“SARS-CoV-2 PCR: DETECTED”: This is a lab result no one wants to get. If teens test positive for COVID-19, whatever semblance of normality they have vanishes instantly. For typical teenagers, “temporary” is not in their mind-set. Their adolescent brains are still developing and they still believe that what happens today will last forever. Teens may feel that being forced to quarantine is punishment.

Teens may not recognize that they have COVID-19 since symptoms may be mild or absent. If they do have symptoms, they may not tell anyone as they do not want to face the consequences of a positive test. Some teens choose not to reveal their contacts; contact tracing could result in family, coaches, teachers, and peers also requiring testing and possible quarantining. In the November issue of Pediatric News, Margaret Thew, a family nurse-practitioner, stated that some teens are “bullied into amnesia” when contact tracers call for fear of being labeled by their peers as tattletales. People can be mean and, unfortunately, there is no vaccine for that.

What do we know about teens and COVID-19? According to the U.S Centers for Disease Control and Prevention (CDC), children and teenagers account for nearly 10% of COVID-19 cases. The vast majority of reported infections in these young people are mild or asymptomatic; in fact, research published in Nature Medicine in June showed that only 21% of 10- to 19-year-olds who test positive have symptoms compared to 69% of people aged 70 or older. Given the fact that children and teens may have mild or no symptoms, and that there can be social consequences if they test positive, I am certain that the true prevalence of COVID-19 among teens is likely underreported.

Some teenagers do get sick. According to the CDC, some children can get severely ill from COVID-19. They might require hospitalization, intensive care, or even a ventilator to help them breathe. Although it is rare, death may occur. In addition, the CDC is investigating a rare but serious medical condition in children associated with COVID-19 called multisystem inflammatory syndrome in children (MIS-C). Symptoms include the same as COVID-19 with the addition of a rash, neck pain, red eyes, cracked lips, and swollen hands and feet.

Super-spreaders? Unfortunately, yes. Teenagers who have COVID-19 but have no symptoms can still spread the virus to others. And a CDC survey released in October found that self-reported measures of mask wearing, handwashing, physical distancing, and avoiding crowds and social activities — all crucial in reducing the spread of COVID-19 — differed significantly by age. The frequency of these behaviors was lowest for those between ages 18 and 29 and highest among those over 60. The CDC’s study did not include individuals under 18, so I suspect that the percentage of teens who practice COVID-19 mitigation behaviors is even lower … making them significantly high risk for spread.

Can we really blame them? Maybe not, as adolescents’ brains are wired differently from those of older individuals. In middle and high school, they live their lives by the “personal fable”: the belief that they are special and unique and invulnerable to harm, so much so that none of life’s difficulties or problems will affect them regardless of their behavior. Real-life superheroes! I know this not only because it’s in the adolescent medicine textbooks, but also because I see it every day in my patients: They don’t use birth control as they believe “pregnancy won’t happen to me” and they don’t use condoms as they believe “I won’t get a sexually transmitted disease.” In the midst of a pandemic, my teenage patients are wearing their masks below their noses and telling me about social gatherings with their friends.

My advice:

  • Review with your children the symptoms of COVID-19.

  • Have a discussion about how they can have COVID-19 without feeling sick, how they may actually have it right now, how they can unknowingly spread the virus to friends and family, and how people can die from it.

  • Help them substitute reality for their “personal fable.”

Rima Himelstein is a pediatrician and adolescent-medicine specialist at Nemours/Alfred I. duPont Hospital for Children.