COVID19 in children: 2 very recent papers

Dr. Albert Yan (Chief of Pediatric Dermatology Children’s Hospital of Philadelphia)
COVID in children, Dong et al.
In this large pediatric case series based in China that involved over 2100 children, several important observations were noted:

  1. Kids generally have milder disease than adults with 90% having non-severe/critical disease
  2. They got diagnosed quickly (median 2 days)
  3. Vulnerability to severe-critical disease was highest among infants with 10.6% of infants being so affected, with risk decreasing as age increased.
  4. About 4% of kids were asymptomatic but had detectable virus.
  5. The risk of severe-critical disease within the pediatric age group was 6% compared to 18.5% in adults, and there was only a single pediatric death in this large series.

As to why kids are less severe than adult centers on the relative immaturity of ACE2 in children, which is presumed to be the cell-receptor for the virus based on its similarity to the previous SARS virus.  This relative immaturity may make children less receptive hosts for the virus.

Take home points:

  • Kids with COVID19 are generally milder than adults but a significant subset can develop severe disease, especially infants.
  • Some of the reasons behind why kids are generally less severe may provide appropriate targets for identifying future therapies.
  • It is also important to note that children on immunosuppressive medications and with predisposing medical issues are likely at higher risk.

Regarding Table 1 (Below): Additional pediatric data from a cohort of 171 children <10yo with confirmed SARS-CoV2 showed a surprisingly high rate of asymptomatic infection (16%).  Of those infected there was a strikingly high proportion who developed pneumonia (65%).  Between 76-90% had a relative with confirmed infection highlighting the likelihood of intra-familial spread. [/av_textblock] [av_image src='' attachment='14521' attachment_size='featured_large' align='center' styling='' hover='' link='' target='' caption='' font_size='' appearance='' overlay_opacity='0.4' overlay_color='#000000' overlay_text_color='#ffffff' copyright='' animation='no-animation' id='' custom_class='' av_uid='av-k857im3u' admin_preview_bg=''][/av_image] [av_textblock size='' font_color='' color='' id='' custom_class='' av-medium-font-size='' av-small-font-size='' av-mini-font-size='' av_uid='av-k857jtu2' admin_preview_bg=''] J Peds
NEJM article March 18, 2020: