Some studies raise concerns that children may transmit COVID-19 through two mechanisms: increased contacts/opportunities for transmission; and high viral loads even when asymptomatic. In Cleveland, Ohio, as the state lifted protective measures, more children tested positive for COVID-19 and hospital admissions for children also increased – raising doubt about the myth that children do not get ill from the virus.

Although other countries’ initial school reopenings show extremely low rates of child-parent transmission, North Carolina and Texas identified several clusters at daycare centers.

In these communities, people are more likely to have “essential” jobs, insufficient health care, higher levels of pre-existing health conditions, and live in crowded housing. Because of the forces of structural racism, Blacks, Latinx, and Pacific Islanders in Los Angeles County are dying of COVID-19 at twice the rate of white residents.

As recently as May, the CDC added three new symptoms of coronavirus, adding congestion/runny nose, nausea/vomiting, and diarrhea to the list. In late June, the CDC expanded its list of people at high risk of severe illness In early July, 239 scientists in 32 countries wrote an open letter to the World Health Organization outlining evidence that airborne transmission may be a significant factor in
the pandemic’s spread. On July 8, WHO confirmed that there is “emerging evidence” of airborne transmission. If true, recommended infection control guidance would change dramatically.

And lost amidst the relief at the low mortality rate in children is the distinction between morbidity and mortality. Many young people still experience severe illness, and the rare multisystem inflammatory syndrome in children (MIS-C) is still not well understood. A European study found that 13% of children required respiratory support, and that patients younger than one month may be more likely to require intensive care. COVID-19 is now suspected to cause lung, heart, kidney, brain, and clotting complications – and these are just the known immediate effects. The longer-term effects are almost completely unknown. As we discuss best practices, practices may shift or expand as the science shifts and expands.

Los Angeles County accounted for 40% of new cases in the last two weeks of June, despite being home to only a quarter of the state’s population. Other countries that have reopened schools, such as New Zealand, Vietnam, and Germany, did so only after they had flattened the curve and in a setting of broader societal preparedness including rapid case identification, contact tracing, and isolation.