Worldwide, relatively few children have been reported with COVID-19. Data from the Netherlands also confirms the current understanding: that children play a minor role in the spread of the novel coronavirus. The virus is mainly spread between adults and from adult family members to children. The spread of the virus among children or from children to adults is less common.

Not all the information on our website has been updated according to the press conference on 27 May. We will update our information as soon as possible.

Because the virus is still new, we are conducting extensive research to find out more about it. This research focuses, among other things, on the role of children in the spread of the virus. Read more about what RIVMNational Institute for Public Health and the Environment is doing, how we arrive at these conclusions, and what this means.

What is RIVM doing?

After the first national measures were put in place, a debate arose in society about whether or not to close schools. Although the role of children in the spread of COVID-19 seemed limited at the time, there were many uncertainties. RIVM is conducting various studies on the role of children in the spread of the virus. RIVM:

  • studies in detail the reports of COVID-19 patients received from the Municipal Public Health Services (GGDs) in the Netherlands.
  • works closely with the monitoring stations operated by the Netherlands Institute for Health Services Research (NIVEL) to investigate the registrations provided by GPs on patients with flu-like symptoms who are tested for COVID-19.
  • conducts research among Dutch COVID-19 patients and their family contacts. Although this research and other studies are still ongoing, preliminary results are available.
  • has taken blood samples from more than 2000 people to test for antibodies against COVID-19; this is the first phase of a research project known as the PIENTER Corona study.
  • has reviewed relevant literature on children and COVID-19. These are studies that have been conducted in other countries.
     

Children play a minor role in the spread of the virus

RIVM research on the reported cases shows that COVID-19 is primarily spread between persons of approximately the same age. This is based on data from patients with symptoms. Most of these people are between the ages of 40 and 80 years. It is less common for adults to infect children. When this does happen, research shows that it mainly occurs in the home situation. Patients under 20 years play a much smaller role in the spread than adults and the elderly.

grafiek 2

Skip chart and go to datatable

At the start of the epidemic, all Municipal Public Health Services (GGDs) conducted source and contact tracing. They kept track how many contacts of a source patient also became infected. The upper graph shows the absolute numbers (infected/non-infected) of infected contacts according to the age of the source patient. The lower graph shows the percentage of contacts that also became infected, by age group of the patient. Source patients in the age groups under 18 years that were monitored here did not infect others.

When a COVID-19 patient is reported, it is also possible to report which other patient is a probable source of the infection. This has also become apparent from source investigation and contact tracing data. The figure below shows the ages of the infector and the infected in 461 paired patients (source patient=infector, secondary patient=infected).

Transmissions appear to take place mainly between infector and infected of about the same age, and to a slightly lesser extent between parents and children (of all ages).

transmissionpairs

The figure above shows the distribution of COVID-19 by age. The infector is the source of a COVID-19 infection, the one infected is the one who is infected by the infector. We call these transmission pairs. The size of the sphere indicates the number of transmission pairs in the infector/infected combination.

No infected children in GP practices

Around 40 GP practices in the Netherlands register the number of patients visiting the practice with flu-like symptoms; these practices are the Nivel monitoring stations. A swab is used to take a sample from the nose and throat of some of these patients; the resulting culture is examined in the laboratory to detect viruses, including COVID-19. A total of 6.5% of those patients turned out to be infected. This percentage was highest in week 14 with 30%. In the last weeks, the percentage has been about 15-20%. No coronavirus infections were found in the patients under 20 years who were tested. This confirms the current understanding that children are less likely to be infected and become ill than adults.

COVID-19 in Dutch households

Within a short time frame, RIVMNational Institute for Public Health and the Environment set up a study to find out more about people infected with COVID-19 and their family contacts. In cooperation with GGD Utrecht, various families took part in this study. A total of 54 households took part up to mid-April, involving 239 participants, including 185 housemates. This involves 123 adults and 116 children between the ages of 1 and 16 years.

Although the study is still ongoing, preliminary results are already available. There are no indications that children younger than 12 years old were the first in the family to be infected. Children who were found to be infected with COVID-19 were less likely to have symptoms than adults. Respiratory symptoms, such as sore throats, coughing and nasal colds, were also less common in children than in adults.

Antibodies in the blood are rare

The aim of the PIENTER Corona study is to gain insight into the course of the infection and development of antibodies in the Dutch population, in different age groups. For the ongoing PIENTER Corona study, 6,100 participants were invited to participate. They were asked to take their own finger-stick blood test up to 6 times over the next 1.5 years. With these measurements, it is possible to monitor the further spread of COVID-19 and the change in the development of antibodies in the population by age groups.

Finger-stick blood specimens from 2,096 people were examined between the beginning of the study and 17 April. Initial results show that 3.6% of these individuals actually have measurable  antibodies against COVID-19 in their blood. That figure was about 2% in the under-20 age group, about 4% in adults. The number of people with antibodies found in their blood is still low, especially among children.

Grafiek die lijn toont hoeveel % seropositief is per leeftijdgroep (jaren)

Few children infected worldwide

International research also confirms that the percentage of children among the confirmed COVID-19 patients is low, ranging from 1% in young children to 6% in older children. For example, China, Korea, Italy, Spain and the United States have already conducted research on COVID-19 and children. International research shows that the disease in children is generally much milder than in adults. Worldwide, very few children with COVID-19 have died. Children with COVID-19 do have the same symptoms as adults. The most common symptoms in children are coughing, fever and sore throat. Contact tracing shows that none of the children have infected other people.

