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"No infection drivers"

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From the beginning, children were considered to be real virus spreaders. But the pediatrician and infectiologist Volker Strenger says: "Children are not the main spreaders of the virus."

Daily newspaper: Dr. Stricter, more and more studies are now coming to the conclusion that children are not “super distributors”, as was always thought and claimed at the beginning. So are children not particular drivers of a corona infection?

Volker Strenger (University Clinic for Pediatrics and Adolescent Medicine Graz): In the beginning you thought it for two reasons: First, because you know it from other respiratory diseases, especially the real flu, influenza. Because here it has been clearly shown that children become infected relatively early in the season, bring the virus home with them and infect their parents and grandparents. The coronavirus can by no means be compared with influenza. But there are some who ignorantly still do that. Second, it was known from the beginning that children usually do not get very sick, and therefore it was thought that they very often run around unrecognized and infect others. But that too has never been investigated and proven. So it was wrongly believed that children play a big role in the spread of Covid-19.

So that means that children are not at all corona virus spreaders ...

Yes, certainly not more than adults. Studies meanwhile clearly indicate that children not only often show no or few symptoms, but are also less likely to be infected with the corona virus than adults. There is, for example, an unreported study from Iceland, where over 13,000 subjects were tested, including children. And this came to the conclusion that children are less likely to be infected undetected than adults. Not a single child under 10 years of age was asymptomatic, and only 0.5 percent of children and adolescents between 10 and 20. While adults in some age groups were positive up to 1.5 percent. Studies from China also show that in households with corona-positive people, 20 percent of adults but only four percent of children are infected. This means that even if someone in a household is already infected, they are less likely to contract the virus. With Corona - unlike other infectious diseases - children are therefore no particular drivers of infection. Several studies have shown this in the meantime. They are probably not these so-called “super spreaders” either. To date, there has not been a single report of a "superspreader" event in which a child was involved. So far it has only been adults.

In summary, it can be said: Children are not only infected less often with the virus, they also play no major role in its spread ...

Yes, according to the current data you can say that. As carriers, they play a rather subordinate role. The risk of spreading the virus through children is low. Schools are not drivers of infection either. There is also a study from Australia that has shown that in schools with infected students, further infections are extremely rare. You carried out a study in 15 schools. The starting point was nine students and nine teachers who were confirmed as infected between March 5 and April 3. They had closer contact with over 800 other people in their schools. Despite these contacts, only two other students got the virus. And what's more: a corona infection is usually mild in children.

So children are also less at risk ...

Yes, they contract the coronavirus less often and usually less severely. But that does not mean that children cannot get seriously ill with Corona. It's just a lot rarer.

And what is the danger for small children?

It is known that infants under one year of age are admitted to the hospital more often. But that's probably also because you tend to be more careful with an infant than with a 12-year-old. Just because a baby has been admitted doesn't necessarily mean they are more seriously ill. The few studies that exist indicate that babies are often only slightly ill. Apart from infants, it can also be said that the risk of developing severe corona increases with age. This means that not only children and adolescents often show mild progression, but also young adults. There is no clear threshold as to the age at which one becomes more seriously ill. It is clear that with older people - from 60, 70 or even 80 years - the risk of a severe course increases sharply.

And how can you explain that? Why are children less prone to corona?

There are a couple of theories for that. One theory is that in children the receptor to which the virus attaches to the cells and penetrates may occur less frequently than in adults. This means that the viruses are less able to penetrate the cells and infect the child. This receptor is called ACE2. However, there are contradicting data as to whether children really form less ACE2. Another theory is that children have better immune systems because of the numerous vaccinations they get. It is also assumed that children have more experience with other coronaviruses because they have come into contact with them several times. There are not only SARS-Cov-2, but also four coronaviruses that only cause trivial infections. This is why some believe that this would make them less susceptible to this new virus. However, there are also counter-arguments against all these theories. It is clear that the immune system of children - in contrast to adults - is more used to dealing with new pathogens. The local immune tissue in the throat - for example the pharyngeal tonsils - could possibly also play a role.

Was it then even necessary to close schools, kindergartens and daycare centers so rigorously?

That is difficult to say because there is hardly any comparison as to whether the school closure brought anything or whether the school opening would have led to problems after all. The effects are likely to be very minor. But if we look at Sweden, for example, where schools have remained open as normal, it becomes apparent that there were obviously no major problems in schools there, although Sweden otherwise has a comparatively high number of illnesses. So it can already be said - also on the occasion of the many findings about children - that it is a bit exaggerated to close schools so quickly when a cluster occurs somewhere. On the other hand, you can also understand why you decided to do this in the beginning. At that time we still knew too little. But normal - or at least more normal - school operations should be resumed in autumn. Of course, with hygiene measures and possibly without mixing different classes if possible. But the fact that the classes are divided, so only half of them are still allowed to be in school (as was the case in Austria last time), I think is an exaggeration.

But there are also some parents who worry about starting school. They fear that their child will infect others and take the virus home with them ... What can you tell these parents?

I believe that going to a restaurant, going to a family gathering, shopping in a store, or playing with others in a park is much more risky than going to school in an orderly fashion. Based on current data, I - and I have school-age children myself - would be less worried that they would get infected at school. The problem is rather that children will often meet the criteria for a suspected corona case in the autumn and winter seasons, i.e. have a cough or a fever. In the vast majority of cases, however, that will be something different, because during this time there are also many other viruses present that cause these symptoms much more frequently in children, and then the influenza season begins. In other words, the biggest challenge in schools will be how to deal with it. It can be assumed that every child will show these “corona-typical” symptoms at least once. But just because a child is coughing or has a fever, you cannot quarantine the whole class or even close the whole school.

What should you do instead?

Here it is important to proceed cautiously and to carry out a test in the event of corresponding symptoms, but only when it is really positive to take appropriate measures: i.e. quarantine the contact persons and possibly test them, but do not close the entire school. For this it is of course important that the test results are available quickly.

Interview: Eva Maria Gapp

Photo (s): © 123RF.com and / or / with © archive Die Neue Südtiroler Tageszeitung GmbH (if no information is available)

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