Published on Mar 26, 2020

  • Published on Mar 26, 2020
  • COVID-19 deaths in children have been rare, but one has recently been reported.
  • About 6% of children can get a very serious illness from the coronavirus.
  • Children and teenagers will exacerbate the spread the virus if they gather on playgrounds, beaches, and ball courts and do not follow proper social distancing guidelines.
  • Some teenagers believe COVID-19 is a conspiracy or hoax, while others understand the need to flatten the curve.

Video Transcript

JOHN WHYTE: Hello. I'm Dr. John Whyte, Chief Medical Officer at WebMD, and welcome to Coronavirus in Context. Today, we're going to talk about coronavirus in young people, and my guest is Dr. Alok Patel. He's an editorial board member at Medscape Pediatrics, and he's a practicing pediatrician in San Francisco and New York City. Dr. Patel, thanks for joining me.

ALOK PATEL: Thank you.

JOHN WHYTE: Now, we heard this week about a death in someone under the age of 18 occurring in Los Angeles. We typically haven't heard about people dying that are young. Why do you think this might be the case? Is something different going on here in the United States than, perhaps, in China and Italy?

ALOK PATEL: Well, first and foremost, my heart definitely goes out to the family of the child who died in Los Angeles. We don't know a lot about that child's age or if he or she had another medical condition. What we're seeing in the United States kind of reflects what we thought. Children are still at a lower rate of getting a critical illness or hospitalized, but here's the thing. That doesn't mean that they are not going to get infected and still be contagious.

You know, a lot of people last week were talking about that data that came out of China which showed that about 6% of children can still get a really, really critical illness from this. And 6% is a huge number, if we start getting thousands and thousands of children infected. So just because kids seem to be at less risk, that doesn't mean we should be any less vigilant in protecting them.

JOHN WHYTE: Has there been a false sense of security up till now that, you know, kids are going to get infected, and if do, it's a mild case?

ALOK PATEL: I think we can still be optimistic about the fact that children seem to be better protected against this. When I say -- when I think about the false sense of, security the only thing I want to caution people with is that children, we think, can still get infected at the same rate. So even though they may not get the same level of a critical illness as the elderly or somebody with a chronic medical condition, they can still be infected. They could still spread this disease everywhere, if they aren't given the right type of social distancing and personal hygiene.

JOHN WHYTE: But there's been talk that there might be some natural immunity that-- that kids develop to coronavirus. What's the evidence there?

ALOK PATEL: I think it's a fascinating discussion scientists and infectious disease experts are having, and what the thought is is that it's possible children have young, robust immune systems. Or their immune systems might be different and/or the virus can't attach the same receptors in the same way in children as they can't in older people. Another fascinating point is this coronavirus right now, SARS CoV-2, is one of seven that infect people, four of which are circulating in the United States every year.

So is it possible that children have seen more recent viral infections? Maybe their immune systems are more adept at fighting this off. We don't really know, but we postulate it has something to do with those young immune systems.

JOHN WHYTE: And what do parents have to watch for in their kids? Are the symptoms different? Do you have a device for parents?

ALOK PATEL: Parents have multiple devices here. So the first thing, if we're purely talking about medical management, I think it's extremely important that parents, first and foremost, know their children's risk factors. So extremely young children, especially newborns and babies, are at an increased risk. They have different immune systems. On top of that, any child who has another illness, whether it be heart disease, asthma, or diabetes, is also a particular risk. Children with cancer or children taking immunosuppressive medications should also be closely watched.

JOHN WHYTE: It's just the same for adults. Is that true?

ALOK PATEL: It's the exact same. You know, and parents should understand that children are going to really model their behavior. So in terms of protecting your kids, you want to make sure that you are also following all the same social distancing guidelines -- hand hygiene, cleaning up your area at home and everything, and getting your kids involved in the exact same thing. Children like control. They like understanding. They like to feel empowered about what's happening.

JOHN WHYTE: Are kids actually making the situation worse in terms of spreading the disease? There's been some discussion about that. You mentioned, they often can have mild cases, yet they could be infecting elderly grandparents. Or they could be infecting teachers, and that's why we've been talking about closing the schools. What role does youth play in terms exacerbating coronavirus, or could they actually be helping to stop the spread?

ALOK PATEL: I think it really depends on the age we're talking about. Now, if we have older children, if we have teenagers, and even a little older that that, you're talking young adults and millennials. And they're out on crowded beaches or basketball courts or wanting to go on spring break, then yes, they could be potentially exacerbating the spread. Because we have enough evidence now to show us that asymptomatic spread is a huge player here, if not the majority of -- if not the majority contributor to the spread. And so older children really need to understand that them staying at home, them social distancing, is going to be clutch right now in curbing all the spread.

As far as young kids go, a lot of that's going to be modeled after parents behavior. And young children are the ones who are going to want to know, like, why can't I go to the playground? Why am I not going to school? Why do I have to FaceTime my friends on their birthday? And that, again, is behavior that's really going to be modeled after the parents. For older kids, for older teens and millennials, parents, public health officials, anyone who is a role model just really needs to make sure they understand why right now is just a different time, and they need to stay away and stay home.

JOHN WHYTE: Now, it can be harder for very young children to understand, as you point out, what social distancing is all about. Can they have playdates?

