COVID-19 and kids' health: Your questions answered

• This information is current as of Sept. 11.

As schools re-open across the country and the coronavirus pandemic enters its seventh month in Canada, we spoke to Dr. Fatima Kakkar, a pediatric infectious disease specialist at CHU Sainte-Justine in Montreal, about the latest evidence on transmission of COVID-19 among children. 

Kakkar is the principal investigator on a study by the Canadian Paediatric Surveillance Program which is capturing clinical information across the country on children under 18 who were hospitalized with COVID-19. The group published preliminary results this week about the severity of COVID-19 in children in Canada. 

Have any children died of COVID-19 in Canada?

According to the Paediatric Surveillance Program, there are no children under the age of 18 that have died from COVID-19 in Canada.

Have any children been admitted to the intensive care due to COVID-19? 

Yes, there have been children admitted to ICU due to COVID-19 across Canada. The Surveillance Program has data on 13 pediatric patients across Canada, but Kakkar says there might be up to 29 children who have been admitted so far. 

In comparison, 2341 adults over 19 have been admitted to ICU in Canada as of Sept. 10. 

"I can speak from a personal experience that it is not at all the same disease that it is in adults and that they haven't had the same level of complications and they have not required high levels of ventilation or very long," Kakkar said.

How does this admittance rate compare to other diseases?

Generally, Kakkar says, COVID is much milder in kids than other routine viruses.

"For example, last year, during flu season, we had deaths from flu here in Canada. We had hundreds of ICU admissions from flu in Canada. It's been a very, very different disease than what we were expecting," she said.

What are the symptoms of COVID-19 in children?

Generally, the most common symptom in children is fever, said Kakkar. Additional symptoms include an equal mix of respiratory symptoms like cough, sore throat, and digestive ailments like vomiting and diarrhea.

"The symptoms have been very mild, and it hasn't been the same kind of respiratory illness or vascular illness that we've seen in adults where right away they've had trouble breathing," she said. 

In fact, she says, in some of the hospitalizations of children with COVID-19, the patients had been admitted to the hospital with another ailment like an arm fracture or appendicitis.

Are there lingering effects in children who have had COVID-19?

One of the main post-infection issues for children around the world has been cases of multisystem inflammatory syndrome in children (MIS-C). 

According to the B.C. Centre for Disease Control, MIS-C is likely an exaggerated immune response, leading to severe widespread inflammation. 

Symptoms can include rashes, fever and swelling of the hands and feet, according to the BCCDC.

There have been a "few" cases in Canada, although researchers are still collecting and analyzing that data at this point, and the exact number of cases is still being determined, said Kakkar. Results are expected in the next few weeks.

"The difficulty is making the clear link to COVID because up until now, we haven't had easy access to serology testing," which would show whether or not someone has had COVID-19 in the past, she said.

"But there's some cases where they've been able to link it to COVID."

Schools are opening across the country. Will this lead to more cases of COVID-19 among children?

Kakkar says during the first wave, the majority of cases of COVID-19 in children were those who got it from their parents who were essential workers and had to be outside of the home. The case count among children might have generally been lower because they were mostly isolating at home, and it could increase as children leave home.

"It is reasonable to think that there will be cases in children now that children are out and about in the school setting," she said. 

However, she added, the severity of COVID disease in children is mild compared to pretty much every other respiratory illness that they might have gone through in previous years.

Do children transmit COVID-19 easily?

"We don't have 100 per cent of that answer," said Kakkar. 

Children are typically "great vectors of infection," she said, mostly because they can't necessarily control all of their actions and easily touch their noses, faces, and other surfaces. 

"That said, you know, we don't really quite understand the dynamics of transmission, for example, how much virus each individual might have, how easily they transmit it," she said, noting anecdotal examples of families where one child was infected and the other one remained unaffected. 

"We have to be under the assumption that children will probably spread it because we want everybody to take their precautions but I don't think it's a given," she said. 

Kakkar also noted that the additional precautions for COVID — hand-washing, mask-wearing, and physical distancing — also prevent the spread of other diseases and infections like flu, influenza and ear infections.

"We've never had such strict measures in place, so we might actually see less of these other common viral illnesses," she said.

"We're in for the long-haul. These measures work."