Study Aims To Uncover Rate Of COVID-19 Infection Among US Children

The National Institutes of Health (NIH) has launched a new study to determine the rate of COVID-19 infection among U.S. children.

The study, known as the Human Epidemiology and Response to SARS-CoV-2, or HEROS, will recruit 6,000 people from 2,000 U.S. families located in 11 cities, according to a statement from the National Institute of Allergy and Infectious Diseases (NIAID). The participants will be pooled from other NIH-funded pediatric research studies, in order to expedite recruitment, and will include healthy children and children with asthma or other allergic conditions.

The research team will monitor each child and their family for six months to track who catches COVID-19, whether the children transmit the virus to other family members and which family members ultimately develop symptoms.

"One interesting feature of this novel coronavirus pandemic is that very few children have become sick with COVID-19 compared to adults," NIAID Director Dr. Anthony Fauci said in the statement. "Is this because children are resistant to infection with SARS-CoV-2 [the virus that causes COVID-19], or because they are infected but do not develop symptoms?"

The HEROS study could help fill critical gaps in knowledge by investigating how COVID-19 manifests in children, Dr. Tina Hartert, lead researcher of the HEROS study, added in the NIAID statement.

"So far, data on the extent of SARS-CoV-2 infection in the U.S. population have been limited to people who physically interact with the health care system: those who are tested — especially those who test positive — and those with severe disease," Hartert said. While somewhat valuable for guiding public health policies, these data do not "enable us to understand the full extent of SARS-CoV-2 infection in the entire population," she said.

For instance, preliminary data from an NIAID-funded study, published online April 22 in the Journal of Allergy and Clinical Immunology, suggest that children and adults with respiratory allergies, asthma or a sensitivity to allergens may harbor fewer ACE2 receptors in their airways. The coronavirus SARS-CoV-2 exploits ACE2 receptors as a doorway into cells, so theoretically, people with fewer ACE2 receptors may be less likely to contract a severe infection than people with large quantities of these receptors, the authors speculated. By including children with and without allergies, the HEROS study may help determine how allergies and asthma relate to COVID-19 risk.

The HEROS study will be conducted remotely, so a caregiver in each child's household will be tasked with collecting nasal swab samples from the primary study participant and other enrolled family members every two weeks. Along with collecting swab samples, the caregiver will complete online questionnaires about each participant's symptoms, social-distancing practices, activities outside the home and exposure to people who are sick.

If any member of the household develops symptoms of a possible viral infection, the family will complete a special questionnaire to determine whether the illness is likely to be COVID-19. If so, the infected person will be asked to supply a stool sample within 24 hours, and the designated caregiver will also collect additional nasal swabs from every member of the household. The nasal swabs and stool samples will be screened for the presence of SARS-CoV-2, and any airway cells collected in the process will also undergo genetic analysis.

The caregiver will also collect blood samples from participants at two weeks, 18 weeks and 24 weeks after study enrollment, as well as three weeks after the first likely case of COVID-19. They will collect blood samples "using a new, nearly painless device that extracts a small quantity of blood through the surface of the skin," the NIAID statement said. The blood will be screened for antibodies "once an appropriate antibody test becomes available," the statement added.

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