ALOK PATEL: Playdates are tricky, and so right now, if we were just to make it a steadfast rule, I would say we need to do our absolute best in limiting playdates. That's a lot easier said than done, and we -- I like to encourage people to remember what it was like to be a young child. Because understanding the world when you're 10 is very different than when you were five, and you may believe in Santa Claus. You know, young children have magical thinking, and sometimes, it's irrational.

So when it comes to things like playdates or going to the mall or something, we just need to make sure we're giving children reassurance, and that they understand the situation. And they understand, no, you're not going to die. You're going to be just fine. We're prepared for this.

Grandma and grandpa are going to be OK, but here's why people are getting sick right now, and here's the reality. A lot of people are getting sick right now, and we're going to make sure they're all protected. And I think when you give children these clear rules, and you make sure they understand, and they felt listened to, they'll understand.

JOHN WHYTE: Do teenagers understand the seriousness of the condition? Many of them are having challenges of being socially distant and don't quite understand why can't they play that pickup basketball game with their friends that they've known, you know, all their lives?

ALOK PATEL: I hear you. I talked to a lot of my colleagues, even some of my patients who are teenagers. And what I find is a lot of it depends on where they're getting their information from which is why it's so important for parents to kind of monitor their children's media consumption. You know, try to limit how much news they're watching, or pay attention to what questions they have, either it's from the internet or talking to their friends.

You know, teens have kind of a different gauge of the world depending on who they're around and where they're getting your information from. I've heard from teenagers who think this entire thing is a hoax. I've heard from teenagers who think this is a conspiracy theory. And then on the other hand, I've heard from teenagers who 100% understand why we need to flatten the curve.

And so I think it's up to just taking a step back and talking to our teenagers and saying, what questions do you have? What beliefs do you have? Let's talk about it. And once teenagers understand their role, I do have belief in them. I think they'll step it up. JOHN WHYTE: What do you tell them?

ALOK PATEL: To be honest, I tell them the truth, and I'm very straightforward with teenagers. Teenagers do not like to feel belittled. I think they want to understand what's happening right now. And so with teenagers, I try to really empower them and make sure they understand that, even if they're young, healthy, and feel great, they still play a huge role here.

You know, some teenagers, even millennials, even young adults, have this belief that if they're young and their immune systems are healthy and they have no chronic illness, they should be able to go out. They should be able to live their life, which is what I've heard. And we just need to make sure they understand that, even if they feel great, they could still be coronavirus positive.

One important point I want to make, teenagers also look up to role models. And you know, two weeks ago, I tried to explain this point to a couple of teenagers. I had a hard time getting through to them.

So I brought up the NBA. I brought up NBA player Donovan Mitchell, 23 years old. He said, the scariest thing about this coronavirus was that he was coronavirus positive and had no symptoms. And if he wasn't tested positive, he would have been walking around and possibly infecting people. I think sometimes, when you make that analogy, when you give teenagers something that they can kind of relate to, it clicks.

JOHN WHYTE: Let's talk a little bit about testing. For testing in a younger population, that may not be, you know, quite 18, there's really been a discouraging. There's really been a lack of encouragement of testing, partly due to lack of protective devices and supplies. And I've been hearing from parents that it's hard to get a test for your child, if you think they might have coronavirus. What have you been seeing in terms of testing of kids?

ALOK PATEL: It's hard for almost anyone who is not at a particular risk to get testing right now, and I'm really hoping that changes soon. So what I've been personally saying is, if parents have a child who is otherwise healthy and just has mild cold symptoms, it really depends on their child's particular -- it really depends on their child and if their child has any risk factors. And it's usually a conversation with a pediatrician or a doctor's office, emergency department, et cetera.

Now, in other cases, hospitalized children, you know, some of the children I take care of who have cancer, who have heart disease, are going to be at particular risk, and we can get them our tests. We have in-house coronavirus testing in some hospitals in this country. So it just really depends on the risk stratification.

And I'm going to be honest. That's not just for children. I feel like that's for millions of Americans right now. And I'm hoping that changes, because it would be really important for us to know where exactly these outbreaks are across the country, and what pockets could be potentially spreading this disease right now?

JOHN WHYTE: What else do parents need to know about coronavirus in kids?

ALOK PATEL: I think we've got to take a step back and really look at kind of the social impact right now. We make these general statements, such as call your doctor or homeschool your children, when the reality is we have 30 million uninsured Americans, and calling a doctor is not always possible. We also have parents who are hourly wage workers. We have 30 million children who get their meals from the National School Lunch Program. And so I think it's really important for parents to know, number one, that we're all in this together, and number two, to reach out for help if they need it.

You know, I'm inspired right now, because all over the country, I'm hearing stories of different ways communities are stepping it up right now to support kids. I'm hearing stories about schools who are still offering breakfast and lunch if children can get a way there. You know, and a lot of teachers right now are offering different types of online education.

A lot of children don't have Wi-Fi, and there are public hotspots, Wi-Fi hotspots which are being set up to make sure children still get education. There's book drives happening. You know, parents can check in with their schools, social services, with their neighbors, and just figure out how the community is doing it. You know, right now is a critical time. School's even a huge intervention point for social services, and so I do think that we should be looking at every parent, every socioeconomic group to get through this together.

JOHN WHYTE: Well, Dr. Patel, I want to thank you for taking the time to talk to us today and thank our viewers for watching Coronavirus in Context. I'm Dr. John Whyte.