Each of these pieces of information that we, our collaborators and other scientists around the world are working to gather is critical for developing policies that will slow the rate of viral transmission in our community,” she said.

Coronavirus update

As of Thursday, COVID-19 had infected 26,118,288 people worldwide, which mostly does not account for asymptomatic cases, and killed 864,801. The U.S. still has the world’s highest number of COVID-19 cases (6,131,344), followed by Brazil (3,997,865), India (3,853,406) and Russia (1,006,923), according to data aggregated by Johns Hopkins University.

Cases keep rising in the U.S. with California becoming the first state in the country to surpass 700,000 confirmed cases; infections hit 721,281 there as of Thursday with 13,317 COVID-related deaths. New York has recorded 436,218 infections and the highest number of deaths in the U.S. (32,972). COVID has killed 186,293 people in the U.S.

AstraZeneca AZN, -1.10% , in combination with Oxford University; BioNTech SE BNTX, -5.61% and partner Pfizer PFE, -2.40% ; GlaxoSmithKline GSK, -1.61% ; Johnson & Johnson JNJ, -1.23% ; Merck & Co. MERK, -0.31% ; Moderna MRNA, -2.41% ; and Sanofi SAN, -1.34% are among those currently working toward COVID-19 vaccines.

The Dow Jones Industrial Index DJIA, +0.75%, the S&P 500 SPX, +0.75% and the Nasdaq Composite COMP, +1.39% were trading lower Thursday. Doubts about traction for further fiscal stimulus from Washington may be one factor discouraging investors who have been betting on Republicans and Democrats striking a deal to offer additional relief to consumers and businesses.



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Kids under age 5 may carry a much higher coronavirus viral load than older children and adults: study


A small study is raising questions about whether young children could be coronavirus super spreaders, even as the country deliberates how to reopen schools in the coming weeks.

But how contagious are kids? And could reopening schools lead to more community outbreaks if children (and teachers) become exposed to COVID-19 in classrooms, and then spread the virus to their families? A small Chicago study published in JAMA Pediatrics this week is renewing such questions, as it suggests that small children infected with COVID-19 carry at least as much of the virus as adults do — if not much, much more.

Dr. Taylor Heald-Sargent, a pediatric infectious diseases specialist at Lurie Children’s Hospital of Chicago, analyzed 145 nasal swabs from patients with mild to moderate cases of COVID-19 within a week of showing symptoms. Her team tested for the genetic pieces of the virus (RNA) in the samples. And they found that older children and adults had similar amounts of the viral genetic material, which can be extrapolated to measure how much live virus they carried. (Live viral cultures are used in research settings, not clinical settings like this one, which is why they went this route.)

The most alarming finding, however, was that kids under 5 had significantly more of the viral genetic material in their noses — 10 to 100 times more, in fact, compared to older children and adults.

“People thought maybe [young children] can’t get infected, and that is not the case. They definitely do get infected,” Heald-Sargent told MarketWatch. “And once they get infected, they have rip-roaring amounts of virus.”

There are some caveats to keep in mind with this report -— namely that it was a small study, and it wasn’t looking at samples of live virus, but rather the genetic material that the virus leaves behind.

The study also did not measure transmissibility, and so these findings do not prove that children are more contagious. But it does provide more evidence that kids can indeed become infected with COVID-19, which suggests that it is also possible for them to spread it.

“There has been some suspicion that kids may actually not transmit it to adults, which would be a good thing, but I do not think we can hold out that hope,” Dr. Sunil Sood, a pediatric infectious disease specialist from Northwell Health’s Southside Hospital who was not part of the study, told MarketWatch.

“I see no biological reason why they wouldn’t be contagious,” he continued. “Why would this virus be different from other respiratory viruses — even coronaviruses that cause common colds? Kids transmit them to other kids and adults commonly, so why would this virus be any different?”

Of course, this virus has proven to be different at almost every turn — from its growing laundry list of symptoms to how many asymptomatic patients could be unknowingly carrying the virus — which has helped make it so difficult to bring under control.

“It’s so confusing,” Heald-Sargent said. “We’re learning more every day, so it’s hard to weigh each piece of data on its own. You have to take it collectively.”