Schools have now reopened in various European countries. RIVM is in close contact with sister organisations in these countries to evaluate the impact of this policy on the spread of the novel coronavirus there.

Secondary schools vs Primary schools

The primary schools have partially opened since 11 May. It is still too early to know what impact this will have on the spread of the novel coronavirus. Similarly, information from other countries where the schools are open is not available yet. RIVM is keeping a close eye on this. Once we have the information, we will publish it on this page.

Secondary education, special secondary education, practical education and newcomer education will reopen on 2 June. To ensure that the spread of the novel coronavirus is kept to a minimum, it is important to follow the measures in schools:

  • Stay home if you have cold-like symptoms, such as a nasal cold, runny nose, sneezing, sore throat, mild cough or slight temperature (up to 38 degrees Celsius).
  • Stay 1.5 metres away from other people
  • Practice good hygiene (wash your hands often with soap and water, cough and sneeze into your elbow, use paper tissues to blow your nose and discard them after use)

It would be preferable to have schools providing lessons all day long. This ensures that people can avoid travel as much as possible. A framework is being developed for the transport of pupils in special education.

 

Frequently Asked Questions

Why is the 1.5-m measure for young children less stringent?

This is because children play a smaller role in the spread of COVID-19 than adults. We know that there are few children with COVID-19 and that when children become ill, the disease is milder. Ongoing research suggests that the transmission of the virus from one child to another or from children to adults is less common. So going to school and playing outside is therefore possible.

Nevertheless, it is wise to limit contact between children from different groups, between children and parents and between parents themselves as much as possible. That is why the 1.5-meter measure should be applied as much as possible, especially between primary school pupils and teachers. It is also essential that children regularly wash their hands with soap and water, and cough and sneeze in the inside of the elbow.

Why do teachers have to keep their distance from others?

Adults play a more significant role in the spread of COVID-19 than children. We know that the transmission of the virus from one child to another or from children to adults is less common. However, children can be infected by adults. That is why the 1.5-metre measure should be applied as much as possible, especially between primary school pupils and teachers.

My child belongs to a risk group, can my child attend school, childcare and BSO?

Children with underlying health conditions do not seem to run a greater risk of a severe course of COVID-19 than healthy children, with the possible exception of children with severe obesity and or diabetes. In case of doubt, it is wise to consult with the attending physician (or paediatrician) and school management.

Can COVID-19 cause a severe inflammatory response in children?

Reports have been received from abroad about some children with a severe inflammatory response, suggesting a possible link to COVID-19.  These children presented with a fever, a skin rash and inflammation around the heart. The symptoms are similar to those seen in Kawasaki disease. Research will show whether there is a link to COVID-19.  As yet, this has not been proven.

My child has persistent cold symptoms / hay fever. Can he or she go to school / childcare / sports activities?

If your child has hay fever or a chronic cold every year, you will recognise the symptoms.  In that case, the child may go to school as usual. If you are uncertain whether the symptoms are different than usual, keep your child at home until the (new) symptoms go away.

My child’s school/ childcare facility does not want to accept my child’s attendance because he or she has persistent cold symptoms / hay fever. What should I do?

Have a talk with the school and explain that you recognise the symptoms as a chronic cold or hay fever, and that these symptoms are normal for your child. In that case, the child can go to school as usual. If there is any doubt, or if the symptoms change, the child must stay at home until the (new) symptoms go way or the familiar pattern of symptoms has returned to normal. If the conversation with the school or childcare facility does not have any results, please contact the local Municipal Public Health Service (GGD). The GGD will give advice in specific situations based on official guidance.

A household member belongs to a risk group. Can my child go to school?

If a family member is in a risk group and receiving specialist treatment, consult with your doctor and the school management as to whether the child can go to school.

Can teachers and people working in daycare and BSO be tested?

Yes, they can be tested for COVID-19 if they have a nasal cold, cough or fever for more than 24 hours. From June on, it will be possible to test everyone in the Netherlands who has symptoms that could indicate the novel coronavirus. If the test shows that you are infected with the novel coronavirus, the Municipal Public Health Service (GGD) will carry out intensive source and contact tracing.

Why will the reopening of primary schools and childcare not result  in more Intensive Care admissions?

This is because children play a minor role in the spread of COVID-19. We know that there are few children with COVID-19 and that when children become ill, the disease is milder. Respiratory complaints are also less common in children compared to adults. It is therefore expected that the re-opening of schools and childcare will not result in more admissions to Intensive Care.

What about the vaccinations within the National Immunisation Programme for my child and the novel coronavirus?

It is very important that your child receives the usual vaccinations provided within the National Immunisation Programme (RVP in Dutch). If, for example, you postpone the 14-month vaccinations, there is a risk of diseases such as measles and meningitis caused by meningococcal infections. These are highly contagious diseases that still occur in the Netherlands. If you or your child has a cold or a fever, or if someone in the family has a fever, please contact the well-baby clinic.