Sadie and Phoebe Worthen, 4, smile as they leave Sedge Garden Elementary with their sack meals on Monday. Children can get a breakfast and lunch each weekday for free and adults can purchase breakfast for $1 and lunch for $2.

The spread of the COVID-19 virus over the past several months has been a public health crisis like nothing we have seen in most of our living memories. Mixed in with the fear has been a steady drumbeat of misinformation (no, drinking bleach will not cure the coronavirus). Children and parents have been especially confused about how much to worry.

This is what we know about children and COVID-19 (with the caveat that information is changing rapidly as outbreaks spread around the world). First, children can get infected with COVID-19 and generally have the same symptoms as adults: fever, cough, muscle aches and shortness of breath. Less common but still reported symptoms include sore throat, headache, nausea, vomiting, diarrhea and runny nose. Based on data from China, there have been no known instances of transmission from pregnant mothers to their fetuses. The CDC has also not advised that COVID-positive mothers refrain from breastfeeding — and, in fact, breastmilk may confer protection to newborns. A key point for parents and kids to know is that older adults have made up most of the cases to date and infants and children have generally had milder symptoms than adults. Out of more than 100,000 cases worldwide and more than 5,000 deaths, there have been no deaths in children under 10 years old as of this writing. One adolescent has died of the virus. One toddler required intensive care but has since recovered. There are very little data about children with underlying chronic conditions, and until more is known, we need to be cautious about these potentially vulnerable kids. But overall, the tiny number of severe cases in children is astounding given the vast spread of this disease, and it is quite different from almost every other viral illness.

It remains one of the biggest mysteries of this pandemic. During the “Spanish” flu pandemic of 1918, many children and young adults died. We know COVID-19 is different but don’t yet know why.

So, does that mean that all of the cancellations, precautions and social distancing is all overblown? No. There are still many vulnerable populations, including the elderly and those with chronic cardiac and respiratory conditions, for whom this disease can be deadly. Our biggest mistake with this pandemic would be to underestimate it. While to some these measures seem overblown, an inadequate response would be catastrophic.

We have already seen vast numbers of sick adults in China, Iran and Italy. We should not ignore the warnings from those countries, and it is to our advantage to act sooner rather than later. The best analogy is using a fire extinguisher to put out a fire on the stove — when the fire is small, a fire extinguisher may be all you need, but if the whole kitchen is on fire, it’s too little too late. Now is the time to act. While some have pointed out there are far fewer COVID-19 infections and deaths at this point than the flu causes in a typical flu season, this is just the beginning of this story and we are nowhere near the peak.

So, how should parents and kids react to all this? For the most part, we need not fear for children’s own safety, given the information that kids are relatively spared from this illness. But taking precautions and being prepared are still crucial. The advice that we have all been hearing about washing hands is critically important (think about how often doctors and nurses are exposed to illnesses and how uncommonly they get sick — it’s the handwashing). But equally important is our civic duty to social distance ourselves. We must avoid large gatherings and outings (though it is perfectly fine to let children go outside to play). This is by far the best way to slow the spread of the virus and ensure that limited resources, such as intensive care hospital beds, are sufficient to care for people who become seriously ill. As we talk our children through this, let’s help mitigate their fears but also inspire them to be the kind of citizens who do the right thing for their neighbors. School is out, but kids are still learning. In the battle against this virus, they are as important foot soldiers as any of us.

Dr. Suresh Nagappan is a pediatrician who works in Greensboro.

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