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It’s Time to Put Children and Young People First During the Global COVID-19 Pandemic

Educational Objective
To understand the importance of researching the role children and young people play in spreading COVID-19
1 Credit CME

Children have been relatively spared from the effect of clinical coronavirus disease 2019 (COVID-19). The newly described inflammatory syndrome1,2 is rare in terms of the total population of children, and severe acute forms of COVID-19 are even rarer in children and young people.3 Despite this, both experts and the public have struggled to come to terms with the fact that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is also different from all other known respiratory viral infections: there is significant uncertainty regarding children and young people’s ability to catch, transmit, and spread the virus. With no immediate vaccine or cure available, the only effective public health response has been widespread lockdown, including school closures now approaching more than half of the calendar year at considerable detriment to the long-term education and mental health of an entire generation.4,5 With the start of the academic year in northern hemisphere countries, there is an urgent need to understand children’s role in transmitting SARS-CoV-2.

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Article Information

Corresponding Author: Saul N. Faust, MD, PhD, National Institute of Health Research Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom (s.faust@soton.ac.uk).

Published Online: September 25, 2020. doi:10.1001/jamapediatrics.2020.4582

Conflict of Interest Disclosures: Dr Faust reports personal fees or grants for contract commercial clinical trials were paid to his institution (with no personal payment of any kind) from AstraZeneca/MedImmune, Sanofi, Pfizer, Seqirus, Sandoz, Merck, GlaxoSmithKline, and Johnson & Johnson outside the submitted work. Drs Faust and Munro are funded in part by the UK National Institute for Health Research (NIHR) Southampton Clinical Research Facility; Dr Faust is an NIHR senior investigator.

References
1.
Whittaker  E , Bamford  A , Kenny  J ,  et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia.  Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.   JAMA. 2020;324:259. doi:10.1001/jama.2020.10369PubMedGoogle ScholarCrossref
2.
Feldstein  LR , Rose  EB , Horwitz  SM ,  et al; Overcoming COVID-19 Investigators and the CDC COVID-19 Response Team.  Multisystem inflammatory syndrome in U.S. children and adolescents.   N Engl J Med. 2020;383(4):334-346. doi:10.1056/NEJMoa2021680PubMedGoogle ScholarCrossref
3.
International Severe Acute Respiratory and emerging Infection Consortium. Accessed September 15, 2020. https://isaric.tghn.org/
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Meara  ER , Richards  S , Cutler  DM .  The gap gets bigger: changes in mortality and life expectancy, by education, 1981-2000.   Health Aff (Millwood). 2008;27(2):350-360. doi:10.1377/hlthaff.27.2.350PubMedGoogle ScholarCrossref
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UNESCO. Adverse consequences of school closures Accessed August 16, 2020. https://en.unesco.org/covid19/educationresponse/consequences
6.
Viner  RM , Mytton  OT , Bonell  C ,  et al.  Susceptibility to SARS-CoV-2 infection among children and adolescents compared with adults: a systematic review and meta-analysis.   JAMA Pediatr. Published online September 25, 2020. doi:10.1001/jamapediatrics.2020.4573Google Scholar
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L’Huillier  AG , Torriani  G , Pigny  F , Kaiser  L , Eckerle  I .  Culture-competent SARS-CoV-2 in nasopharynx of symptomatic neonates, children, and adolescents.   Emerg Infect Dis. 2020;26(10):23-26. doi:10.3201/eid2610.202403PubMedGoogle ScholarCrossref
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Heald-Sargent  T , Muller  WJ , Zheng  X , Rippe  J , Patel  AB , Kociolek  LK .  Age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19).   JAMA Pediatr. Published online July 30, 2020. doi:10.1001/jamapediatrics.2020.3651PubMedGoogle Scholar
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Jones  TC , Mühlemann  B , Veith  T ,  et al. An analysis of SARS-CoV-2 viral load by patient age. MedRxiv. Preprint posted online June 9, 2020. doi:10.1101/2020.06.08.20125484
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Kawasuji  H , Takegoshi  Y , Kaneda  M ,  et al. Viral load dynamics in transmissible symptomatic patients with COVID-19. MedRxiv. Preprint posted online June 4, 2020. doi:10.1101/2020.06.02.20120014
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Ismail  SA , Saliba  V , Bernal  JAL , Ramsay  ME , Ladhani  SN . SARS-CoV-2 infection and transmission in educational settings: cross-sectional analysis of clusters and outbreaks in England. MedRxiv. Preprint posted online August 24, 2020. doi:10.1101/2020.08.21.20178574
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Fontanet  A , Tondeur  L , Madec  Y ,  et al. Cluster of COVID-19 in northern France: a retrospective closed cohort study. MedRxiv. Preprint posted online April 23, 2020. doi:10.1101/2020.04.18.20071134
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Stein-Zamir  C , Abramson  N , Shoob  H ,  et al.  A large COVID-19 outbreak in a high school 10 days after schools’ reopening, Israel, May 2020.   Euro Surveill. 2020;25(29):2001352. doi:10.2807/1560-7917.ES.2020.25.29.2001352PubMedGoogle Scholar
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Park  YJ , Choe  YJ , Park  O ,  et al; COVID-19 National Emergency Response Center, Epidemiology and Case Management Team.  Contact tracing during coronavirus disease outbreak, South Korea, 2020.   Emerg Infect Dis. 2020;26(10). doi:10.3201/eid2610.201315PubMedGoogle Scholar
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Fateh-Moghadam  P , Battisti  L , Molinaro  S ,  et al. Contact tracing during phase I of the COVID-19 pandemic in the province of Trento, Italy: key findings and recommendations. MedRxiv. Preprint posted online July 29, 2020. doi:10.1101/2020.07.16.20127357
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Kim  J , Choe  YJ , Lee  J ,  et al.  Role of children in household transmission of COVID-19.   Arch Dis Child. 2020;0:1-3. doi:10.1136/archdischild-2020-319910PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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