Understanding How COVID-19 Affects Children Vital to Slowing Pandemic

A report published noted that there are subpopulations of pediatric patients with COVID-19 who have an increased risk for more significant illness.

Analyzing how the coronavirus disease 2019 (COVID-19) infects children is necessary in order to accurately model the pandemic, limit the spread, and ensure that any infected children get needed care, according to physicians at the University of Virginia Health System.

According to a new report from the CDC, just 5% of 2449 analyzed COVID-19 cases were among patients 19 years old or younger. However, a report published in Pediatrics noted that there are subpopulations of pediatric patients with an increased risk for more significant illness.

In an earlier study of 2000 children with suspected or confirmed COVID-19 infection, the authors said 13% were asymptomatic. Among those with symptoms, however, 5% had dyspnea or hypoxemia and 0.6% progressed to acute respiratory distress syndrome (ARDS) or multiorgan system dysfunction. In the study, preschool-aged children and infants were found more likely than older children to have severe clinical manifestations.

The researchers noted 3 key points. First, some children are at an increased risk for significant illness. Second, more research is needed in order to discern the attributable risk for severe disease from COVID-19 in children. And finally, children may play a very important role in vital transmission in communities.

According to a study in a pediatric intensive care unit in China, coronaviruses were detected in more children with ARDS than human metapneumovirus, whereas another study in hospitalized Norwegian children found coronaviruses in 10% of children with respiratory tract infections. These findings suggest that younger age, underlying pulmonary pathology, and immunocompromising conditions are all associated with more severe outcomes with non-COVID-19 coronavirus infections in children.

Similarly, the authors of the current study noted that earlier research shows children with detected coronaviruses in the respiratory tract can have viral coinfections in up to two-thirds of cases. Earlier studies have also found that children without virologic confirmation were more likely to have severe disease than children with detected COVID-19 infection, possibly because their symptoms were caused by other pathogens. These findings suggest the need for more research on coinfections and their impact on pediatric patients with coronaviruses and specifically COVID-19.

Finally, the authors of the current study noted that children can play a major role in community-based transmission based on findings that children may have more upper respiratory tract involvement rather than lower respiratory tract involvement.

“Prolonged shedding in nasal secretions and stool has substantial implications for community spread in daycare centers, schools, and in the home,” the authors said.

Despite these early findings and the epidemiologic, virologic, and clinical data already published on COVID-19, the authors said there is still a lack of information about its effects on children, as well as how children affect the spread.

Although vertical transmission has not yet been reported, this may present an area in need of further research, according to the study authors. Pregnant women are more severely impacted by some infectious diseases and respiratory diseases can result in poor fetal outcomes, which necessitates the need for further understanding of how COVID-19 affect pregnant women and newborns, the authors noted.

“While the focus on pandemics often is on the impact on the persons who utilize the highest resources or on the economically productive age groups, rigorously gauging the impact of COVID-19 on children will be important to accurately model the pandemic and to ensure that appropriate resources are allocated to children requiring care,” the authors concluded.

REFERENCE

Cruz A, Zeichner S. COVID-19 in children: initial characterization of the pediatric disease. Pediatrics. 2020; doi:10.1542/peds.2020-0834. https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0834.full.pdf. Accessed March 20, 2020.