Children are unlikely to have been the primary source of household SARS-CoV-2 infections

Yanshan Zhu; Conor J Bloxham; Katina D Hulme; Jane E Sinclair; Zhen Wei Marcus Tong; Lauren E Steele; Ellesandra C Noye; Jiahai Lu; Keng Yih Chew; Janessa Pickering; Charles Gilks; Asha C Bowen; Kirsty R Short

The limited number of defined SARS-CoV-2 household clusters with children as the index case could have been influenced by the fact that disease in children can be asymptomatic. Accordingly, it is possible that within a household cluster children were not correctly identified as the index case of the infection (i.e. the first to develop symptoms) and were instead mistakenly identified as a contact case. To exclude this possibility, we reanalysed the data looking at the number of families where an adult was identified as the index but one or more children were identified as asymptomatically infected ( Figure 1 ). However, even if we assume that all asymptomatic children in these families were in fact the index case, only 6/28 (21%) children were identified as the index case in the household cluster ( Table 2 ). These data suggest that even if children are being mistakenly overlooked as the index case, they are still likely to only have accounted for a limited percentage of household cluster transmissions of SARS-CoV-2.