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Frequently asked COVID-19 questions

Are the symptoms of COVID-19 the same for children?
Symptoms in children are generally milder than for adults. Children can still however experience other symptoms like nausea, headache, fever (in about 50 per cent of cases), fatigue, irritability, loss of appetite, sore throat, a runny nose, dry cough and, sometimes, diarrhoea
    
Can children get COVID-19 without symptoms? Or are they immune?

Children are definitely not immune from the virus, and children and infants overseas have died from COVID-19. Many children are truly asymptomatic while some children have very mild symptoms and so are not being tested.
    
How will I know if my child has COVID-19?
    
Monitor your child for respiratory symptoms. If they have a cough, fever or sore throat, and you are in Melbourne, they can be tested at The Royal Children's Hospital Respiratory Infection clinic. The only way to know if they have COVID-19 is to receive a diagnosis from a screening clinic. If your child has severe symptoms such as breathing difficulties, call 000 immediately.
    
What do I do if I suspect my child has COVID-19?
    
If symptoms are mild, visit a Respiratory Infection clinic in your area. If symptoms are severe, such as your child having difficulty breathing, call an ambulance immediately.  
    
How many children have gotten sick so far?
    
Fewer than 200 Australian children have tested positive for SARS-CoV-2, which is the virus that causes COVID-19. This is because infants, children and young people are proportionally less likely to be infected than adults. However, in countries which have seen large percentages of the population infected, a corresponding large number of children have also been infected and become unwell.
    
Are children getting infected at the same rate as adults?

Around 2 per cent of children seem to be infected, despite making up around 20 per cent of the population. In households with an infected adult, children appear to infected equally as easily as other adults, but ususally only show mild or no symptoms.  Conversely, young people aged 20-34 are overrepresented in infection numbers as a proportion of the population.
    
How does the coronavirus affect children differently from adults?    

Children seem to either show no symptoms when infected, or only mild symptoms. (See above). Why this is the case is not clear, and there are several hypotheses which are being investigated by our researchers.
    
Are children of different ages affected in the same way, or is there a difference in older kids?    

Children and young people up to about the age of 20 all seem to have no or mild symptoms. After this age symptoms are more in line with those seen in adults. Headache is one of the most common paediatric symptoms.
    
Why do children infected with the coronavirus fare better than adults? 

Why this is the case is not clear, and there are several hypotheses which are being investigated by our researchers.
    
Are children 'super-spreaders' of COVID-19? Can children, with mild or no illness, transmit the Coronavirus to others?    

The international data are mixed. Asymptomatic children have been described that also have a high viral load, but the majority of children have mild symptoms and low viral loads. MCRI clinician-scientists are actively answering this question through ongoing research.
    
Is there a similar pattern, with other viruses, where children experience milder illness than adults but are spreaders of the infection?

SARS-CoV-2, the virus that causes COVID-19, is similar in its infection pattern to SARS, which emerged in 2003. It also infected fewer young people, and gave them milder symptoms than adults. Other infectious diseases with a similar pattern include chickenpox and Epstein Barr virus. In contrast, the influenza strains affect children more severely, and are more readily spread by children and young people. It is especially important that children receive their annual influenza vaccination, and maintain their childhood vaccination schedule. 
    
Are infants more at risk?

Worldwide, only a handful of infants have died from COVID-19. Many of these also had serious underlying health issues. If your child has an underlying health issue and you are especially concerned, contact your GP for further advice.
    
Can COVID-19 affect newborns and how?

Newborns and infants are at slightly higher risk than older children, but this is still very low compared to elderly people. Newborn infections overseas have generally been through an infected parent or hospital worker, so ensure you continue to maintain good personal and hand hygiene at all times.
    
What happens if I am pregnant, am I am more at risk? Is my child at risk?    

A healthy pregnancy seems to convey no extra risk from contracting COVID-19. If you have pregnancy complications such as maternal diabetes or high blood pressure you should take extra precautions around physical distancing and personal hygiene. MCRI is researching the effects of these complications, especially in the context of lower-middle income countries where standards of care can be lower than in Australia.
    
If I am pregnant and get COVID-19 will it be passed on to my child?    

There has only been one documented case worldwide of vertical transmission (mother to foetus). If you are infected while pregnant, your maternal health team will  monitor your health and the foetus' health with extra vigilence to ensure the best outcomes.
    
If my child is up to date with their vaccinations, will they have immunity?

Until a specific vaccine is developed for SARS-CoV-2, the virus that causes COVID-19, or your child is infected and then recovers, they will not be immune to the virus. They should however keep up to date with their vaccine schedule, and have the influenza vaccine, to prevent them from catching those infectious diseases and leaving them weakened in case they come into contact with the virus.
    
If my child recently had a BCG vaccination, will they have immunity?    

Australian children have not routinely been given BCG vaccinations for 40 years. If they received it because they are in a high-risk household, or were born in a country with routine BCG vaccination, they are still at risk of catching the virus. The effectiveness of BCG vaccination in boosting the innate immune system of frontline healthcare workers is currrently being trialled and results will only be known after six months. Importantly, BCG's specific effects against tuberculosis wear off after a period of years, and the same may be expected of its effects on the innate immune system.
    
Are children with pre-existing health conditions more at risk?

Similar to adults with underlying health issues (called co-morbidities), children with co-morbidities seem to be at slightly higher risk of having more severe COVID-19 symptoms. For this reason it is prudent to take extra care to practice social distancing and ensure everyone in the household maintains good personal hygiene. 
    
If my child has had pneumonia before, are they more at risk?

