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Patricia Bruijning: “The decision that children between seven and twelve years old can go back to school with a cold was made purely on the basis of a scarcity of tests.”
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UMC Utrecht
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UMC Utrecht
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Last Friday, Minister De Jonge announced that children between seven and twelve years old may also go back to school with a snot nose. A relief for many parents, who in recent weeks have struggled with the dilemma of whether their child with a cold should stay at home and be tested. At the same time, many teachers are concerned. Because with all those sniffling children in the classroom, does not the chance of the corona virus spreading increase enormously? We asked us coronadenktank-lid Patricia Bruijning. She is a pediatrician epidemiologist at UMC Utrecht.
At the end of the summer, it was decided that young children (up to seven years old) with a cold could simply come to daycare or to school. Why was that limit set at seven years at the time?
“This has two reasons. The first is purely practical. Small children often have a snot nose. That is part of the game and there is no beginning to keep all those children at home or have them tested. The second reason stems from research on Covid-19 in children. Among all the sniffling children, you will only occasionally find someone who tests positive for this. Moreover, we know that children do not easily pass on the corona virus. There is a difference in this between groups. Children under the age of five do not or hardly spread the corona virus. In older children, the spread gradually increases slightly. Young adults between the ages of fifteen and twenty spread the virus just as efficiently as adults. ”
Now children up to the age of twelve are allowed to go back to school with a snot nose. Why was that decision made and is it wise? Are we not going to miss too many potential corona cases if children with colds are no longer tested?
“Cold testing has never been mandatory. Officially, children only need to be tested if other complaints arise, such as chest tightness or fever. That is still the case. But in practice we saw that parents struggled enormously with cold children at home. Normally you just send a child with a snot nose to school, but that was not possible now. And so many parents had their cold children tested anyway, either on their own initiative or because school asked for it. That put enormous pressure on the test locations. Hopefully letting sniffling children go to school will lessen that pressure. So this decision has nothing to do with new scientific insights, but was taken purely on the basis of a scarcity of tests. ”
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The pressure on the test locations may decrease, but unrest among teachers is increasing. Because how do you know whether a student with a cold is not infected with the corona virus?
“You don’t know, but before you actually didn’t know whether there was a student with corona in the class. A corona infection can present very differently in children than in adults. Various studies have been published on this in the past three months, in which all children who were exposed to the coronavirus were tested and followed up. Many infections in children go unnoticed because they do not produce symptoms or symptoms different from what you might expect. For example, fatigue and headaches are common in children with Covid-19. Twenty to thirty percent suffer from stomach pain or diarrhea. If you only look at cold complaints, you probably won’t catch even half of all corona cases in children. ”
That sounds ominous. Isn’t it bad that we miss so many corona cases in children? Perhaps we should look for other symptoms in children?
“From a pediatrician’s perspective, it is certainly good to consider other symptoms. If you see a seriously ill child in hospital with abdominal pain and diarrhea, you should also think about corona. From an epidemiologist’s perspective, other symptoms are less relevant. After all, you want to detect corona to prevent it from spreading. It cannot be ruled out that children with only headaches or stomachaches will pass on the virus, but this will only happen very rarely. They are much less contagious than children who cough or sniffle. ”
What do we already know about the spread of the coronavirus through the faeces? For example, can you become infected by changing a diaper in children with diarrhea?
“The coronavirus has been found in the faeces of infected people, but it turns out that it cannot be grown from faecal samples in the laboratory. The virus particles in the stool are also not infectious. Feces are therefore not expected to be an important route for the virus to spread. ”
Laboratory test versus rapid test
At the moment there is only one method to test for corona; the laboratory test (or PCR test). Mucus samples are taken deep from the nose and throat of a sick person. In the laboratory, analysts search the samples for genetic material from the coronavirus.
Rapid tests for corona are new in the testing arsenal. The reliability of such tests is now being investigated. Rapid tests work like a pregnancy test. If coronavirus proteins are present in a person’s mucus or saliva, the test strip will stain.
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A rapid test for corona is similar to a pregnancy test.
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Rapid tests are less sensitive than a lab test. That is an advantage in this case. With the current laboratory test you can track down all corona cases. Also people who only carry a very low concentration of virus particles and probably do not contribute much to the spread of the virus. With a quick test you will not find these people and only detect the people who are really contagious.
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What do you expect this fall and winter? If many more people will catch a cold or get the flu in the future, can we still test enough?
“That is indeed the question. The RS virus is also common in small children in the autumn. This causes complaints such as coughing and shortness of breath, which are also associated with corona. Then you have to test more. I myself very much hope that rapid tests (see box, ed.) Will be useful by that time. Then much less laboratory capacity is needed and the results are available more quickly. Moreover, especially small children experience less problems with taking a rapid test, because the samples then do not have to be taken deep from the throat or nose. ”
Coronadenktank
Of corona think tank from NEMO Kennislink consists of experts from various scientific disciplines. By looking at the corona crisis from different areas of expertise, we hope to get a better grip on the problems and possible solutions in the coming months.
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