Many of us read bedtime stories to our children. We delight in seeing their faces light up at their favorite lines. Story time represents a moment in the day when parents and caregivers offer reassurance to their children about the world. We laugh and encourage while discussing fears and possibilities. Mostly, we cherish the bond built through story. Think Dr. Seuss’s The Cat in the Hat Comes Back.

Today, parents and caregivers share classic tales with a pandemic spreading across the globe that alters the day-to-day lives of our young people. With social distancing mandated, managing this new social reality for children represents a challenge for many families.

Supporting students socially and psychologically through the pandemic is a priority. With young children and teenagers present on the home front 24-7 and schools, parks, and recreation centers closed, it is important to understand how COVID-19 impacts their health.

Individuals under 18 years of age represent one-fifth of the populations in St. Louis city and county. Twenty-two percent of the population in the United States are infants and children, defined by those less than 18 years of age, but as of April 2 only 1.7% of COVID-19 patients with available age data had been children, according to the Centers of Disease Control and Prevention (CDC).

The first reported case of an adolescent contracting the virus was on March 2. Of the limited data available as of April 2, 73% of adolescent patients reported symptoms such as shortness of breath, cough, or fever, as compared to 93% of adults up to 64 years of age. There are similar trends for other symptoms as well, such as sore throat, headache, diarrhea, or myalgia.

Based on the data available on hospitalization statuses, 20% of adolescent patients were hospitalized, while 33% of adults up to 64 years of age were hospitalized. Adults were also admitted to an ICU at higher rates as well. Infants less than 1 year old are the most vulnerable out of all adolescent age groups to be hospitalized.

The median age for adolescent patients was 11 years, and about 33% of patients was 15 to 17 years of age. Additionally, 27% of reported pediatric cases were among children 10 to 14 years of age, while 15% was among children aged 5 to 9 years. Fifty-seven percent of adolescent patients had been males, compared to 53% male in adults. Data for underlying conditions in adolescents is scarce, with information on only 345 cases as of April 2; but of those cases, 23% had at least one underlying health condition, including asthma, cardiovascular disease, and immunosuppression.

The CDC collected this data from all 50 states, Washington D.C., New York City, and four U.S. territories in the period from February 12 through April 2. Because of the shortage of various data points and factors, some of the numbers represent estimated ranges. In addition, other limitations exist such as differing testing practices across jurisdictions, limitations to who is getting tested, and more. Despite these limitations, however, there are important preliminary findings.

All this information supports previous reports and data, much of it from China: adolescents do not experience severe forms of the virus at the same rates as adults; there are more fatalities among male patients for both adults and children, suggesting a biological relationship to sex; and children less than 1 year old and with underlying health conditions are more vulnerable.

The CDC analysis reports characteristics of COVID-19 disease among children in the United States that suggests that symptoms like fever or cough are not always present. And while the severity of symptoms has been milder for children than for older adults, it remains important to monitor the progression of illness with children, particularly among young persons with underlying conditions.   

While adolescents experienced fewer severe cases, the CDC report documents hospitalizations and loss of life, with three reported deaths as of April 2. According to the CDC report, exposure to the virus occurred largely through a member of the community or from an individual in the household. The remaining fraction, about 9% of exposures, occurred during travel.

Individuals with a mild form of the disease or asymptomatic, including children, play a role in the transmission and the spread of COVID-19 in the community. Many individuals who experience mild, limited, or no symptoms can expose a far greater portion of the community than would occur if the disease were documented and the individual quarantined. According to an article in Science, it was estimated that a large proportion of undocumented infections, many likely not experiencing severe symptoms, influenced the rapid spread of the virus in China. With respect to children and adolescents, delayed school reopening along with other broader measures such as restricted travel and face masks slowed the spread of the virus.

Therefore, to protect people of all ages and backgrounds, it is essential for everyone to participate in social distancing and efforts to flatten the curve, regardless of the level of vulnerability and susceptibility. The CDC continues to recommend that people stay at home and maintain good hygiene. More recently, the CDC has also recommended that people wear cloth face masks and coverings when leaving home for essential travel.

Parenting offers many challenges. The pandemic intensifies our concerns about the children in our lives. Safe, secure, healthy, and tucked into bed is the goal. Story time is nearly complete.

Don’t go near the virus.

That virus hurts people.

It comes and it goes.

Don’t want to carry it.

You know how it harms the young and old.

And one more thing,

We will beat this

Just know.

William F. Tate IV is dean and vice provost for Graduate Education; Edward Mallinckrodt Distinguished Professor in Arts & Sciences; and faculty scholar, Institute for Public Health, at Washington University in St. Louis. Find him on Twitter @WFTate4.

Kally Xu is a John B. Ervin Scholar and Gephardt Institute Civic Scholar at Washington University in St. Louis, where she is a candidate in the 3-2 Masters of Public Health in the George Warren Brown School of Social Work and the A.B. program in International and Area Studies and Asian American Studies.

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