If your child has previously been treated for, or hospitalised for pneumonia, the lung usually recovers completely. The good news is that childhood is a period of massive growth of new lung tissue, and if the infection has entirely cleared up they should not be at a significantly greater risk than otherwise healthy children.
    
If my child has asthma, are they more at risk?

Any disease that reduces lung function confers increased risk during a respiratory infection. Ensure you have an adequate supply of your particular asthma medications on hand and follow prevention / treatment schedules. For this reason it is prudent to take extra care to practice social distancing and ensure everyone in the household maintains good personal hygiene. If your child is experiencing breathing difficulties see your family doctor or call an ambulance.

Read more on asthma and COVID-19 from respiratory physician Dr Danielle Wurzel.
    
If my child is receiving immunosupressive medical treatment, are they more at risk?

Immunocompromised children are more at risk of experiencing severe symptoms if they contract a respiratory infection. For this reason it is prudent to take extra care to practice social distancing and ensure everyone in the household maintains good personal hygiene. MCRI is running an observational trial of immunocomprised children to ascertain any additional risk posed by COVID-19.
    
What is the best way to protect my child from getting COVID-19?
While children generally show only mild symptoms, it is important to try to avoid infection to minimise any risk. For this reason it is prudent to take extra care to practice social distancing and ensure everyone in the household maintains good personal hygiene.
    
If my child does get COVID-19, what do I do? How do I look after them at home and avoid the rest of family getting sick?

Within households, it appears that children are at low risk of passing on the infection to other members, and are in turn at low risk of picking it up from adults. To avoid infecting each other, it is a good idea to wipe down common surfaces frequently with an alcohol based sanitiser or soap and water, wash hands often and well (for at least 20 seconds) , use separate toilets where possible and sleep in a separate room.
    
If a child does get a respiratory infection from COVID-19, is there any lasting negative health impacts on their lungs or similar?

There is not enough data on this, as the infection has only been around since late-2019. Other severe childhood respiratory illnesses however can 'scar' the lungs. Luckily COVID-19 appears to only rarely produce severe symptoms in children, and they also recover quickly.
    
Is it safe for us to visit a grandparent?
Even if you have been physical distancing for more than two weeks, there is a chance children could be infected but showing no symptoms. Visiting grandparents does involve an element of risk, and given their high risk of experiencing more severe symptoms if they do become infected, it is probably not worth that risk.
    
Why aren't children getting as sick as adults?

The data available to date are not clear. There are several hypotheses and these are being urgently investigated by our clinician-scientists. It is an important area of research as this information could help us find ways to protect older people who are at significant risk from the infection.
    
Who are the most vulnerable children in our community?

Although children are generally at low-risk, children with existing illnesses and a lower health 'baseline' are probably at increased risk. These include immunocompromised children and children from disadvantaged backgrounds.
    
Are children in lower middle income countries more vulnerable? Are they getting worse symptoms?

Although children are generally at low-risk, children with existing illnesses and a lower health 'baseline' are probably at increased risk. These include immunocompromised children, undernourished children and those from disadvantaged backgrounds, likely including lower-middle income country settings. MCRI is actively working with health authorities in many of these countries to study, and minimise, COVID-19 impacts in these populations.
    
If children aren't getting as sick, is it safe for the community to let them go back to school?

Although children are not becoming as sick, they may still pose an infection risk to other children and adults. Along with public health authorities advising state and federal governments,  MCRI supports an evidence-based policy on a graded physical return to school.
    
Are the vaccination and anti-viral treatments that are being tested and developed safe for children too?

Clinical trials of new vaccines and drugs will first be conducted in adults. Once proven safe, they will be trialled in children. Some of the treatments being tested are already licensed for use in children but their benefit is currently unproven. Given the lower risk for children generally, safety of any intervention is going to be paramount.
    
Will it be safe for children to receive chloroquine medication to treat severe symptoms?

Chloroquin and hydroxychloroquine do have known side effects including on the heart and vision. The doses that will be used in the CATCH-19 trial have already been used in children for treatment of malaria and have been shown to be safe. All trials will be conducted with strict oversight by the RCH Human ethics committee and a rigorous adverse event reporting system.
    
Will it be safe for children to receive BCG vaccination to treat severe symptoms?

There are no plans to give BCG vaccination to test its off target effects against COVID-19 in children, given that children are generally low risk. BCG is still given to over 130 million children annually against TB, and is one of the safest vaccines available.
    
Is it critical to understand how COVID-19 affects children, and why? What questions do we need answers to, and why? What difference will it make to children, paediatric treatments or to the government responses (i.e. testing regime, physical distancing, school remote learning, sporting club closures etc) ?

Ongoing research into COVID-19's effects on children is crucial to inform policy, our response to future pandemics, allow parents to return to their jobs and careers. Importantly we need to understand and reduce the coming impacts on children who may never become infected, but will suffer the consequences of less available resources such as food, education, housing and security that will come as a result of the pandemic decimating communities in lower-middle income countries.

Should I be worried about Kawasaki disease if my child becomes unwell with COVID-19?
Kawasaki is a rare condition, and severe symptomatic COVID-19 in children is also rare. Parents can be reassured that these two rare events have an even rarer chance of occurring together. The risk for an individual child is extremely low. Be as vigilant as you normally would be in the event of a sudden severe illness, i.e if your child is less responsive, lethargic and maybe has a rash that doesn’t change colour when pressed, and is having difficulty or pauses in their breathing, is particularly pale, then you should urgently bring them to hospital as you would have before the pandemic.

The AHPPC has released a statement on the inflammatory syndrome, PIMS-TS, that has been seen in some children overseas and may be associated with C-19.
This statement was prepared by the PAEDS network, in conjunction with the Acute Inflammatory Vasculitis Working Group, and contains more information on this rare complication.