How children are affected by COVID-19 in Beaufort County, SC

Teenagers are now playing a larger role in the course of Beaufort County’s coronavirus outbreak.

More than 30% of the county’s COVID-19 cases last month were identified among 11- to 20-year-olds, according to S.C. Department of Health and Environmental Control data.

Just 13.1% of infections, meanwhile, were recorded among people 61 or older.

As the Beaufort County School District resumes face-to-face instruction this week, DHEC’s data offer a stark reminder: mitigating COVID-19 transmission in classrooms will prove crucial to preventing further local disease spread this fall.

“The older age groups, especially children over the age of 16, do seem to be acting more like the people in their 20s,” said Dr. Frank Esper, a pediatric infectious disease specialist at Cleveland Clinic Children’s in Ohio.

That trend wouldn’t be unique to the Lowcountry.

Some of South Carolina’s biggest counties reported similar case numbers in September. And researchers at the Centers for Disease Control and Prevention recently found that 12- to 17-year-olds are about twice as likely to contact SARS-CoV-2 than younger kids.

“We really shouldn’t be surprised,” said Dr. Tamera Coyne-Beasley, a pediatrics and internal medicine professor at the University of Alabama at Birmingham. For teenagers and young adults, “social interaction is incredibly important,” she said.

A sign at the Bluffton campus of the University of South Carolina Beaufort welcomes the class of 2024, as seen on Tuesday, Aug. 11, 2020, and is located west of Sun City Hilton Head. A form of in-person and virtual classes will begin Thursday, Aug. 20, 2020. (This caption has been updated to reflect the starting date for when classes resume.) Drew Martin ‘They weren’t detected’

Five months ago, Beaufort County’s COVID-19 caseload looked much different from today.

Before the summer surge, only 8.7% of infections in May were among 11- to 20-year-olds, DHEC data show. By June, that figure had ticked up to 23%. In August it sat at 25.2%.

Young adults 21 to 30 accounted for a higher percentage of cases month-to-month until August. For example, that age range comprised 25.8% of the county’s infections in June.

Experts, though, said adolescent cases spiked later due to several compounding factors.

Esper said that in March, April and May, the country was mostly testing symptomatic patients and people at heightened risk for critical illness, like elderly residents in nursing homes.

Children and teenagers weren’t tested as much, he said, considering how they’re typically prone to mild bouts with the disease.

“They probably flew under the radar,” Esper said. “They weren’t detected.”

Once states were able to test at a greater scale — like South Carolina in early July — adolescents started to show up more frequently in case numbers, Esper said.

Coyne-Beasley, though, added that infections among teenagers also rose this summer after Memorial Day and the Fourth of July, as school-age kids congregated together.

“Adolescents are more likely to take risks and experiment as they explore the world around them,” Coyne-Beasley said, “and this is particularly important around COVID, because they’re also receiving mixed messages about what they should do with the adults in their lives. ‘Do you wear masks or don’t you wear masks?’ You know?”

Dr. Amyna Husain, a pediatric emergency medicine professor at Johns Hopkins University and the assistant pediatric director of Johns Hopkins Hospital’s biocontainment unit, stressed that an increase in adolescent COVID-19 cases could also be traced back to school reopenings.

However, depending on how well education systems enforce social distancing and mask requirements, Husain said future SARS-CoV-2 outbreaks might be limited at schools.

The average age of those attending face-to-face classes could also play a role in later virus transmission.

Only 2.5% of Beaufort County’s cases were recorded among those 10 or younger last month, DHEC data show.

That figure isn’t unusual, experts say. Children under the age of 10 are easier to control and are seemingly less susceptible to the virus.

Chloe Clark, an eighth grade student at Beaufort Middle School, practices her new trumpet on Monday, Oct. 5, 2020 on the first day of in-person instruction. Chloe chose the equipment room to remain socially distanced from four other music students as Amanda Trimpey, instrumental music director, worked with in-person and virtual students. The Beaufort County School District is developing hybrid models of in-person instruction to keep staff and students safe from the spread of the coronavirus. Drew Martin Returning to class

As Husain pointed out, the county’s high case numbers among 11- to 20-year-olds last month were likely driven, in part, by local students testing positive for the coronavirus at the start of the academic year.