Her paper is consistent with research that has come out of France and Germany. A recent study of 47 COVID-19 infected children between the ages of 1 and 11 in Germany found that even asymptomatic kids had viral loads on par with those of adults — if not higher. And a French study also found that children without symptoms appear to have COVID-19 viral loads similar to those of children with symptoms.

And in May, another JAMA study found that children age 4 and under are largely responsible for spreading respiratory syncytial virus (commonly called RSV) in adults over 65. “We know for sure that kids spread RSV,” Sood told MarketWatch. While it’s predominantly found in younger kids, he noted that it can cause severe cases of pneumonia in seniors.

“So what I think our paper adds [to the discussion of kids and coronavirus] is this answer to whether children can get infected. They can,” Heald-Sargent said. “We don’t know that they’re spreading it, but we need to be cautious. It doesn’t mean schools can’t open; we just need to be safe about it.”

“This paper should reinforce to any skeptical parents that kids need to wear masks so that they are less likely to transmit the virus to others,” Sood added. “They may have a high virus count in their noses, even without being very sick themselves.”

The CDC states on its site that children do not appear to be at higher risk for COVID-19 than adults, based on available evidence. But it does caution that “the more people children interact with, and the longer that interaction, the higher the risk of COVID-19 spread.”

To keep families safe, the CDC suggests practicing good hygiene, such as: washing hands often; cleaning and disinfecting high-touch surfaces daily; and laundering clothes and plush toys as needed. It also recommends practicing social distancing with kids: avoiding people who are sick, sneezing or coughing; keeping at least six feet away from other people outside of your household; and having kids ages 2 and up wear cloth face masks in public settings where it is difficult to follow social distancing. Its guidelines for reopening schools also include encouraging mask wearing, spreading desks at least three feet apart and canceling group activities like choirs and assemblies.

The CDC has also stated that “decisions about how to open and run schools safely should be made based on local needs and conditions.”

Follow MarketWatch’s coronavirus coverage here.



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My children, aged 10 and 15, each received $1,200 stimulus checks — will the IRS penalize us if we keep them?


Dear Moneyist,

I received three direct deposits yesterday for $1,200 each for my kids, all of whom are under 17. They are aged 10, 10 and 15. We already received our $2,400 stimulus check. My wife is on permanent disability and she receives a Social Security payment monthly for them. Were we supposed to get this money? If not, will the Internal Revenue Service penalize us if we keep it?

Don

Dear Don,

Sometimes, the answer is in the question. Actually, often times the answer is in the question. Your letter asks if you were supposed to receive this money and you simultaneously wonder if you will be penalized for keeping it. In situations such as this, it’s always good to go with your gut.

The Internal Revenue Service is sending $1,200 to individuals with annual adjusted gross income below $75,000 per year and $2,400 to married couples filing taxes jointly who earn under $150,000, plus $500 per qualifying dependent child. Some 160 million checks have been sent out.


Sometimes, the answer is in the question. Actually, often times the answer is in the question.


— The Moneyist

The payouts reduce in size above the $75,000 per year/$150,000 per year household income threshold and stop at $99,000 per year for individuals and $198,000 per year for married couples. The money will appear automatically in your bank account if the IRS has your account information.

I have received countless letters from people who have received no economic impact payment at all. Some taxpayers say they’ve received stimulus checks for dead relatives. Others have received more than one check and, like you, have wondered what they should do.

Also see: I received my ex-husband’s $1,200 stimulus check because we filed joint taxes in 2018. Should I give him the money or return it to the IRS?

Your can return the money via check or money order with the notation “2020EIP,” plus the Social Security number or taxpayer I.D. of the check recipient. Those people who received a paper check can write “void” on the back and mail it back to the IRS, according to the IRS directions (see Q41).

You can add a note to explain and, assuming you need the $500 now like many Americans, deduct $1,500 from the entire amount and return the rest. I understand that it’s very difficult to make ends meet during the lockdown, and many families are struggling.


The coronavirus pandemic may change Americans’ views of the IRS of an organization that is to be feared.


