COVID cases climb among Tennessee children as schools seek to resume instruction

In one-week period, cases increased 20% among state’s school-age children

Stratton Elementary School (Photo: Metro Nashville Public Schools)
Stratton Elementary School (Photo: Metro Nashville Public Schools)

A football player at a Knox County Catholic high school tested positive for COVID-19 two weeks after team practice got underway in early July. Practice was suspended for another two weeks as a precaution.

In Oak Ridge, a band student and an instructor tested positive for the virus at the public high school’s band camp, a note from the district’s superintendent said. The camp shut down, the school rooms used for practice were deep cleaned and the superintendent told students and parents to get in touch with their physicians for guidance. 

And in Alcoa, a city of 11,000 in Blount County, an individual tested positive two days after the city’s middle school resumed in-person classes on Wednesday. In a note to parents and guardians, Principal Rebecca Stone said families would be notified over the weekend if their child had come into contact with the individual and then asked to quarantine for 14 days. The note did not specify if the infected person was a student, teacher or parent. 

Five months into the COVID-19 pandemic, public and private school officials across Tennessee have unveiled a patchwork of plans for a return to schooling even as cases among children are climbing and much remains unknown about the virus’ impact on children. 

As of Monday, 8,834 Tennessee school age-children, ages 5-18, have tested positive for the virus, according to the state’s health department.

That represents an increase of 1,627 positive cases — a 20 percent jump — among school-age children in Tennessee over the course of one week.

The state’s children also have had a higher positivity rate than adults, meaning more children who have been tested for the virus have had positive results, according to health department data.

In total, 12,953 children, ages birth to 18, have tested positive as of Friday — a test positivity rate of 12.9% on 99,991 tests performed on children in Tennessee, according to department data.

Experts said that it makes sense that more children being tested for the virus are positive, compared to adults. Adults without symptoms may be more likely to seek out testing in order to return to work and because of widely available testing in Tennessee. Children, who have been out of school since March, may not have gotten tested unless they displayed symptoms.

The race of children who are positive mirrors the state’s overall COVID-19 racial breakdown. Roughly 16% of infected children are African American, 38 percent are white, 20 percent are multi-racial. About 25% of cases are still pending demographic data.

Race of Tennessee children positive for COVID-19. Data source: Tennessee Department of Health

COVID-19 has thus far behaved differently than other respiratory infections in children, said Dr. Buddy Creech, director of the Vanderbilt Vaccine Research Program and associated professor for Pediatric Infectious Diseases at Vanderbilt University School of Medicine.

“Usually respiratory infections especially affect children, particularly young children,” Dr. Creech said. “This has been different. It’s flipped. It’s not anywhere close to the severity in children.”

Most of the children with the virus Dr. Creech has seen are through tele-health because their symptoms are mild enough for them to stay home. Many of his child-patients’ positive tests were “incidental findings,” when a child, for example, was given a precautionary test before an unrelated surgery, he said. Children with symptoms have tended to experience vomiting, diarrhea, and, in a few cases, respiratory symptoms, he said.

In the few cases of children Dr. Creech has treated in hospitals, “we are seeing this multi-system inflammatory syndrome that looks a lot like Kawasaki’s disease,” he said. In those cases, the virus can attack children’s organs and respiratory system.

“We’re still learning about those children,” he said.

“In the West we have not had in-person school since the beginning of this pandemic and some would hypothesize that the reason we are not seeing so much in kids is because they are not in school,” he said. “But then you look at Denmark, where school opened about 10 weeks ago, and they are doing well.”

“I think a return to school absolutely has to be contextualized to the local community,” he said. “If the local community has high rates, then that (school) has to be modified so as not to go on feeding the fire.”

Dr. Creech, a father of three, has had a closer perspective on the course of the disease in children than many of his colleagues.

In March, the doctor, then his wife, and ultimately all three of their children — ranging in age from a second-grader to a college student — were among the first Tennesseans to contract COVID-19.

“I think I was (patient) No. 8 and my wife was No. 10 back in March,” he said.

The entire family has since recovered.

Dr. Creech and his wife, a school teacher, plan to send their children back to school once in-person instruction has resumed.

“I am going to send them back because they’ve had COVID and because I know when we do have in-person instruction it will be because my children’s schools’ will have contextualized disease data in the community,” he said.