The Coronavirus, Children, and Pregnancy
It’s STILL hard to believe the world we’re living in right now. Life “before” feels like an eternity ago.
And it seems like every month or season we have to wrap our heads around yet another new situation… I know I for one continue, even after all this time, to vacillate back-and-forth between thinking “it’s all going to be OK!” and feeling like I’m going to burst into tears. (Maybe we all need a little pep talk….)
At this point we all probably know the basics WTR COVID-19. But just in case: SARS-CoV-2 is the particular coronavirus circling the globe right now, and COVID-19 is technically the label for the illness this virus causes in people.
COVID spreads through respiratory droplets (in the air), and manifests differently in different people, leaving no trace of its presence in some people (asymptomatic cases), causing a cold/flu-like illness in others, triggering weird symptoms in still others, and causing severe illness, requiring hospitalization and even leading to death, in a small minority.
Data shows that a vast majority of people who contract COVID have mild symptoms.
A disclaimer: This situation is constantly evolving and is widely varied based on geography, evidenced by the stark discrepancies across the US and over the past several months. There is no playbook for this pandemic, friends — it’s uncharted territory for all of us… and there’s no way to predict how things are going to continue to pan out or what COVID-19 will mean for any given family.
Although it’s true that scientists and researchers are still working to get a handle on the exact clinical picture for COVID-19, we know a lot more than we did in March. Increasingly, experts have been explaining that many people may be entirely asymptomatic (perhaps upwards of 40%), which may partly help explain how the virus can spread so widely and rapidly (and quietly) — people can transmit the virus without even knowing they are infected.
^^This is a huge reason reason why wearing a face mask — especially in indoor and/or more crowded settings — is so important.
With inadequate testing (it’s getting better, though) and geographically-diverse testing protocols, for a long time we had no handle whatsoever on the overall death rate among individuals who had COVID. As of September, the CDC started stratifying its “best guess” estimates by age:
- 0-19 years: 0.00003
- 20-49 years: 0.0002
- 50-69 years: 0.005
- 70+ years: 0.054
Regardless of these exact death ratios, though, it’s clear that the virus can be deadly (especially among elderly patients and individuals with underlying health conditions (called “co-morbidities”)); nearly 240,000 Americans have died from it.
How Does the Coronavirus Affect Children?
The growing body of evidence from the US and all around the world is confirming what early studies reported: that children do not seem to be as impacted by the virus as adults — but they are not immune.
More specifically, research has continued to reinforce the early conclusions that a vast majority of pediatric cases are asymptomatic, mild, or moderate, and data indicates that most pediatric COVID patients suffer mild symptoms and have an “excellent prognosis.” Children also have lower hospitalization rates compared to older age groups.
Current research does, however, suggest that babies (under 1 year) may be more likely to suffer “severe” or “critical” symptoms compared to older children.
Note: Although it is tragic that there have been any, the numbers of pediatric deaths involving COVID-19 are small.
Numbers show that the coronavirus is increasingly deadly with age. In China, the average age of death from the coronavirus was in the seventies (especially individuals with other health problems or smokers); in Italy, the median age of death was eighty, and by far most fatalities are among seniors.
Younger age groups are still susceptible, and younger populations can still develop serious illness that requires hospitalization. Sadly, here in the US, we’ve learned this over the summer and into this fall/winter.
[Note: there has been a major problem in the media, which has often relayed these statistics with the insinuation that it’s “only” old people who are affected. Even if that were true — and it’s not — it would still be a tragic and unacceptable loss of life.]
Experts aren’t 100% clear as to why children seem to be mostly dodging the bullet, but they agree that children either aren’t getting infected at the same rates as adults or else aren’t exhibiting visible symptoms. IOW, children either don’t come down with COVID-19 at the same rate, or they are way more resilient to it if they do. Or both. Either way, they could potentially still be carriers.
This debate continues to unfold, and there are proponents in both camps. We saw pediatric cases rise over the summer and fall (they now make up roughly 10% of total COVID cases, and into the winter those numbers appear to be growing.)
Note: It’s becoming more and more clear that not all “kids” are the same, and researchers are starting to differentiate between babies, kids, and older kids — IOW, the data looks different for a 5-year-old vs. a 15-year-old.
One of the biggest questions continues to be what role kids play in transmission — because if we could figure out the extent to which children are capable of spreading the virus, it could potentially be huge, and drastically influence our reopening projects. (Like what to do about schools.) One prominent opinion (based on a study from South Korea), suggests that children <10 are much less likely to spread the virus but that children 10-19 years-old may be capable of spreading the virus at the same rate as adults. [COVID Explained offers a succinct synopsis of the data on kids and transmission.]
