"The Covid-19 really does not concern children very much"

Christèle Gras-Le Guen, General Secretary of the French Pediatric Society, Head of the Pediatrics Department at Nantes University Hospital.

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• "Children rarely get infected and when they do, it's not serious"

• "Barrier measures and distancing must mainly concern adults"

• "We must not find ourselves in a situation where we have to make the children undergo a test per month or even per week"

Contagion, masks, closing of classes… There were still many questions in the conversations of parents and teachers on Tuesday at the start of the school year.

The assertions concerning the Covid-19 and the child remain sometimes contradictory.

went to interview Christèle Gras-Leguen, secretary general of the French Pediatric Society and head of the pediatric emergency department of the Nantes University Hospital, to take stock.

Is Covid-19 dangerous for children?

It is a disease that we know better and better, certainly better than at the time of confinement.

And what we know is that this virus really affects children very little.

There are two aspects to this.

The first: the proportion of infected children is very low compared to adults, around 1 to 5% among positive cases.

The second: when children become infected, they develop mild forms in the vast majority of cases.

Almost half don't even have symptoms.

So they rarely get infected and when they do, it's okay.

These are data confirmed by all the countries affected by this pandemic.

Does age increase the risk?

This is one of the originalities of this disease: newborns become infected very, very little, infants very little, children up to 10-11 years old, it is rare.

And then, then, from adolescence, there is a progressive continuum until adulthood.

The closer you get to adulthood, the more likely you are to catch the virus and develop a symptomatic form.

This is a finding that suits us well since it roughly corresponds to the school organization with colleges and high schools.

However, there is hardly any serious form in adolescents.

The serious forms, remember, it remains the elderly and adults with co-morbidities.

Are children with chronic illnesses at increased risk?

Unlike in adults, we have not observed a direct link between chronic pathologies [obesity, diabetes, asthma, etc.] and the development of the disease.

It is difficult to establish a general rule because we have had very few cases of positive children but, for the moment, we have no particular concerns for a particular patient profile.

This is something very surprising because we know, for example, that for influenza, chronic pathologies predispose to severe forms of the disease.

We asked several learned societies, specialists in pediatrics.

All advocate that all children return to school.

However, he said to himself at the start of confinement that children could be the main transmitters of the virus?

It was not confirmed at all.

We thought that because the Covid was new and that's what happened with the flu.

However, definitely, it has nothing to do with the flu.

And, unfortunately, this idea of ​​transmitting children persists as a misconception.

The information collected since, during the study of the clusters in particular, shows that the child is very little involved in the contaminations, unlike the flu.

A teacher is more at risk of infecting a student than the other way around.

What about Kawasaki disease?

Is there a link with the Covid-19?

It was observed at one time that the coronavirus could generate several weeks after infection a post-infectious syndrome similar to Kawasaki syndrome which, usually, mainly affects the youngest.

Once you have diagnosed Kawasaki, there is a treatment that has worked very well in the vast majority of cases.

Today, we know that it exists, we are on alert, we will quickly be able to diagnose a possible Kawasaki and administer the treatment.

But it remains marginal: we are talking about 200 cases, compared with the 275,000 cases of Covid in France.

But then, is it relevant to maintain social distancing and barrier gestures between children in the yard, in sports clubs, in associations?

We obviously understand the precautionary principle, but we must avoid distancing measures which can be stressful for the child, contrary to the course of a normal day, and which are not based on scientific data.

Barrier measures and distancing should mainly concern adults.

Children must be able to resume a child's life, play with each other, interact with each other, without this generating excessive worry on the part of their supervisors or their parents.

I see that they are still very worried when we should have been able to reassure them much sooner.

In some European countries, the mask is compulsory in school well before the age of 11.

In others, it is not imposed on teenagers.

Why these differences?

I will not be able to justify the choices of foreign countries.

For France, the choice of 11 years old follows recommendations based on the most precise scientific reading possible and on what seems, to us pediatricians, rational.

The important thing was to find a compromise between the scientific data and the feasibility of wearing a mask.

Of course, we will have to remain vigilant about the epidemiology and be able to adapt the measures, in one direction or the other, when the time comes.

Schoolchildren wearing masks in the canteen.

- L. Bonaventure / AFP

Should all students with symptoms be tested?

We recommend the test from the age of 6, if there is no obvious sign of another disease.

With winter, viruses (bronchiolitis, flu, gastro, rhino, etc.) will come back, for sure, and each time, we will ask ourselves the question of whether it is not the Covid.

We know, for example, that a child in a nursery has an average fever four to six times in the winter.

We must not find ourselves in a situation where we have to subject children to a test every month or even per week.

It is also recommended to have children over 6 months of age vaccinated against the flu because the symptoms can be confused with those of the coronavirus.

By the way, there are about ten children in France who die of the flu every winter and the vaccine is used very little.

Should we close the class as soon as a positive case appears?

We know that most positive children are infected in their family environment and that they do not contaminate themselves very much.

It is therefore considered that a positive child does not justify a class closure, nor a second.

Beyond that, yes.

Our real concern is that the children are going through a truncated second school year, with closures and reopens.

This year really has to be as stable as possible.

You insist a lot on the importance of school ...

There is the knowledge aspect, which is all the more important when there are social inequalities.

But there is also well-being: a child must play, be with his friends, be carefree.

Children must be given a living environment that is a childlike environment and not a crisis environment.

They have to get back to their childhood.

I hope it will.

Many teachers have sent us very reassuring messages.

Conversely, health professionals recently published a column calling for more restrictive measures in schools ...

This forum surprised us a lot because no doctor or child caregiver is among the authors, no scientific rationale is presented.

We do not understand what their concerns and recommendations are based on.

What should not be done is for there to be several speeches and initiatives by school leaders or elected officials that end up in a cacophony.

Can we still have surprises with this coronavirus?

Yes.

It is a new disease.

We know her better and better.

But you would have to be crazy to consider that you have mastered it perfectly.

We must stay alert.

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