Worldwide, relatively few children have been reported with COVID-19, the disease caused by the novel coronavirus. 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 COVID-19 among children or from children to adults is less common.

Distance among children

Since children play a minor role in the spread of the virus, the 1.5 metre measure is less strict for young children:

  • Children up to and including 12 years of age do not have to keep 1.5 metres apart from each other and from adults. This also applies to childcare and primary education.
  • Young people aged 13 until 18 years old (i.e. 17 years old and younger) do not have to stay 1.5 metres apart from each other. In secondary schools, this applies to all pupils, regardless of their age.
  • In secondary vocational education (MBO) and higher education, all students should stay 1.5 metres apart, regardless of their age
  • Since adults play a greater role in the spread of the novel coronavirus, teachers need to stay 1.5 metres apart from others as often as possible.

Younger children with nasal colds symptoms are allowed to attend childcare and primary school

Children aged 0 to 4 years old with cold symptoms (runny nose, nasal cold, sneezing and sore throat) are allowed to go to the childcare centre or host parent, as long as they do not have a fever. Similarly, children in group 1 or 2 of primary school with cold symptoms may go to school and to after-school childcare, as long as they do not have a fever.
This does not apply if:

  • Children have had contact with a patient who has the novel coronavirus.
  • Someone in the household of the child has a fever or difficulty breathing (see the symptoms of COVID-19).
     

In that case, the child has to stay home, and it is important for the child to be tested for COVID-19*.
Children who have a cough, shortness of breath or other symptoms that could indicate COVID-19 should stay home until the symptoms are gone. Children can be tested at the request of their parents. Contact your GP if your child has severe symptoms.
It is known that young children often have a persistent cold. However, the number of children infected with the novel coronavirus is low.  In the first two weeks of June 2020, 3,500 children aged 0 to 6 years old who had symptoms were tested. 0.5% of these children tested positive. That percentage was higher in children who were tested in the same period because they had been in contact with a COVID-19 patient: 14.3%.

Preventing the virus from spreading in schools

To ensure that the spread of the novel coronavirus is kept to a minimum, it is important to follow the measures in schools: 

  • Do you have mild symptoms, such as a nasal cold, runny nose, sneezing, sore throat, mild cough or elevated temperature (up to 38 degrees Celsius)? And/or have you suddenly lost your sense of smell or taste? Get tested* and stay home until you get the results of the test. 
  • If you have a fever (higher than 38 degrees Celsius) and/or shortness of breath, everyone in the household must stay home.
  • 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).

* Please note: small children who have a cold do not always need to be tested. Testing is necessary if the children are in contact with someone infected with the novel coronavirus, if they are part of an outbreak investigation, or if they have other symptoms that could indicate the novel coronavirus.

More information can be found at government.nl.

Researching the role of children in the spread of the virus

Because the virus is still new, we are conducting extensive research to find out more about it. For example, RIVMNational Institute for Public Health and the Environment is researching the role of children in the spread of the virus. Read more below about what RIVM is doing, how we arrive at these conclusions, and what this means.

What does RIVM do?

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. For that reason, RIVM is conducting various studies on the role of children in the spread of COVID-19. RIVM:

Data from municipal public health services (GGDs)

Based on reports from municipal public health services (GGDs), children aged 0-17 years only represent 1.3% of all reported patients with COVID-19, although they comprise 20.7% of the population. Only 0.6% of the reported hospitalisations involved children under the age of 18. There are no reports of children who have died from COVID-19.

Since 1 June 2020, all Dutch people with (mild) symptoms can be tested for the coronavirus. Data from the GGD test lanes show that more than 16,500 tests were administered to children up to 12 years of age between 1 and 25 June; 0.3% of those tests were positive. More than 4,800 tests were administered to children between the ages of 13 and 18 years, and 1.4% were positive.  In the same period, nearly 14,000 people working in education or childcare were tested. 0.5% of these employees tested positive. This percentage is lower than the total of 1.3% of all people tested in the test lanes in the same period. 