Why are Most Children Protected?
There are a few ideas floating around in regards to why children seem somewhat “protected” from the coronavirus. First, the most susceptible people are individuals who are already suffering from medical conditions, and children are simply more likely to be in better health compared to older adults and elders.
Another thought is simply that children’s immune systems are thriving and may have more antibodies to fight viruses compared to adults. On the flip side, it’s also possible that kids’ immune systems, since they are still revving up, don’t grossly overreact to the coronavirus — an outcome which has been observed in elderly populations.
All of this said, children can still be susceptible and get sick. Kids who have compromised immune systems, congenital heart problems, respiratory conditions or metabolic problems, or who are obese, may be at a higher risk for more severe symptoms from COVID-19, if they contracted it. And as mentioned before, babies and toddlers do appear to be at a higher risk for severe illness compared to older children, possibly because their immune systems are still in “training mode,” leaving them more vulnerable to infections (babies’ immune systems tend to under-react to infections rather than risk over-responding to every foreign stimuli).
Beginning in May, isolated case reports of children exhibiting serious and rare inflammatory symptomology at much higher rates than would be expected — and speculation that it may be COVID-related — have thrown a wrench into the picture. (The condition is referred to as Pediatric Multisymptom Inflammatory Syndrome, or PMIS.)
Although these episodes are alarming, doctors are still reassuring parents to remain calm and continue to enact the same basic safety measures. “It would be a terrible mistake for parents to worry,” Dr. Jeffrey Burns told The Washington Post. “The chance for a child up to this point of becoming critically ill is very, very rare.” If you’re worried about this, I highly recommend reviewing this explanation.
Nonetheless, we can all take heart in the fact that our children are at a generally lower risk for COVID-19 complications.
When swine flu (H1N1) broke out in 2009, it was a terrifying time to be pregnant. Pregnant women were especially vulnerable to this virus and died at a much higher rate.
The good news is that this doesn’t seem to be the case with COVID-19. Even months in, we are still in the learning phase… but the information we do have about how COVID-19 affects pregnant women and babies suggests that pregnant women are not necessarily at special risk.
The very quick summary is this:
- pregnant women do not seem to be at increased risk for infection or for severe illness compared to the general population [see further notes on this below];
- transmission from mothers to babies is quite uncommon (and in-utero transmission is very rare);
- and so far doctors are not documenting negative outcomes among babies to born to COVID-positive mothers.
That said — we need more data. Especially on early pregnancy (first and second trimester).
Accumulating research has, for the most part, corroborated the pictured painted by early data out of China: that pregnant women with COVID-19 pneumonia suffered typical symptoms and went on to have healthy babies. One study of pregnant women in NYC showed that nearly 88% of COVID-positive pregnant women were asymptomatic.
A recent analysis documented that symptomatic pregnant women may have a higher risk for severe illness and outcomes. It’s an important contribution to our knowledge base, but as Emily Oster explains, when you pick apart the data, it doesn’t necessarily move the needle. All-in-all, most data suggests pregnant women are not more likely to suffer severe illness from COVID-19 than the general population.
Furthermore, there is scant reason to believe that maternal-fetal transmission is generally occurring. We say “scant” because research has documented the rare possibility of transmission. Experts also clarify that transmission likely occurs near birth, rather than in utero (and there is currently no evidence suggestive of placental infection). Researchers are adamant that we need more data to better understand the possibility of vertical transmission and especially the effects on gestation.
The takeaway here? So far, evidence on the impact of COVID-19 in pregnancy is all relatively good news.
Note: The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) explain that even though pregnant women are not evidently at a greater risk (since they have depressed immune systems and are known to be a greater risk for other respiratory viral infections), they should still be considered an “at-risk population” for COVID-19.
I can’t even imagine being pregnant right now, and our hearts go out to all of you who are trying to wade through this pandemic with heightened nerves (and more) — we’re so sorry you’re going through this right now. We have more information on what’s happening with pregnancy/labor/delivery and other relevant FAQS on our coronavirus information home page.
Bottom line — coming up on the end of 2020 (and it can’t get here fast enough), the world continues to feel pretty messed up. We’re all doing our best to keep adapting to a scary, fluctuating, and frustrating reality… but one thing that I am taking heart in every day is the fact that I’m not also constantly terrified for my children’s lives, because that would be truly unbearable. Hopefully this gives you too some small sense of solace.
