COVID-19: Children play 'limited role' in coronavirus pandemic (Children maintain social distancing measures while taking part in a lesson at Earlham Primary School © Justin Setterfield/Getty Images)

COVID-19: Children play ‘limited role’ in coronavirus pandemic

Study on infection rates show children account for just one in every 100 cases in England.

Children under the age of 16 accounted for 1 per cent of coronavirus cases in the first peak of COVID-19 in England, a new study has concluded.


The authors said that their study provides further evidence for the “limited role of children in the pandemic”.

The study, led by Public Health England (PHE), comes after Prime Minister Boris Johnson said getting all children back to school full-time in England next month is the “right thing for everybody” amid calls to boost coronavirus testing and tracing to ensure a safe return.

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Between 1 January and 3 May 2020, 129,704 out of 540,305 people tested positive for the novel coronavirus – also known as SARS-CoV-2 – in England, the authors wrote in the Archives of Disease in Childhood journal.

The first confirmed case involving a child was on 29 February. Cases among children started to increase during the second week of March and peaked on 11 April 2020 before declining gradually – a similar trend seen in adults.

Overall 35,200 tests were performed on children under the age of 16 and there were 1,408 cases among children aged 15 – meaning around 4 per cent of all children tested had a positive result. This compared to 19.1-34.9 per cent positive results among tested adults.

When considered in light of positive cases among all age groups, children accounted for 1.1 per cent of all cases of COVID-19. Just over half (53 per cent) were boys.

Pupils work on a task to produce artwork that depicts life during the lockdown with social distancing practices in place due to the Coronavirus, at Greenacres Primary Academy in Oldham, northern England on June 18, 2020 as primary schools to recommence education for Reception, Years 1 and Year 6 classes, alongside priority groups. (Photo by OLI SCARFF / AFP) (Photo by OLI SCARFF/AFP via Getty Images)
Pupils work on a task to produce artwork that depicts life during the lockdown at Greenacres Primary Academy in Oldham © Oli Scarff/AFP via Getty Images

The highest number of positive cases in children were among children under the age of three months – but researchers said that this was just a reflection of the higher number of tests done among children in this age bracket.

They said that young infants are more likely to have more tests done when they are unwell and parents are more likely to take them to a doctor if they are younger.

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During the study period there were eight deaths of children confirmed to have COVID-19.

In four cases “another cause (of death) was identified and SARS-CoV-2 was reported to be incidental or an indirect contributor to death”, the authors wrote.

And among four children aged 10 to 15 who died, three had “multiple” other health conditions, they wrote.

The authors added: “There has been no increase in excess deaths in children aged 0–15 years until 3 May 2020 [the end of the study]”.

Pupils return to Holyrood Secondary School in Glasgow for the first time following the easing of coronavirus lockdown measures on August 12, 2020. - It will be the first time since March that Scottish pupils will have attended schools. (Photo by Andy Buchanan / AFP) (Photo by ANDY BUCHANAN/AFP via Getty Images)
Prime Minister Boris Johnson says getting all children back to school full-time in England next month is the “right thing for everybody” © Andy Buchanan/AFP via Getty Images

They conclude: “The experience in England adds to the growing body of evidence on the limited role of children in the COVID-19 pandemic, with just over 1 per cent of confirmed cases occurring in children.

“Children accounted for a very small proportion of confirmed cases despite the large numbers of children tested.

“SARS-CoV-2 positivity was low even in children with acute respiratory infection.

“Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2.”

Previous research has implied that lower infection rates among children may be due to “lower expression of the cell surface enzyme ACE2 in the nasal epithelium of children compared with adults”.

ACE2 is a protein on the surface of cells to which SARS-CoV-2 binds, and can be found on the cells on the inner lining of the nose. Previous research has implied that the lower risk in children may be down to the fact they have lower expression of this enzyme in the inner lining of their nose.

The authors of the current paper say that a “key” unanswered question remains whether children without symptoms might be contributing to community transmission of the virus.

But they point to other research which shows low infection rates among children and a separate study which found that among household infections children were “never the first to be infected or to be the source of infection in the household”.

Coronavirus: aggressive 'L type' strain affecting 70 per cent of cases (An illustration of the coronavirus, created at the Centers for Disease Control and Prevention (CDC) © Smith Collection/Gado/Getty Images)
An illustration of the coronavirus, created at the Centers for Disease Control and Prevention (CDC) © Smith Collection/Gado/Getty Images

The authors, which include experts from PHE, the University of Oxford, the Evelina children’s hospital, King’s College London and the London School of Hygiene and Tropical Medicine, concluded: “England is currently nearing the end of the first peak of the COVID-19 pandemic.

“Consistent with other countries, children account for a very small proportion of confirmed cases and have very low case-fatality rates. Despite the large number of children tested, only 4 per cent were positive for SARS-CoV-2.”

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Lead author Dr Shamez Ladhani, from PHE, added: “It is still not clear why young children have such a low risk of infection compared to older children or adults. One theory is that, compared to adults, children have fewer ACE2 receptors which the virus can bind to in cells that line the respiratory tract.

“The way the immune system reacts to the virus is also likely to be different in children compared to adults.

“Whilst these numbers are reassuring for children, they include a long period of complete lockdown where children were less likely to have been exposed to the virus.”

And he cautions: “We need to remain vigilant as the lockdown eases and children have increased contact with other children and adults in the coming weeks. In particular, we need more information about asymptomatic infections and silent transmission.”

Key Stage 1 pupils in academic years 1 and 2 eat their lunches individually at their desks, sitting well apart from each other in order to minimise the risk of passing on Coronavirus at Willowpark Primary Academy in Oldham, north-west England on June 18, 2020, as primary schools to recommence education for Reception, Years 1 and Year 6 classes, alongside priority groups. (Photo by OLI SCARFF / AFP) (Photo by OLI SCARFF/AFP via Getty Images)
Children across the nation have had to adjust to life with social distancing measures in place at school © Oli Scarff/AFP via Getty Images

PHE said that an analysis of COVID-19 cases in educational settings in England, and the preliminary results of its nationwide study of antibody prevalence in schools, will be published “in the coming weeks”.

Commenting on the study, Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, said: “These data are high quality and very useful and confirm international evidence that children and young people as a group are little affected by this virus, even showing a slight reduction in total excess deaths.

“Any death of a child is one too many, however, even the extremely low COVID-related death rate is an overestimate as COVID-19 infection appeared incidental in half those who died.

“Testing of symptomatic cases can be misleading about the chances of transmission, as children are much less likely to be symptomatic than adults, however, these data provide another part of the jigsaw that together tells us that children play only a minor role in this pandemic.”

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Dr Mike Tildesley from the University of Warwick, added: “These results provide further supporting evidence that the reopening of schools in September should represent an extremely low risk to any individual child, though it is important to recognise that, despite these low numbers, we would expect that children may play a role in the transmission process.


“With this in mind, the vast majority of parents should feel reassured regarding the safety of their children when schools reopen, though given the likely role of infected children in transmission, parents and teachers with underlying health conditions may need to take precautions in order to minimise their own risk over the coming months.”

Reader Q&A: Do children have a better sense of smell than adults?

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