Children may shed the coronavirus long after their symptoms clear up, according to study conducted in South Korea. The researchers also found that children can remain contagious for weeks, even when they never developed symptoms of COVID-19 infection.
In an editorial commentary, Dr. Meghan Delaney and Dr. Roberta L. DeBias of Children’s National Hospital said that many questions remain about the significance of the pediatric population as vectors for COVID-19.
The commentary was written in response to a study focused on 91 pediatric patients at 22 hospitals throughout South Korea. “Unlike in the American health system, those who test positive for COVID-19 in South Korea stay at the hospital until they clear their infections even if they aren’t symptomatic,” said Dr. DeBiasi.
About 22 percent of the patients observed for the study had been identified through contact tracing and never developed symptoms, while 20 percent were initially asymptomatic but developed symptoms later. Nearly 60 percent of the young patients were symptomatic at their initial test.
Over the course of the investigation, the hospitals tested the children every three days on average, which provided researchers with a picture of how long viral shedding continues over time.
The study showed that the duration of COVID-19 symptoms varies widely, ranging from three days to nearly three weeks.
Great variation was also found in how long children continued to shed the virus and were potentially infectious. While the virus was detectable through testing for an average of two-and-a-half weeks across all patients, many of the children were still shedding virus at three weeks.
The study provides important insight on COVID-19 in children, as communities continue to develop public health strategies to control the spread of the disease.
The experts said the study adds important knowledge to what is known about how children are affected by the disease, including the duration of viral shedding and the large number of children who could be asymptomatic.
Another important finding is that children – a group widely believed to develop a mild version of the disease that quickly passes – can remain contagious for weeks.
However, the doctors say, despite these important findings, the study raises several questions such as the reliability of testing. A “positive” or “negative” on testing platforms may not necessarily represent a transmittable infection. Some positives could be false, while some negatives reflect low levels of virus that could still be infectious.
Drs. DeBiasi and Dr. Delaney pointed out that the study only tested for viral shedding from the respiratory tract even though multiple studies have detected the virus in other bodily fluids, including stool. The role that sources other than the respiratory tract may play in the spread of COVID-19 is unknown.
According to the experts, each of these findings and additional questions should be addressed and continually refined to help get COVID-19 under control.
“Each of these pieces of information that we, our collaborators and other scientists around the world are working to gather, is critical for developing policies that will slow the rate of viral transmission in our community,” said Dr. DeBiasi.
The study is published in the journal JAMA Pediatrics.