Provided by Tom Ulmet on April 27, 2020.

This Alert is meant to advise and inform, not to alarm. Based on information received most recently, it is better to take every precaution possible with screening people upon entrance to campus and during the time they are on school premises. Here is a useful notice about children and the coronavirus.

Children and COVID-19
The World Health Organization (WHO) has consistently stated that children and adolescents can become infected and spread the disease as any other age group. They are for unknown reasons less likely to contract severe disease, although recently more severe cases (still in very small numbers) are appearing in major cities. Children should be reminded to avoid close contact with older people who are most susceptible until the epidemic subsides. 1)          https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Children as Asymptomatic Carriers
For nearly four months, we have received the encouraging news that COVID-19 does not affect children to the same degree as older people with other afflictions. While this remains true, recent evidence from a thorough study of children in China shows they can be asymptomatic and spread the disease without being severely affected themselves. 2) https://pediatrics.aappublications.org/content/early/2020/03/16/peds.2020-0702.1

ACAMIS Model Infectious Disease Prevention and Cleaning Procedures
This is to alert you to be aware of the fact that multiple daily health monitoring is necessary, even in your pristine environment, if you have followed all or most of the ACAMIS Model Infectious Disease Prevention and Cleaning Procedures. Particularly after the May holiday when there are many family gatherings, monitoring should intensify. 3) https://www.acamis.org/membership/blog/details/~board/acamis-members/post/acamis- model-infectious-disease-prevention-and-cleaning-procedures-april-5-2020

“Can Children or Adolescents Catch COVID-19?”
According to state data in (Boston Massachusetts), “Of the 38,077 confirmed coronavirus cases in Massachusetts as of April 26, only 899 — or 2.4 percent — involved people age 19 or younger.” That percentage of infected children is consistent with previous reports worldwide. However, a recent increase in the number of children who contracted COVID-19 has been recorded in the UK and in Boston, USA. “Children are not thought to be badly affected by COVID-19 - very few youngsters have died around the world since the pandemic began in December.

Their apparent resilience to the disease has baffled doctors for weeks because they are often 'super-spreaders' of viral illnesses such as flu.” However, in large Boston hospitals they have seen an increase of severe cases that lead them to believe that the number of infected children is much higher that thought. Due to an ongoing severe shortage of tests in the US, children are not tested unless they are exhibiting symptoms and are admitted to hospital for treatment. Some children in affected family or social clusters may also have the virus, but show no symptoms. 4)
https://www.msn.com/en-us/news/us/in-rare-but-growing-number-of-cases-children- hospitalized-with-coronavirus-in-massachusetts/ar-BB12Tblz

We are now sharing the symptoms that are not among the usual COVID-19 symptoms, but that were noted in children as something to watch for and not take for granted. Although tummy pains may increase due to readjustment to school lunches (as opposed to mother’s home cooking!), these additional symptoms below should not be ignored, but shared with school medical staff and teachers. The chances remain low that any of these will result in anything, but better safe than sorry. In addition to high temperature have been, “Low blood pressure, a rash, and difficulty breathing. Some also had gastrointestinal symptoms - tummy pain, vomiting or diarrhoea. 5) https://www.theguardian.com/world/2020/apr/27/nhs-warns-of-rise-in-children-with-new- illness-that-may-be-linked-to-coronavirus

Be alerted and alert, not alarmed
The alert by NHS serves as a warning to physicians that children with these additional symptoms may be infectious. “Doctors at prominent pediatric hospitals in U.S. hot zones from Seattle to New York said they had not observed alarming increases in the number of pediatric patients being hospitalized for covid-19. Instead, physicians said they felt that increase correlated with a rise in cases in the general population, rather than an emerging threat to children. Michael Agus, chief of medical critical care at Boston Children’s Hospital, said last week he had observed a “steady flow” of positive tests in children that “seems like it’s correlating with the peak for Massachusetts that the adults are seeing as well.” It was reported that Children’s National Hospital in the District (Washington DC) had treated 105 children with the coronavirus between March 15 and Wednesday. Roughly 40 percent of the children had an underlying condition.” Therefore, school medical staff would be wise to have a list of any children with underlying conditions, ie, asthsma, lung problems, blood conditions, etc. as they may be among the most susceptible to the virus. 6) https://www.washingtonpost.com/health/2020/04/27/britains-national-health-authority- issued-worrisome-alert-about-children-covid-19-potential-complications/

