Early on, I repeated an assumption about coronavirus that proved to be incorrect, that children weren’t very susceptible to becoming infected and hence weren’t prime transmitters the way they were for seasonal flus.

A preprint of a paper based on a study of coronavirus incidence and transmission in Shezen found that children do contract coronavirus, albeit typically getting mild cases, and can transmit it. We’ve embedded the full article at the end of this post. The sample size is large, 391 cases, and the contact tracking looks to be good.

Key sections:

Attack rates were similar across infectee age categories (Table 3), though there is some indication of elevated attack rates in older age groups (Figure 1). Notably, the rate of infection inchildren under 10 (7.4%) was similar to the population average (7.9%). There was no significant association between probability of infection and age of the index case.

We’ve had confirmation in the US. The Mayor of White Plains put out a press release yesterday stating that three children has tested positive for coronavirus and their school will be closed until at least March 16:

According to the Westchester County Department of Health there are now up to 18 confirmed cases of Coronavirus in Westchester County. As has been widely reported, there are three confirmed cases associated with a private school in White Plains, Westchester Torah Academy. The three students who tested positive are the children of the man who is a friend of and spent time with the original patient. Westchester Torah Academy has been closed until March 16 and the NY State Department of Health has required all students, faculty, and staff to isolate themselves at home through that date. The re-opening of the school is conditional on whether any new positive COVID-19 cases are identified.

Those who get sick are sick for a while:

Based on 228 cases with known outcomes, we estimate that the median time to recovery is 32 days (95% CI 31,33) in 50-59 year olds, and is estimated to be significantly shorter in younger adults (e.g., 27 days in 20-29 year olds), and significantly longer in older groups (e.g., 36 days in those aged 70 or older). In multiple regression models including sex, age, baseline severity and method of detection, in addition to age, baseline severity was associated with time to recovery. Compared to those with mild symptoms, those with moderate symptoms wereassociated with a 19% (95% CI, 17%,22%) increase in time to recovery, and severe symptomswere associated with a 58% (95% CI, 55%, 61%) increase. Thus far, only three have died.These occurred 35-44 days from symptom onset and 27-33 days from confirmation.

The median incubation period was 4.8 days and in this sample, there were more female cases than male.

An important new preprint finds that children are just as likely as adults to be infected. This is a key piece of data that may support school closures as an effective intervention. https://t.co/w5E0N0InTU — Caitlin Rivers, PhD (@cmyeaton) March 5, 2020

Needless to say, this work supports the logic of school closures in Italy and ones underway in the US. An update from CivilEats:

The rapidly growing spread of COVID-19, the disease caused by the novel coronavirus, has forced the closure of schools in 22 countries on three different continents, according to UNESCO. In the U.S., as of Thursday, just a small number of schools are closed in Washington, California, and New York—so far—but 13 countries have taken the drastic step of closing all their schools nationwide. As a result, nearly 300 million school children are at home right now, with some able to keep up with their studies remotely while others are surely losing educational ground…. Earlier this week, when Los Angeles declared a state of emergency due to COVID-19, parents in the nation’s second-largest school district were told to plan for school closures. In Washington state, where 11 people have so far died from the illness, a number of schools were closed temporarily for deep cleaning, while others will remain closed for the next two weeks. And in New York’s Westchester County, four schools recently closed after a local man there tested positive for the virus.

As much as this is a prudent public health measure, it’s also a nightmare for families and communities. How are working parents supposed to take care of children who are too young to be left home alone? Most families have working wives. Generally speaking, only the relatively affluent have the slack in their schedule or the disposable dollars to adjust without too much pain to minding their housebound kids.

