CORONAVIRUS “In pediatrics we are seeing very difficult situations, families who do not have what to eat”


In June, a study of 582 patients across Europe confirmed that Covid-19 is generally a mild illness for children. Begoña Santiago, co-author of this pioneering work, talks in this interview about something that is taking much longer to clarify: if children, despite not suffering much from the disease, are great transmitters.

In line with the recommendations of the Spanish Association of Pediatrics (AEP), this pediatrician insists on the need for face-to-face teaching: “Children must socialize with their peers, they need it; in addition, for many , school is a place of care that does not they have in other places. ”

Children have been said to be the silent transmitters of the pandemic. Is that so?
With the opening of the schools , this message has been repeated a lot. There is great controversy and social alarm that tends to bias or misinterpret some recent publications. Children can also be infected, symptomatically or asymptomatically, and transmit the infection. But what we see today is that children only play a secondary role in the transmission of the epidemic. Epidemiological surveillance studies show that adults are the main transmitters and that children are rarely the primary case of an outbreak.

Stock photo of the interior of a nursing home. – EFE
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Recent work concludes that children have a high viral load and that they spend weeks shedding viruses. Does this mean that they are very infective and for a long time?
You have to know how to interpret these articles rigorously. For example, a much-cited work in JAMA Pediatrics has shown prolonged detection of viral RNA in children; however, the work is based on qualitative and not quantitative detection, and could correspond to RNA fragments without infective capacity.

Regarding viral load, other recent work in the Journal of Pediatrics shows a high amount of viral RNA in children in the first days of infection; but the study was carried out in a small group of children treated exclusively in the hospital, and their contagiousness is not proven , so we cannot extrapolate to infectivity either.

What does infectivity depend on?
Infectivity is determined by many factors, such as the force and frequency of coughing, the proximity of contacts, the ventilation of the environment, etc. If a person coughs more forcefully, they project the viral particles farther away. That is a very important factor.

Children and coronavirus: why a high viral load does not mean that they are more infectious. EFE / Biel Aliño
Children and coronavirus: why a high viral load does not mean they are more infectious
And children cough more weakly.
Yes. They pass the disease with milder or completely asymptomatic symptoms and, if they do have symptoms, they cough less intensely and forcefully than adults. There are several factors, but in the end the reality is that we are seeing that children are not playing a leading role in the transmission of the virus.

It has been said that, in reality, the role of children in the pandemic has not been seen because schools have been closed.
No, it has nothing to do with schools. The lower contagiousness of children has been seen in contact studies : children have not started outbreaks and transmission from a child to an adult is rare. There are already countries in which schools have opened and there have not been significant associated foci either. As I have commented, there are probably other added causes, but the evidence we have now is that children transmit less than adults.

What about teenagers?
The older the child, the more his illness resembles that of the adult: they cough more forcefully, they have different social habits from those of children. The older the adolescent, the more he resembles a young adult.

WHO does not expect massive vaccinations against COVID until mid-2021. EFE / Federico Anfitti / Archive
WHO believes that the anticovid vaccine will not be widely available before 2022
Is it already known why children pass the disease in a milder way than adults?
There are several hypotheses. There are differences in the responsiveness of the immune system of children and adults. And in general the pathophysiology of the disease is very different. One reason could be the lower expression of the ACE2 protein in the nasal epithelium of children, which is the mechanism of entry of the virus into the cells it infects. But it is still a subject for study. There are still many open questions regarding the new coronavirus and children.

Can you mention another?
The possible vertical transmission of the virus from mothers to newborns , the transfer of antibodies from the mother to the baby, and its kinetics [its changes] throughout the first months of life. To study this in our hospital we have launched the Ges-Neo study , led by our colleague María Luisa Navarro and in which centers from all over Spain participate.

Do they already have any results?
We are still recruiting participants, we have more than a hundred pregnant women. But we have started to analyze the data, so we will be able to give more information about it soon.

What is known about pediatric multisystemic inflammatory syndrome?
During the pandemic, cases of children with an inflammatory syndrome that has common characteristics with others already known, such as Kawasaki disease, have been detected. It is the most serious spectrum associated with covid-19 in children. But it is rare, as shown in the EPICO registry of the AEP : we have seen it in 10% of the children admitted, but the incidence in the general population is estimated to be less than 1%. The good news is that thanks to what has been learned in other countries, and the experience in the first wave of the pandemic, the response to treatment is very good.

Can this syndrome be linked to covid-19 with complete security?
The exact relationship with covid-19 has not yet been proven, but it is striking that a new pediatric syndrome appears in temporal coincidence with the pandemic and that is why it is thought that there is a microbiological association.

Why has it been seen less in Spain than in other countries?
We do not know, it is also being investigated. Genetic causes are thought to underlie that could make certain populations more susceptible. In this second wave we hope to continue seeing cases, but we have well established protocols for action, we are prepared.

With the current situation, in which infections are increasing every day, how do you see the opening of schools?
Our position is that we must respond to the need of children to receive education in a stable way, to recover schooling activities as much as possible. It’s fundamental. Studies indicate that the most important thing to do is maintain physical distance and do as many outdoor activities as possible. Also, of course, the mask and hand hygiene; respect the ratios by class, the bubble groups; and that positives be closely monitored, speeding up the surveillance of suspected and confirmed cases.

Even when there is community transmission?
Now in Madrid we can say that there is, with many asymptomatic cases, and yes, we still recommend going back to schools with the measures mentioned. The AEP has issued recommendations in this regard. Children must socialize with their peers , they need it. In addition, for many children, school is a place of care that they do not have in other places.

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