— The Moneyist

In 8 of the top 10 cities, the economic impact payment only covers between 60% and 71% of an estimated monthly budget for a family, this study found. The EIP is an advance payment of a 2020 tax credit. If you don’t return these payments, the IRS may adjust your 2020 return accordingly.

Nearly one-third (30%) of people said they used their stimulus checks to pay bills, according to a study released this week, another sign that Americans are struggling to make ends meet, particularly with more than 38 million people filing for unemployment since mid-March.

Those bills — including for cellphones, utilities, cable TV and rent — are the No. 1 priority, even more than purchasing essentials and “relief spending” on apparel, televisions, video games, sporting goods and toys at Walmart
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+0.29%
,
Costco
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and Target
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+3.29%
.

IRS employees are essential workers. They’re working from offices and clearly doing their utmost to process all of these payments. If nothing else, the coronavirus pandemic may change Americans’ views of the IRS of an organization that is to be feared or disliked for taking cuts of our income.

Dispatches from a pandemic:Letter from New York: ‘New Yorkers wear colorful homemade masks, while nurses wear garbage bags’

You can email The Moneyist with any financial and ethical questions related to coronavirus at qfottrell@marketwatch.com

Want to read more?Follow Quentin Fottrell on Twitterand read more of his columns here

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Blinking in the sunlight: Children make halting return to Spain’s streets after weeks of coronavirus lockdown


An unseen Pied Piper worked his way across Spain on Sunday, bringing children out of apartments and houses of all sizes with their bikes, scooters, skates and balls, and most important, their parents.

A literal baby step down from one of the strictest coronavirus lockdowns in the world arrived as the country was set to enter its seventh week of economic shutdown and restrictions of movement. Prime Minister Pedro Sanchez announced a week ago that children 14 and under would be able to accompany their parents to the pharmacy or supermarket. The rules quickly changed again as many pushed back over social media on the idea of cramming more people into confined spaces or waiting in long lines to enter for grocery stores with children.

As it now stands, Spanish children — up to three at a time — can go to the streets for one hour a day with one parent or adult supervisor who they live with. They cannot use playground equipment and cannot get close to other playmates or friends.

At 9 a.m. in Madrid, few children could be spotted on the streets. But by lunchtime children and parents were filling the streets, and the afternoon brought more outside, with many residents hanging out on their balconies to watch. Parents snapped pictures and videos of their children to mark the day, a scene that repeated across the country.

MarketWatch reporter and son, finally leaving the apartment together on Sunday, April 26.


NBC/Willem Marx/

My 11-year old and I joined not-too-busy pre-lunchtime crowds in Madrid. He gaped at empty streets and closed businesses, eventually returning home weary after weeks of no activity, content to sit on the balcony and wait for a friend to pass by with his mother and brother for a brief, safe distance chat.

Not all needs have been met in Spain by a long shot. The 16-year old in my house remains discontent as a visit to the supermarket or pharmacy doesn’t interest her in the least — alas what the teens want in this country, hanging out with friends, may take a little bit longer.

But we may be inching toward that moment for her. Sanchez announced on Saturday that by May 2, families may be able to leave the house for walks and outings together, with adults able to exercise, provided the country’s pandemic evolution continues in a favorable manner. The government is expected to announce a de-escalation plan Tuesday.

On Sunday, the government announced 288 new deaths in the past 24 hours, the first time the number of deceased has been below 300 since the lockdown began on March 15, and well off a peak of 902 on April 2. Of course, as in many countries, some question whether Spain’s total death toll to date of 23,190 could be much higher. The infection rate is above 200,000, while 98,732 have recovered.

The day wasn’t without its critics, with fears Spain was too quick to loosen the rules. Some complained over social media of groups of children gathering to play football and parents sitting on benches chatting casually, not observing required social distancing rules. And there were alarms raised over parks that appeared to be packed with parents and children.

The country will have to wait and see if the new freedoms result in a spike in infections, or if the country can keep normalizing. Spain’s schools remain shut for physical classes and only essential businesses and construction and factories are up and running. Food banks are seeing a surge in those seeking aid as jobless claims soared by over 300,000 in March and are expected to keep climbing.



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