Editor's Note: Dr. Stephen Kessler is a physician in Phoenix, Arizona. He and his wife wrote an open letter to Arizona Governor Doug Ducey regarding the reopening of schools that received coverage from CNN, NPR and The Arizona Republic. The opinions expressed in this comment are yours. See more opinion pieces at cnne.com/opinion
(CNN) - Sometime in the spring of 2020, an intriguing idea began to circulate in epidemiological circles. As the first studies on the transmission of COVID-19 by children began to leak, some prominent academics began to defend what can be fairly called the "magic virus hypothesis."
The thinking went something like this: In addition to children generally having a very mild illness with Covid-19, they are also highly unlikely to spread the virus.
This was an astonishing hypothesis because it went against everything we know about the transmission of traditional respiratory viruses, such as influenza and the common cold, which, of course, is often caused by one type of coronavirus. With these traditional viruses, children are recognized as important drivers of transmission.
The radical nature of the hypothesis should have resulted in a pause for serious reflection on the part of responsible scientists and physicians. Instead, it was quickly taken advantage of and expanded upon by highly respected medical journals.
On May 5, the normally serious British Medical Journal (BMJ) published an editorial titled "Children are not covid-19 super-spreaders: time to go back to school." The official journal of the American Academy of Pediatrics (AAP) quickly followed suit with a similar comment, "Covid-19 transmission and children: the child is not to blame." Both advocated for the reopening of schools, with the BMJ editorial going so far as to argue that "governments around the world should allow all children to return to school regardless of comorbidities."
Never mind the paucity of research available at the time, nor the fact that the few existing studies had serious flaws in their methodology. Not to mention the presence of conflicting evidence.
The magic virus evangelists went ahead.
On June 25, the AAP issued a statement strongly advocating the reopening of the schools. They noted that "although children and adolescents play an important role in amplifying influenza outbreaks, to date, this does not appear to be the case for covid-19 ... children may be less likely to become infected and spread the infection" .
Phrases like "does not appear" and "may be less likely" were technically accurate but dangerously arrogant. It is unwise to rely on a handful of small, inconclusive epidemiological studies to reverse the knowledge gained from a century of virology research.
Politicians bent on reopening schools took advantage of these recommendations, culminating in the assertion by Secretary of Education Betsy Devos on July 15 that “more and more studies show that children are actually the ones who stop the disease and not they neither contract it nor transmit it themselves ”. Devos received widespread criticism for her comments, but, in essence, her comments were simply a rearticulation of those of the AAP without the qualifiers.
In mid-July, South Korean researchers published perhaps the largest and best-designed study to date on the transmission of Covid-19 in children. They found that, in fact, children ages 10 to 19 spread COVID-19 just as effectively as adults, and children under the age of 10 contribute less.
This was quickly followed by research that demonstrated significant peer-to-peer spread in the pediatric populations of Israel and Georgia.
What effect did this new research have on the magic virus evangelists? They simply adjusted the demographic age of the virus downward to accommodate the latest findings.
This included the AAP, which, effective August 21, amended its initial statement to read: "Children under the age of 10 may be… less likely to spread infection."
What prompted the initial adoption of the radical idea that children under 18 do not contribute to the spread of COVID-19, as well as its equally radical revision? I don't have the answer, but I guess it's a combination of things.
First, society is legitimately anxious about getting children back to school, possibly causing undue optimism as a result of a handful of early and deeply flawed studies.
But equally to blame is the lack of intellectual rigor when examining the methodologies of existing research on the spread of covid-19 by children. Any doctor or scientist can tell you that the strength of the conclusions that can be drawn from an investigation is firmly based on the methodology of the study. And the existing research has many flaws.
Put another way: Why might studies find less transmission of covid-19 by children if the transmission rate was in fact the same as that of adults? In general, the reason lies in the fact that children with COVID-19 often have very mild symptoms, if any at all. As a result, they are much less likely to be tested during the acute phase of the virus, when they are most likely to test positive. And if they transmitted the virus to their parents or other adults in the home, their nasal passages may be free of viral RNA at the time of testing, in which case the virus is presumed to originate from an adult host.
Combine this with the fact that pediatric testing is incredibly difficult to come by in many communities, and it's easy to see why getting an accurate accounting of the amount of COVID-19 infection in children, as well as its spread, is challenging.
Of course, it may turn out that covid-19 is indeed a magical virus, in which transmission by children is extremely rare. If that happens, no one would be more delighted than me. But currently, there is no one alive who can state that with certainty. Not experts from the Centers for Disease Control and Prevention or the World Health Organization. Not even Dr. Anthony Fauci himself.
And that's exactly the point.
If you are going to argue that a new respiratory virus is transmitted in a radically new way, the barrier to making that claim should be formidable.
Young children have been shown to harbor similar or higher COVID-19 viral loads in their upper airways than those found in older children and adults. Given this, in addition to our acquired knowledge about the transmission of other respiratory viruses, the default assumption should be that children are as infectious as adults. The responsibility of the researcher is to prove that the hypothesis is incorrect, not the other way around.
Arguing otherwise is potentially dangerous. Especially when those arguments are being used by legislators to guide the reopening of schools and other activities for children.
Having said that, I hope that the magic virus hypothesis finds a foothold.
covid-19