Still, experts stress that very few children become severely ill with coronavirus - evidence from around the world suggests they are the population least affected by the disease. The problem is that they may as, asymptomatic carriers, infect others who are more susceptible. 7)
https://www.bbc.com/news/health-52439005

UV Lighting is Effective in Reducing Virus
This study shows for the first time “that Far-UVC efficiently inactivates airborne aerosolized viruses, with a very low dose of 2 mJ/cm2 of 222-nm light inactivating >95% of aerosolized H1N1 influenza virus (SARS Covid-2/COVID-19 is a type of H1N1 virus). Continuous very low dose-rate far-UVC light in indoor public locations is a promising, safe and inexpensive tool to reduce the spread of airborne- mediated microbial diseases.” If you are looking for an inexpensive means of eliminating airborne virus and bacteria in classrooms, installing UV lighting, particularly in enclosed ECE and Primary classrooms and turning them on at night is an easy decision that parents will also appreciate. This will also reduce bacteria of all kinds during normal operations. 8) 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807439/pdf/41598_2018_Article_21058.pdf

Conclusion:
In our joy that campuses are reopening, there can be a hopefulness that we are returning to normal. Actually, we are still in a very dangerous phase in most parts of the world. Thus, this serves as a reminder to observe strict entrance screening and controls as well as a stringent cleaning regimen. Ensure that someone inspects the cleaning being done. As cases continue to appear in some communities in China, it is possible that a child will be part of an impacted social or family cluster. While still a low percentage of those identified with the virus, children can be asymptomatic carriers and staff must monitor them upon arrival and during the day.

Except for China, Korea and Germany, testing in most other countries is inadequate and most children are not tested even if they go to hospital. Therefore, the biggest danger will be when foreigners are allowed to reenter China and Hong Kong. If children are asymptomatic, it will be challenging even after quarantines. Be alert after the May 1 holiday when many families gather for dinner or social celebrations.

The use of UV lighting is a safe, easy and inexpensive means of protecting younger children who immune systems are not fully developed. Rearranging classroom to increase social distancing by any amount is helpful.

Attached to the message is a poster to share with parents if you wish. It is based on information from The Royal College of Paediatrics and Child Health. It is important to keep parents apprised of all the hygiene measures taken on campus and to remind them why this is being done.

References:

1. “Q&A on coronaviruses (COVID-19)”, WHO, April 17, 2020 
https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

2. Yuan Yuan Dong, Xi Mo, Yabin Hu, Xin Qi, Fan Jiang, Zhongyi Jiang, Shilu Tong, “Epidemiology of COVID-19 Among Children in China”, Pediatrics, March 13, 2020 , 
https://pediatrics.aappublications.org/content/early/2020/03/16/peds.2020-0702.1

3. https://www.acamis.org/membership/blog/details/~board/acamis- members/post/acamis-model-infectious-disease-prevention-and-cleaning-procedures- april-5-2020

4. Rebecca Ostriker, “In rare but growing number of cases, children hospitalized with coronavirus in Massachusetts”, MSN News, April 20, 2020
https://www.msn.com/en-us/news/us/in-rare-but-growing-number-of-cases-children- hospitalized-with-coronavirus-in-massachusetts/ar-BB12Tblz

5. “At least 12 UK children have needed intensive care due to illness linked to Covid-19”
https://www.theguardian.com/world/2020/apr/27/nhs-warns-of-rise-in-children-with- new-illness-that-may-be-linked-to-coronavirus

6. Ariana Eunjung Cha, “Britain’s national health authority issued a worrisome alert about children, covid-19 and potential complications”, Washington Post, April 27, 2020, https://www.washingtonpost.com/health/2020/04/27/britains-national-health- authority-issued-worrisome-alert-about-children-covid-19-potential-complications/

7. Michelle Roberts, “Coronavirus alert: Rare syndrome seen in UK children”, BBC News, April 27, 2020, 
https://www.bbc.com/news/health-52439005

8. David Welch, Manuela Buonanno, Veljko Grilj, Igor Shuryak, Connor Crickmore, Alan W. Bigelow, Gerhard Randers-Pehrson, Gary W. Johnson & David J. Brenner, “Far-UVC Light: A New Tool to Control the Spread of Airborne-mediated microbial diseases”, Scientific Reports, February 9, 2018 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807439/pdf/41598_2018_Article_210 58.pdf