Why Are Children Less Affected By COVID-19?

“I’m wheezing.”

The words from my ten-year-old daughter, who’s had an underlying respiratory issue since she had the flu two winters ago, made my heart start racing. Not because she needed a nebulizer treatment—she’s needed a nebulizer a few dozen times this winter—but because she’s never needed a nebulizer treatment during a pandemic, while a virus that attacks the respiratory system is circulating.

Her wheezing and subsequent headache and dizziness qualified her for a COVID-19 test, which we got in a drive-through testing site from a woman dressed in a hazmat suit in a scene that might have been plucked from every dystopian movie ever. We were lucky. In a nation that continues to struggle to meet the demand for tests, I know we are lucky to have received a test at all.

The literature I received after the test stated I’d receive results in about four days. For four days, I watched my daughter’s breathing. I worried. I researched, and I comforted myself with the only consistent statement coming from officials regarding the novel coronavirus: children are safe.

Months and weeks into our collective fight against COVID-19, questions continue to swirl about the novel coronavirus. We don’t yet have concrete answers with respect to immunity or re-infection, or even why some people with no risk factors are struck with the severest of symptoms.

What we do know is that children are less affected. Studies show that children represent about 2% of confirmed COVID-19 cases.

Studies show children are largely safe from the worst of this disease, and often present with milder symptoms.

Studies show that the majority of children, even newborns, survive.

It’s a truth we’ve seen globally and experienced nationally, and probably the only reason I (and millions of parents around the world) still have any semblance of functioning. Because my children aren’t the primary targets of this disease, it’s incrementally easier to breathe every morning.

To be clear, I’m definitely not saying that precaution should be thrown to the wind when it comes to children. Some children do get more severe symptoms, and not all of them survive. Plus, children can unknowingly spread the virus to someone—or a lot of someones—who are at risk.

And knowing that most children survive provides minimal comfort on nights when you’re listening to your daughter breathe, terrified she might be in the unlucky minority that needs more intense medical intervention.

Understanding why children are less affected is important. Not just to help parents sleep better at night, but because understanding why children are less affected by COVID-19 might help scientists and researchers and doctors as they find ways to treat, and hopefully, eradicate, the disease.

Scary Mommy spoke with Priya Soni, MD, a Cedars-Sinai Pediatric Infectious Disease specialist, about the reasons why children might be less affected by COVID-19. Dr. Soni suggested that ultimately, the underlying reason will likely be multifactorial.

One popular theory surrounding the mystery behind why children are less affected by COVID-19 has to do with the fact that children have young immune systems and those young immune systems don’t respond with the same aggressive alarm system seen in some adults. One of the dangers of COVID-19 is not the virus itself, but the cytokine storm—the aggressive immune response that damages lungs and other organ systems—that the body creates to fight the virus. Children are less likely to develop a cytokine storm.

Dr. Soni put forth another theory to explain children’s apparent resistance to the worst parts of this virus. She suggests that perhaps children are presenting with milder symptoms because they are receiving vaccines more often, and thus priming their immune system more than adults—most children received their first live vaccine at around age one, and continue receiving vaccines for the next decade or so.

“Something about vaccines could play a role in causing a child’s immune system to activate in a different way and ramp up different types of white blood cells, part of our innate immunity, that would allow them not to get sick,” she suggests. The phenomenon, known as “trained immunity,” provides some level of protection against viruses and bacteria.

In history, for example, when vaccination against smallpox was introduced around 200 years ago, some of the collateral benefits were that this vaccine then provided protection against other infectious diseases like measles, scarlet fever and whooping cough, Soni explained.

Researchers are studying live vaccines like Bacillus Calmette–Guérin (BCG), which is frequently given in high-risk areas where tuberculosis is more common than in the United States, to determine whether it can be given to “prime the immune system in a particular way that provides some resistance.”

But the answer could also be something simply environmental. Older lungs are exposed to more pollution, more environmental stressors, that cause them to weaken. In that respect, children are more likely to be a clean slate—and less likely to present with the underlying conditions many of the severely affected adults are afflicted with.

For parents of immune-compromised children, that’s likely not encouraging. Dr. Soni notes that we don’t yet have enough cases to know how COVID-19 affects children with a compromised immune system. But, she stressed the “silver lining of this situation is that so many pediatricians have come together in collaborating and creating registries and sharing clinical data about what they’re seeing and doing with pediatric cases.” That large-scale collaboration will be vital in attacking the virus.

What Do Symptoms of COVID-19 Look Like in Children?

In the four days I waited for my daughter’s test results, I researched symptoms of COVID-19 in children. The answer I was met with most often was: children present with mild symptoms. But what does that actually mean? What counts as a mild symptom with respect to a potentially deadly virus?

“Cases that have been noted with pediatric COVID-19 do fall in line with adult symptoms, such as cough, fever, and shortness of breath, but kids may also have a runny nose and upper respiratory symptoms, which makes COVID-19 differentiate from other childhood viruses,” says Dr. Soni. She also notes that children can be asymptomatic or can present with vomiting and diarrhea. But in many of the cases where children are presenting with diarrhea, doctors are also finding respiratory symptoms—either a mild runny nose or pneumonia, found via x-ray.

Testing in Children and What Lies Ahead

Testing for children is the same as it is in adults. A woman dressed in a hazmat suit stuck a long nasal swab into my ten year old’s nose as my daughter squeezed my hand and did her best not to squirm. The entire procedure was quick—less than a minute to be swabbed—but not painless.

The question when it comes to children’s tests is not whether the test will recognize a child’s infection, but about the quality of the sample. Whoever is swabbing the child has to really know what they’re doing, particularly with a child, who is more likely to squirm and protest a nasal swab swirling around their nose for 10-15 seconds.

Four days after my daughter’s test, I received her results. Negative. Whatever was causing her wheeze was not COVID-19.

I doubt I’ll stop studying her breaths while the pandemic rages and questions remain unanswered. I’m sure I’ll continue to go on high alert at the sound of every sniffle. But I know knowledge is power—in all situations, but especially against a virus we’ve never seen before—and every day that base of knowledge is growing, and that makes it a little easier to breathe.

Information about COVID-19 is rapidly changing, and Scary Mommy is committed to providing the most recent data in our coverage. With news being updated so frequently, some of the information in this story may have changed after publication. For this reason, we are encouraging readers to use online resources from local public health departments, the Centers for Disease Control, and the World Health Organization to remain as informed as possible.