To
slow the spread of the coronavirus, society is becoming much less social.
Public areas are emptying, businesses are shutting down, and schools and day cares
are closing. Parents are struggling to navigate this new way of isolated family
life, often with imperfect information.

Here’s
what we do know: The virus behind the pandemic, SARS-CoV-2, can infect
children. Kids under 10 are just as
likely
as adults to become infected from a person in the home, a study of
transmission in Shenzhen, China suggests.

For
reasons that remain mysterious, kids carrying the virus are less likely to get
sick than adults. Of about 2,500 U.S. COVID-19 cases reported as of March 16, only
5 percent
were in people aged 19 and younger. None died, but children
aren’t out of the woods.

“Kids
do better than adults, but they can still get sick,” says Sean O’Leary, a
pediatric infectious disease specialist and spokesperson for the American Academy
of Pediatrics. And COVID-19, the disease that the coronavirus causes, can
be severe
, particularly for babies and preschoolers, an analysis of 2,143 children
in China suggests. That study, published March 16 in Pediatrics, found that the 5 and under crowd suffered more severe
symptoms, including breathing trouble, than older children. 

In
addition to possibly getting sick themselves, children can spread the virus. A
study of children in Wuhan posted March 18 at medRxiv.org concludes that
although children account for a sliver of the confirmed illnesses, they are “nonnegligible
invisible infection sources
.” Put another way, kids are huge germ bags.

What’s
more, people are highly contagious before
they show symptoms
(SN: 3/13/20), which means they unwittingly
spread the virus
(SN: 3/17/20). Although
scientists are still missing key details about this spread, upper airways are
known to be packed with virus early in the illness. And young children are terrible
at covering coughs and wiping their noses.

As
scientists scramble to answer basic questions about COVID-19, parents are left
with practical questions about how to keep their children — and the more
vulnerable members of their wider community — healthy. Here, infectious disease
experts offer their thoughts on how parents can navigate these questions in the
face of great uncertainty.

Are playdates ok? Should I ground my teenager?

Some experts are taking a
hard line
, including the Pennsylvania Department of Health, which gives a
firm “no.”

Others say the answer isn’t clear-cut. “Everyone wants a
binary answer — do this, do that, yes or no,” says John Swartzberg, an
infectious disease specialist at the University of California, Berkeley. “This
is not a binary condition.”

The best answer, Swartzberg says, is highly individual. Factors like whether you’re in an area with lots of virus circulating, whether you live with an older person, or whether you yourself are at high risk of exposure through your job could all change the answer.

Parents
ought to ask themselves, “Am I doing my best to keep the spread of this virus
from happening?” O’Leary says. “That means changing a lot of behaviors, but not
necessarily never leaving your house.”

Some
parents have teamed up with another family to create a small circle that
interacts, but limits exposure to other people. This imperfect solution also
accounts for the fact that we may be in this scenario for a long time. “People
can do anything for a short time,” Swartzberg says. But families will struggle
to keep their children isolated for a long stretch of time, he says. “On the
other hand, if we stop [distancing] too soon, we might as well not have started
it.”

For
both young children and teenagers, the same principles apply: Small numbers of
people are better, outside is better than inside, no one with symptoms should
be present, and no face touching (an impossible expectation for young children).
And, of course, lots of handwashing.

One
more tip from Swartzberg: Wash the toys kids touch, and their clothes — a lot.

Should I take my children to playgrounds?

That’s not a good idea. The virus is known
to linger on hard surfaces
(SN:
3/4/20
), though it’s not clear how much that scenario might contribute to
infections. The virus
remains viable longest on plastic and stainless steel
, where it can be
detected for two to three days, though infectivity drops substantially after 48
hours, researchers report March 17 in the New
England Journal of Medicine.

“You can imagine young kids playing on a playground, and
they cough on a piece, then another child crawls on that, and then they rub their
eye,” O’Leary says. “That’s potentially a pretty easy way to spread it.”

Bottom line: Take a family hike or bike ride instead of a
trip to the playground.

Schools and day cares are closed. Can my parents watch my kids?

Contact between grandparents and grandchildren is
particularly risky with this coronavirus. That’s because people aged 60 and
older are at the highest risk of death from the disease. Of about 2,500 U.S.
COVID-19 cases reported as of March 16, adults 65 and older accounted for 53
percent of intensive care unit admissions, and 80 percent of deaths. In stark
contrast, no
ICU admissions or deaths have been reported for people 19 and under
, the U.S.
Centers for Disease Control and Prevention reports March 18.  

“If parents have the option to stay home with their kids and
not infect the grandparents, that’s obviously something they should seriously
consider,” says Valerie Reyna, a risk and decision-making expert at Cornell
University.

That may not be realistic. Normally, an estimated 40 percent
of grandparents in the United States babysit their grandchildren. That
percentage is likely to go up
as schools close around the country,
according to the CDC.

For parents at high risk of COVID-19, such as medical staff
and service workers, the best option is to stay away from older loved ones, says
epidemiologist Jennifer Horney of the University of Delaware in Newark. Other
families might be able to hunker down together, forming intergenerational,
closed groups.

Swartzberg, a grandpa himself, has been asked to keep his
distance from his grandchildren, whose parents are doctors who treat COVID-19
patients. Their new protocol involves walks outside, at a distance, but no
babysitting or hugs. This new way of life is “very reasonable, and very
painful,” he says.  

My kid just spiked a fever. Should we go to the doctor for a test?

No.
Chances are high that a test wouldn’t happen, given the still limited testing
going on in the country, and even if it did, clinical care wouldn’t change.

“There’s
no specific treatment that we’re going to give,” O’Leary says. Children who
might carry the virus ought to be cared for at home, unless they’re showing
signs of distress such as trouble breathing. Unnecessary trips to the doctors
would add to already burdened health care facilities and potentially risk
exposing health care workers, O’Leary says.

“There
are still a lot of people who are thinking this is not a big deal,” O’Leary
says. “This is a big deal. The sooner we recognize that, the better off we’ll
be.”