Thank you for this information. I am
Due with my
First baby in two weeks and I feel better having read this.
Thank you! This (like all your articles) was very easy to read, even though it’s a lot of information, I didn’t feel overwhelmed. I always appreciate your perspective and your candidness.
Very nice piece. I appreciate the level of detail.
Thank you for this. I have a toddler and am pregnant with my second child. I am also a healthcare professional and have found much of the information about the virus is not public-friendly or particularly helpful. This is excellent, keep it up!
It’s also a good idea to teach our kids to treat Asian classmates with respect, and that they don’t necessarily have or are in any way connected to the corona virus.
Absolutely! Thank you so much for this very important addition, Susan.
This was helpful and reassuring to read! We are located in RI and have had our first family trip booked to Disney upcoming in March with our 8 month old. Thank you for all of this info all in one place
I live in San Francisco-where there is a presence of many coronavirus cases, increasing by the day in CA.
Should this change our approach to hiring a postpartum night nurse/doula? Bringing someone else into our home and in such close, intimate proximity to our newborn?
Thoughts?! Also-tha k you for this article. It also makes me feel a bit better!
That’s a tough one, Elise — it’s certainly possible (perhaps even likely) that things may look different come April… however I think the decision regarding hiring a postpartum night nurse/doula is ultimately a very personal one, without any clear right/wrong answer. For now, you may want to consider speaking with your pediatrician about your concerns (as well as your potential candidates, if you are interviewing) and of course continuing to monitor the situation. Sorry we can’t be of more help with this one — good luck!
So, so helpful and reassuring. Thank you for all of this info in one place!
Thank you for all the detail information. I have a toddler and a 3 month old, you answered a lot of questions I had.
so glad to hear it!
Thank you for an informative article in terms I could I understand.
As a physician and a mom, I really appreciated this article and it’s evidence based medicine. Thank you for writing this for the mass to read. Also, thank you for doing your research and reporting on COVID-19 scientifically and accurately.
I have a 9 month old and almost 4 year and have been very concerned. I work for the company that makes Purell, so we have already taught the toddler about hand hygiene and washing. He loves sanitizer! But, Covid-19 freaks me out, so thank you for this!!
THANK YOU! Seriously, I found this to be really helpful and comforting as a pregnant mama with 2 young children.
Thank you for spreading facts over fear! Unfortunately so many media outlets seem to be spreading the “doomsday” message without including certain facts. As always, thanks for the great content.
Thanks for this clear and informative article! I’m struggling with whether to cancel an upcoming vacation to Mexico (with my 1yo)—not for fear of getting sick but rather for fear of being quarantined away from home if the spread advances while we’re away. Any good coverage about what to expect or prepare for with quarantines? Knowing our rights if we are quarantined?
Hi, Eva – I’m not 100% certain on this issue, but after a little bit of digging it looks like the State Department is a good place to start. Here is a list of US embassies with specific info on coronavirus by country. Check it out, and hopefully this helps. Good luck and safe travels. 🙂
Thank you so much for this article! A lot of the research being reported (and here) talked about “kids” (ages 1+). I’ve also read (elsewhere) that one theory as to why kids are doing better is because they have had lots of exposure and thus built up immunity to common forms of coronavirus (e.g., the common cold). But none of the reporting has talked about infants (0-12 months). We have an 11 week old who hasn’t gotten sick with anything yet (cold, etc). Should parents of newborns be worried that their infants are less safe than their older kids? I can’t find any reporting on this age group. Thank you for any guidance!
Hi, Libbie! You’re absolutely right that there isn’t very much reporting on infants specifically. Largely this seems to be the result of a lack of data. There’s one study published in JAMA that describes a series of affected infants in China — all the babies survived (9), and none of them needed intensive care or had any serious complications. (You can also read a synopsis of the report here.) Hope this helps somewhat.
Keep up the good work.
Thanks for the depth and breadth of your research.
Very informative, thanks Brit!!
Great summary! As a physician, I appreciate your complete approach to addressing what the virus actually is and its realistic concerns – rather than feeding into the frenzy of fear.
Thank you, Brit and Lucie’s List! I am a pediatrician and pregnant, and have been following this info closely. Kudos to you– I have to say, I am continually impressed with how up-to-date your data is, and how thoughtful, careful, and clear your insight is. You are really talented as a science writer! The fact that you include such recent data in a well-summarized way is truly awesome.
Thank you for putting useful, good info out there for the public. Keep up the good work!