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Interview: When It Comes To Coronavirus, What About The Children?


Children infected with the coronavirus are much more likely to have "better outcomes" than elderly patients, says infectious diseases specialist Barun Mathema.

As the number of coronavirus infections rise across the globe, children seem to be showing more resilience than others.

While children can be infected with the coronavirus, relatively few cases have been reported among children in general, and fatalities among those under nine years of age are virtually nonexistent.

Valona Tela, a correspondent with the Kosovo Desk of RFE/RL's Balkan Service, spoke with Dr. Barun Mathema, an infectious disease researcher at Columbia University in New York, to get his thoughts on why children are avoiding the worst amid a growing pandemic.

RFE/RL: Doctor Mathema, what do we know so far about the coronavirus and children?

Barun Mathema: From what we've seen, certainly initially out of China, the bulk of the infections that have led to more severe disease have been among the elderly. And roughly about 6 percent or so of infections that have led to more serious disease have been in children.

So, for the most part, children do not seem to have a terrible disease or, you know, more severe disease. Although the picture has been changing as this epidemic has been growing. We've been learning, in fact, about a fair number of…younger individuals getting coronavirus infection, certainly from the United States and as well as from Europe.

So, our information is changing and changing very fast, but I would say that clearly the risk mostly lies among the elderly. When I say risk, I mean risk of a sort of bad disease or bad outcome. But children can certainly be infected and also have certainly milder disease.

RFE/RL: Why does the virus seem to be sparing children somehow?

Mathema: I should stress that some children, for sure, can get disease and symptoms. They tend not to be very serious, but some can be so. There could be mild pneumonias for example, which are not trivial. So, the theories: There are multiple, sort of competing, theories on why children don't seem to be getting disease. The virus currently called SARS-CoV-2 virus needs a particular receptor, called the ACE2 receptor, that's really found within the lungs. And that's what the virus uses to…get in, if you will.

Dr. Barun Mathema
Dr. Barun Mathema

And one [line of] thinking is that in children that particular receptor is not well-developed. So the virus does not efficiently enter into the system deep in the lungs, therefore likely not giving rise to serious disease.

That's one theory. Another theory is that children generally have healthy lungs, right? And so that's a very big factor. And certainly we know from some of the early data in China that…people who have histories of smoking or other lung disease tended to have bad outcomes​

RFE/RL: Are there any groups of children that may have greater risk of complications?

Mathema: I think children who have other immunosuppressive chronic conditions certainly may be at risk. We haven't seen such strong evidence. The numbers are big globally, of all individuals -- but we don't have such granular data to know what groups of children may be at higher risk. One can probably imagine that children with lung diseases, diseases prone to pneumonias, maybe asthma may have more serious or severe outcomes.

RFE/RL: Despite the fact that the mortality rate is highest among, as you said, older people, most countries report a high rate of infections among the younger population, children included. How can this disparity be explained?

Mathema: I think this really has to do with, you know, older individuals in general have a lot of other conditions -- competing conditions, including lung conditions, hypertension, diabetes, you know, various conditions that sort of complicate the recovery.

And younger individuals -- and certainly children as well -- are likely to have better outcomes. Again, they may still have disease and may still be quite sick, as we know from a number of individuals. You know, 30-year-olds, 20-year olds will get very, very, very sick [with] some requiring ventilators. But they tend to have better outcomes in comparison [to the elderly].

I think there are some conflicting reports, early reports suggesting that maybe very young children -- very, very young children -- may be at risk should they develop symptoms versus children who may be a little older. Again, this is a very fast-moving field and the information seems to be changing quite often.

RFE/RL: When should a child get tested?

Mathema: Again, it depends on where you live, but I believe the idea is [that the] child should be tested if they have symptoms. And…if somebody in your household has been diagnosed with the coronavirus, then you may be at heightened alert to make sure that the child does not have or does not exhibit any symptoms. But, again, [it depends] on where you are in the world and what the testing policies are.

An employee wearing protective gear sprays disinfectant at a children's playground as a protective measure against the coronavirus in the western Ukrainian city of Lviv.
An employee wearing protective gear sprays disinfectant at a children's playground as a protective measure against the coronavirus in the western Ukrainian city of Lviv.

RFE/RL: Should parents do something special to protect their children?

Mathema: I think we should do what we should do for ourselves in terms of our families. Their social distancing is very important. Needless to say, a lot of hand washing, you know, it's not the most sophisticated way of dealing with things but it is in fact, very, very effective.

Social distancing is very important and…keeping sort of sanitary conditions, if you will. Mostly hands. Children put their hands, you know, everywhere, and then it goes in their mouth often, right? Certainly. I know, I have two small children. So, this is what I look out for.

RFE/RL: Data shows that pregnant woman may also be infected with the coronavirus. Would the infection also affect the fetus?

Mathema: This is, needless to say, a really big concern. The initial data suggested that there was no evidence of the coronavirus in the amniotic fluids of pregnant women, suggesting that perhaps there could not be transmission to the fetus. Although there was another smaller study that came out of China that suggested that there could be transmission. But it was a very small sample size.

And, you know, it's plausible -- both scenarios are plausible. But I think what this tells us is this is something we really need to look into. Because...pregnancy is a very -- for the mother as well as the unborn child -- sort of a vulnerable period. So, this is something that we absolutely need to look into. But the data is not completely clear.

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RFE/RL: How would you compare the numbers with the traditional flu, for example?

Mathema: This is new. And so, when we when we see something new come about, the outcomes and the additional burden on a system can be very devastating.

So, if you compare this, for example, to seasonal flu, at least in the United States, this potentially has the possibility of being severalfold higher in terms of the number of -- when I say bad outcomes, I would say…death but certainly also the stress to the system. Not only the economic system, but really the health-care system can be devastating to people who don't have the coronavirus but have other reasons to be in the hospital.

RFE/RL: Anything you would add?

Mathema: I think the last thing I would add is [that] I think people should stay strong, and most importantly, try to think of the community. We're all in this together. So, our individual actions really matter to those around us. And we may not know how it impacts them. But you know, [for] our neighbors and people in our neighborhood who may be more vulnerable to disease and bad outcomes, we really need to protect ourselves. Not only for ourselves, but really for the community. So this is perhaps a chance for humanity to take a sort of a second look at each other.

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