The BBC reports that Italian parents, faced with nation-wide school closures, are “stressed.” Even parents who don’t have scheduling frictions are finding it hard to cope, in part because they feel they can’t ask elderly parents and relatives to help:

At the San Cosimato playground in Rome, parents have that unmistakeable look of “how on Earth am I going to entertain them?” The perennial problem has struck early this year: with schools and universities now closed across Italy until at least 15 March, in an effort to contain the spread of coronavirus, some 8.4 million children are out of class well before the Easter break. It’s an unprecedented response by Europe’s worst-hit country. Malvina Diletti watches her eight-year-old, Edoardo, play on the climbing frame. “We think 10 days off is totally useless, it’s not even enough to discover if you’re sick,” she says…. They are heading home for lunch with six other children, as parents are taking it in turn to host, sharing the babysitting load during this difficult period. “It’s so we avoid grandparents having to stay with us,” Malvina tells me, “because if more elderly got sick, hospitals would just crash.”

Some schools say web-based teaching is filling the gap, but I’m not sure how well this would work with elementary-school aged children. Again from the BBC:

In the northern town of Busto Arsizio, part of the region worst hit by the virus, the Tosi High School is using web-learning to stream classes. “Our lessons continue uninterrupted,” says Amanda Ferrario, the headteacher. “The teacher enters a virtual classroom, does the roll call and can see students connected on their devices. They can work in groups, make presentations and show videos.”… Some schools are recording entire lessons on WhatsApp, while others are incorporating the news into their lessons, one teacher telling an Italian newspaper that she’d asked pupils to come up with stories about “the monster of coronavirus”.

The New York Times gave a broader view:

The speed and scale of the educational tumult — which now affects 290.5 million students worldwide, the United Nations says — has little parallel in modern history, educators and economists contend. Schools provide structure and support for families, communities and entire economies. The effect of closing them for days, weeks and sometimes even months could have untold repercussions for children and societies at large. “They’re always saying, ‘When can we go out to play? When can we go to school?’” said Gao Mengxian, a security guard in Hong Kong whose two daughters have been stuck at home because school has been suspended since January. In some countries, older students have missed crucial study sessions for college admissions exams, while younger ones have risked falling behind in reading and math. Parents have lost wages, tried to work at home or scrambled to find child care. Some have moved children to new schools in areas unaffected by the coronavirus, and lost milestones like graduation ceremonies or last days of school…. Governments are trying to help. Japan is offering subsidies to help companies offset the cost of parents’ taking time off. France has promised 14 days of paid sick leave to parents of children who must self-isolate, if they have no choice but to watch their children. But the burdens are widespread, touching corners of society seemingly unconnected to education. In Japan, schools have canceled bulk food deliveries for lunches they will no longer serve, hurting farmers and suppliers. In Hong Kong, an army of domestic helpers has been left unemployed after wealthy families enrolled their children in schools overseas.

In our stingy US, what happens to the pay of teachers and school administrators and workers, like bus drivers and janitors, who are temporarily furloughed? If they get full or reduced pay, what happens to school budgets when terms are extended to make up for lost days? Parents at home with children might engage in a level of homeschooling, or give their children special projects, but in most cases, that won’t make up for class time.

One consequence in the US will be hunger. Again from CivilEats:

But missing school can mean more than lost instructional time; it can also deprive children of critically needed nutrition. In this country, more than two-thirds of the 31 million students who regularly eat school lunch are economically dependent upon the meal, and low-income kids similarly constitute the majority of the 14.6 million who eat school breakfast and the 1.3 million who receive an after-school supper. So what will happen to at-risk children if this school-based social safety net falls prey to the growing pandemic?

Yet in communities where the school closures haven’t started, I’m picking up signs of freakout. A friend in Westchester County who used to attend one of the afflicted synagogues was doing a frantic mental scan of recent contacts (the Torah Academy is orthodox and hence does not overlap with her social circles). Her concern is that one of her close family members is pregnant, and pregnancy increases the odds of contracting lung infections like pneumonia.

So social stresses look set to become more acute, and the US, with its hollowed out communities and threadbare safety nets, does not look positioned to cope well.