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Our Turn: Don’t let irrational fears derail our children’s futures

Published: 5/20/2020 6:05:10 AM

It is encouraging that Gov. Chris Sununu has convened the School Transition Reopening and Redesign Taskforce to begin to plan to carefully reopen schools in New Hampshire to avoid the permanent educational damage and subsequent lifetime earnings losses inherent in prolonged closures.

As Dr. Dimitri Christakis, editor of the medical journal JAMA Pediatrics, writes, “Some estimate that there will be a 9-month to 12-month loss when children return to school in the fall, and this will only be compounded if distance learning continues.”

At the same time, the description of Pediatric Multisystem Inflammatory Syndrome (PMIS, or Multisystem Inflammatory Syndrome in Children, MIS-C, per the Centers for Disease Control) in the UK, Italy, New York City, and other places hard hit by COVID-19 has caused some to want to pause. Almost certainly associated with SARS-CoV-2 virus infection, PMIS may eventually help us better understand two similar, and similarly mysterious, pediatric syndromes, Kawasaki’s and toxic shock, if not the coronavirus itself. But citing PMIS as a reason to dismiss those planning efforts as “cavalier,” as Dr. Anthony Fauci did in his Senate testimony on May 12, recklessly overstates its risks.

As of May 13, approximately 100 presumed cases of PMIS in the United States had been reported in the lay press, with only three deaths. Current estimates of the number of children and adolescents infected with SARS-CoV-2 are not published, but in many series they have made up 2.5% of the positive cases. Applying that rate to the 1.4 million cases in the U.S. confirmed by Johns Hopkins would yield approximately 35,000 pediatric cases, meaning 0.3% of them might have developed PMIS. While the number of PMIS cases is sure to rise, so too will the estimates of the number of children infected by SARS-CoV-2. It is likely that this will remain an extraordinarily rare complication of an already extremely rare disease.

It is unfashionable to compare COVID-19 to the flu, but extrapolating initial pediatric estimates from the CDC over the entire year, COVID-19 would be expected to hospitalize a small fraction of those under age 18 hospitalized for influenza in an average year. Contrast that with adults, where rates of hospitalization and death from COVID-19 will rival if not far outstrip the flu. And while each death may be a tragedy individually, even with PMIS the death rate from COVID-19 in children is essentially 0%. We can confidently continue to reassure parents and schools that COVID-19 largely spares children of its direct harms.

Writing in the same online alert from JAMA Pediatrics as Dr. Christakis, two Italian pediatricians note that evidence suggests school closures may not contribute significantly to the slowing of SARS-CoV-2 spread, but “the potential negative consequences of this measure cannot be ignored.” In the U.S. and in New Hampshire, advocates and hospitals are starting to see more frequent and severe child abuse injuries, calls to poison control centers about childhood ingestions are up nearly 10%, childhood immunization rates have plummeted, and according to the Brookings Institute “young children are experiencing food insecurity to an extent unprecedented in modern times.”

Children are precious because of their seemingly boundless potential, not because they are fragile. Schools – and high-quality child care – promote their resiliency. We must not let our irrational fears derail their futures by keeping them hunkered down at home indefinitely.

(Drs. Steve H. Chapman Keith J. Loud serve on the executive committee of the New Hampshire Chapter of the American Academy of Pediatrics.)

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