In this issue of Pediatrics, Posfay-Barbe et al6 report on the dynamics of COVID-19 within families of children with reverse-transcription polymerase chain reaction–confirmed SARS-CoV-2 infection in Geneva, Switzerland. From March 10 to April 10, 2020, all children <16 years of age diagnosed at Geneva University Hospital (N = 40) underwent contact tracing to identify infected household contacts (HHCs). Of 39 evaluable households, in only 3 (8%) was a child the suspected index case, with symptom onset preceding illness in adult HHCs. In all other households, the child developed symptoms after or concurrent with adult HHCs, suggesting that the child was not the source of infection and that children most frequently acquire COVID-19 from adults, rather than transmitting it to them.
These findings are consistent with other recently published HHC investigations in China. Of 68 children with confirmed COVID-19 admitted to Qingdao Women’s and Children’s Hospital from January 20 to February 27, 2020, and with complete epidemiological data, 65 (95.59%) patients were HHCs of previously infected adults.7 Of 10 children hospitalized outside Wuhan, China, in only 1 was there possible child to adult transmission, based on symptom chronology.8 Similarly, transmission of SARS-CoV-2 by children outside household settings seems uncommon, although information is limited.