Experts Explain Why COVID-19 Rates Appear to Be Rising in Children

When the pandemic first began last year, experts believed children and young adults were less likely to contract COVID-19. But based on a recent Morbidity and Mortality Weekly Report (MMWR) issued by the Centers for Disease Control and Prevention (CDC), it seems that this assurance may be changing.

The report traced infection rates from March 1, 2020 until December 12, 2020, showing a sharp spike among people ages 0 to 24 during the first two weeks of September. The surge was especially high within the 18 to 24 age group. After a short-lived slowdown in cases at the beginning of October, infections rates rose steadily among those 0 to 24 through December—mirroring the trends of adult cases.

Although the MMWR showed that rates were rising, the study found that infection rates were still lower for younger children. Rates of infection were lowest for preschool and elementary school children, indicating that in-person schooling, while risky, may not be as problematic as it once seemed.

Why Are There More Positive Cases?

Zachary Hoy, MD, a pediatric infectious disease specialist with Nashville Pediatric Infectious Disease, tells Verywell that some of the increases may be due to increased testing availability.

"There's an increase for every group from September to December because the test availability has increased, as has how fast the turnaround time for testing is," Hoy says.

He says that it's not just the increased availability of testing that made a difference. The need for testing has increased due to more symptomatic cases, especially in the 14 to 18 and 18 to 24 year range.

"Those that have underlying medical conditions are more likely to be symptomatic and get tested since COVID-19 can have more risks for those people," Hoy says. "We don't see underlying conditions as frequently in younger children. So those teens and young adults may be more symptomatic and are getting tested more frequently."

There are several theories as to why younger children don't appear to be contracting the virus as often or as severely as older children or adults. One theory, Hoy says, is that many tests aren't administered as thoroughly as needed if healthcare personnel are uncomfortable swabbing children.

Children may also shed the virus more quickly than older people. With the virus leaving their bodies after a few short days, they may never test positive or show any symptoms.

Contact tracing has also become more efficient, meaning teens that work in public-facing part-time jobs, such as restaurants or grocery stores, may be exposed and tested more often, Hoy says.

Is In-Person Schooling a Risk Factor?

Is the surge in cases linked to school coming back in session? Yes and no. On any normal year, viral infections increase when school is back in session, whether strep, influenza, or other viruses.

"Although school is likely a component, I don't think it's the whole reason, as infection rates are rising among adults as well," Hoy says. "More people are congregating in the same area."

With seasonal weather changes pushing more people inside, a perfect storm of factors is most likely at play. Since many children are involved in hybrid schooling or virtual learning, Hoy says that more conclusions will likely be drawn down the line based on continuously-gathered research.

Ilan Shapiro, MD, FAAP, FACHE, medical director of medical education at Altamed Health Services in California, and spokesperson for the American Academy of Pediatrics, tells Verywell that overall, in-person schooling is necessary for the health and well-being of many children, despite increased infection rates.

"We know that schools are extremely important for socializing," Shapiro says. "Especially here in California, a lot of students depend on the schools for food and shelter, and safety."

Shapiro says that he expects case numbers will start to drop now that the holidays are over. "We're past the peaks from Christmas and New Year's where there were gatherings all over the country," he says. "We see that the peak is slowly going down and getting more stable."

While the holidays are in the rearview mirror, Shapiro says that it's what happens outside of school that can make a difference. For children whose parents are essential workers, exposure risks will continue to be high until vaccines are widespread.

Both Shapiro and Hoy agree that in-person school can be conducted safely with the right protocols in place. In fact, the benefits to most students seem to outweigh the risks.