For example, since the University of South Carolina Beaufort began in-person and remote classes in late August, 46 cases have been identified on campus, school data show.

Carol Weir, a USCB spokesperson, said those statistics could include cases among faculty and staff, too.

But, hypothetically, if only 30 of the USCB cases last month were students under the age of 21, that would make up roughly 11% of all September infections — 252 in total — among 11- to 20-year-olds in the county.

Justin Shelley, left, interim Director of Housing and Judicial Affairs at the University of South Carolina Beaufort, listens to recommendations made by a past resident advisor during a training session on Tuesday, Aug. 11, 2020 at the Bluffton campus. Shelley was going over protocols on how to deal with students who have a party in their dorms during the coronavirus pandemic. “There shouldn’t be 20 people in the room.” he stressed to the students. “Please put on a mask and then give a mask to those not wearing a mask.” he stressed before a R.A. writes a violation. “We (the university) only have so many quarantine and isolation spaces.” Drew Martin

At private K-12 schools, meanwhile, a handful of student cases have been reported to DHEC since August.

And at BCSD schools last month, there were nine student cases recorded as of Sept. 24, at least among kids who regularly visited buildings.

In other words, there were no major outbreaks in September, according to DHEC data.

But even a slight uptick in cases among 11- to 20-year-olds could have skewed the county’s numbers, as daily case counts fell and disease spread leveled off.

Experts, though, remain concerned that as face-to-face instruction resumes around the country, SARS-CoV-2 transmission will spike in classrooms and eventually affect surrounding areas.

This week, more than half of BCSD’s 22,000-plus students are returning to school buildings as part of a “hybrid” schedule. Kids will attend in-person classes twice a week under the plan, which also includes a campus mask mandate, among other precautions.

“Children are contributing to spread in the community,” said Dr. Amanda Castel, an epidemiology professor at George Washington University. “For the schools, in particular, it re-emphasizes the need to make sure that the proper mitigation protocols are in place, that social distancing can be followed, that children and the staff are wearing masks.”

Battery Creek High School principal Chad Cox reminds students on Monday, Oct. 5. 2020 to keep distance betweed each other and follow the one-way directions in the stairwell. Cox said that a pre-pandemic student count would have placed about 800 students in the halls of Battery Creek. On Monday that figure was around 165 students. The Beaufort County School District is developing hybrid models of in-person instruction to keep staff and students safe from the spread of the coronavirus. Drew Martin

When students inevitably contract the coronavirus at school, they may carry the pathogen home and infect older, more at-risk relatives, Castel said.

If in-person school reopenings go poorly, a “nightmare” scenario might track like this, added Michael Schmidt, a microbiology and immunology professor at the Medical University of South Carolina:

The virus will spread rapidly, and taking into account the lag time between an infection and a possible hospitalization or death, a COVID-19 surge at hospitals will coincide with the start of flu season.

Children are typically less affected by SARS-CoV-2, Esper stressed.

But that doesn’t mean they can’t be hospitalized, die (in rare cases) or pass the virus along to other people more likely to experience serious COVID-19 complications.

“Anybody — an adult, a child, an adolescent — can be asymptomatic,” Coyne-Beasley said, “and still have the infection.”

Similar to Beaufort County, over 35% of cases in Richland County were reported in the 11- to 20-year-old age range in September, according to DHEC data current as of last Thursday.

Roughly 31% of cases in Charleston County were among that age group, too. And 31.7% of infections in Horry County were recorded among 11- to 20-year-olds.

“Children are more resilient,” Esper said, but they’re not “off the hook.”

“They can get infected. They can spread.”

Sam Ogozalek is a reporter at The Island Packet covering COVID-19 recovery efforts. He is also a Report for America corps member. He recently graduated from Syracuse University and has written for the Tampa Bay Times, The Buffalo News and the Naples Daily News.

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