Many kids show no COVID-19 symptoms. How Vermont schools will address asymptomatic spread

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A parade of cars led by school buses carried teachers and staff from Orchard School in South Burlington to the doorsteps of students on June 11, 2020. Burlington Free Press

A temperature check at drop off won’t be enough to identify students who may be infected with COVID-19. As schools reopen, a strategy for stopping the virus at the front door is not feasible given that many infected children are unlikely to show symptoms but could still spread the disease. 

Nearly half of Vermont children who tested positive for COVID-19 had no symptoms according to data released by the Health Department. In the recent Winooski outbreak — of which 40% were children — about 75% of positive cases were asymptomatic, said Health Commissioner Mark Levine at a June 19 press conference.

Public health officials have considered the unique ways the virus presents in children when developing the school guidelines for the fall and believe measures will be effective against transmission. 

What we know about COVID-19 in kids

Dr. Benjamin Lee, a pediatric infectious disease specialist at the University of Vermont Children’s Hospital confirmed Vermont data reflects what has been seen across the world — children may have milder symptoms or be asymptomatic.

Children tend to get the virus less often and may contract it after more prolonged exposure to someone with the disease, Lee said. The fatality rate is also lower in children.

What makes the novel coronavirus such a challenge to control is “a small but not insignificant proportion of cases could be acquired via contacts who are asymptomatic at the time of contact,” Lee said. 

Coronavirus and children: What state data reveals about COVID-19 in Vermont kids

Facial coverings do help

Under the state guidelines for reopening schools students would undergo daily health checks upon arriving at school — temperature taking as well as questioning about symptoms and exposure to individuals with the virus.

The health checks might catch half of infected students, based on statewide data. According to Lee, that’s why the guidelines put emphasis on strategies to limit transmission of the virus within the school.

Lee cited promising studies showing how facial coverings and social distancing have proved to be effective against the spread of COVID-19. One example was an outbreak on a U.S. aircraft carrier. Those who wore masks and kept their distance contracted the virus at a lower rate.

Other measures against combating the spread of the disease include washing hands, disinfecting and having classes stay together without moving around the building.

Lee, who was on the Reopening Schools Task Force, said the goal is for the Department of Health to contain any potential new outbreaks. 

“With the precautions we have in place, we do believe we have a reasonable plan to maximize the likelihood that an outbreak could be contained,” Lee said. “It’s not realistic to think this is going to completely eliminate the risk of viral transmission, but it should substantially reduce the risk.”

A more comfortable test for children

In planning to reopen Vermont K-12 schools, widespread testing of students was not on the table like at University of Vermont or Middlebury College.

However, targeted testing could be used in association with contact tracing when a positive case is found within a school. This method allows schools to contain the virus without having to shut down an entire school. Lee said it avoids an “all or nothing scenario” approach. 

For children, an anterior nares test is recommended, which tends to be more comfortable than the traditional nasopharyngeal test.

A nares test uses a swab with a smaller tip that has a shorter penetration and is inserted into each nostril for 10-15 seconds. The traditional test performed on most adults utilizes a six inch swab inserted deep into the nasopharynx and has some associated discomfort.

The state is accumulating materials needed for the anterior nares test. On June 2 a health advisory from the state said there was a shortage of anterior nares testing equipment and children under 16 should be prioritized.

On June 22, the state’s Public Health Laboratory received 78,500 nasal swabs and UVMMC received 50,000. Ben Truman with the Department of Health said with the recent shipments “the state’s nasal swab supply looks positive.” The testing also requires room temperature saline. Deputy Commissioner Christopher Herrick of the Department of Public Safety submitted a request for 50,000 units few weeks ago, but the state has yet to receive the supply. Lee hopes  that by the start of school, the state will have ample supply for the possibility of increased testing in children.

Lee said targeted testing may allow schools to remain open until a vaccine or herd immunity is achieved.

“The challenge is how can we safely live with the virus and limit its impact,” he said.

Vulnerable people in the household

Households containing people who are vulnerable to the disease or have underlying conditions may want to consult health care providers when deciding if children should return to school.

For children who have well-controlled asthma or seasonal allergies, the school guidelines suggest they return to school. If the student or another household member is particularly vulnerable, Lee advises discussing it with their personal doctor.

However, clearance from a doctor will not be mandated in order to return to school.

Back to school in a pandemic:What Vermont students and families can expect

Lee said all the decisions and recommendations to Vermont schools were based on available evidence at the time and that further flexibility may be required. He also noted a need to go through the challenges of reopening schools safely so that kids can get back to learning.

Contact April Barton at abarton@freepressmedia.com or 802-660-1854. Follow her on Twitter @aprildbarton.

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