 

Figuur: resultaten GGD-teststraten van medwerkers kinderopvang en PO

 

Results of childcare and primary education employees from GGD test lanes  

Spread of COVID-19 between people in the same age group

When reporting a COVID-19 patient, it is also possible to report which other patient is a probable source of the infection. This data shows that COVID-19 is primarily spread between people who are about the same age. The figure below shows data on 693 paired patients, displaying the ages of both the source patient and the patient that they infected. Transmission of the virus appears to take place mainly between people of about the same age, and less frequently between parents and children (of all ages).

transmissionpairs

 Based on source and contact tracing from the beginning of the epidemic, we see the following: looking at 10 COVID-19 patients who were <18 years old, they had 43 close contacts, and none of them became ill, whereas 8.3% (55/566) of the close contacts of the 221 patients who were ≥18 years old became ill. Now that widespread source and contact tracing is ramping up again, we will be able to update this information with recent data in summer. 

infected contacts according to age

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grafiek 2 infected contacts according to age

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At the start of the epidemic, all municipal public health services (GGDs) conducted source and contact tracing. They kept track of each source patient and monitored how many of their contacts also became infected. The upper chart shows the absolute numbers (infected/non-infected) of infected contacts according to the age of the source patient. The lower chart shows the percentage of the contacts who also became infected, according to the age group of the patient. Source patients under 18 who were monitored in this context did not infect others.

No infected children in GP practices

Around 40 GP practices in the Netherlands are registering the number of patients visiting the practice with flu-like symptoms; these are the Nivel monitoring stations. Using a cotton swab, a smear is taken 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, reaching 30%. No coronavirus infections were found in the 137 patients under 20 years old who were tested (based on data up to end of April 2020). 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. In this family-based study, there were no indications found in any of the 54 participating families that a child <12 years old was the source of COVID-19 within the family. The first part of the study has now been completed.   The second part of the study is still ongoing.  RIVM will be looking at the spread of the virus within families after a diagnosis of COVID-19 in a child. This approach gives us an even better opportunity to investigate how often an infection in children leads to further spread of the virus.

Antibodies in 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 in early April to participate. In early June, the initial study participants and a number of additional participants were asked to do 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.

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

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 1-2% in the under-20 age group, and about 4% in adults. The number of people with antibodies found in their blood is still low, especially among children. This is another indication that children are infected less frequently, and therefore play a less significant role than adults in the spread of the virus.

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. 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. Children with COVID-19 do have the same symptoms as adults. The most common symptoms in children are coughing, fever and sore throat. Worldwide, very few children with COVID-19 have died.

In clusters of patients, adults are almost always the source patient. A large study from Iceland that tested a total of 6% of the population shows that children are less likely to be infected than adults, both in those who were tested because of symptoms and in a random sample of the population.

Schools and childcare facilities

Primary schools have been partially reopened since 11 May. The schools reopened fully on 8 June. Childcare facilities are also open again as of that date. Secondary education, special secondary education, practical education and newcomer education reopened on 2 June. 

After double-checking with all 25 municipal public health services (GGDs), it has become apparent that there were no reports of possible COVID-19 clusters that had a link to schools or childcare facilities (or temporary childcare) before the schools closed on 16 March. After reopening the primary schools and childcare facilities, a few reports have come in regarding infections among employees at schools; RIVM has not received any reports of employees who were infected by children (based on data as of early June 2020).  The reproduction number R, which represents the average number of new infections by a COVID-19 patient, has fluctuated below 1 since mid-March. This means that the spread of the epidemic is slowing down. After the partial reopening of primary schools and childcare facilities on 11 May, there was no sudden increase in the reproduction number (based on data as of early June 2020). 

Experiences from schools in other countries

Schools have now reopened in various other 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. Denmark was the first country to reopen childcare and primary education, as of 15 April. They have not reported any negative effects after reopening the schools and are not seeing any increase in the reproduction number.  A study from Australia showed that there had been confirmed cases of COVID-19 in 9 children and 9 employees. 735 children and 128 employees had been in close contact with these patients. Two other children may possibly have been infected by one of these 18 patients. No other teacher or staff member contracted COVID-19. A study from Ireland looking at 3 children and 3 adults in schools, dating from before the school closure, showed that there were no infections by children in school. The study looked at 1155 contacts in total and identified two patients; these two were both adults that were related to two adult source patients, and the infection took place outside the school. There were 924 children and 101 adults who had had close contact with one of the source patients at school, and none of them had COVID-19.

Frequently Asked Questions

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.  If a family member is in a risk group, then also consult with the doctor and the 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.

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.

Would you like to know more over vaccinations and the novel coronavirus? Go to the frequently asked questions on the site of the National Immunisation Programme (in Dutch).