What Do We Know About COVID-19 in Children?

As cases of COVID-19 continue to surge in the United States, efforts to slow the spread of SARS-CoV-2, the virus at the root of the pandemic, have ramped up. From school closures to pushes for more people to work remotely, these are all critical parts of responding to a pandemic.

The growing emphasis on social distancing and advocating for steadfast infection prevention measures, like hand hygiene and environmental disinfection only represent a society that is focused on disease mitigation.

For many states, school closures in particular, have been challenging. From the reliance on school lunches to how childcare will be managed, it’s not difficult to see how pandemic response trickles into all facets of our lives.

As we learn more about the clinical manifestations of the disease, much has been raised about pediatric cases. Interestingly, there have been fewer cases of children acquiring the disease and having severe symptoms. A new research study sought to evaluate the SARS-CoV-2 infections in children and the clinical manifestations of the COVID-19 disease.

While symptoms can range from mild to severe in patients with coronaviruses including SARS-CoV, MERS-CoV, and SARS-CoV-2, the viruses appear to affect children less commonly and when they do, result in much more mild symptoms and are less likely to lead to severe disease. Moreover, they also have lower case-fatality rates.

The authors do note that “many children affected by MERS-CoV are asymptomatic. The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them.”

In comparison, adults tend to have more health care-associated exposure, which is logical considering they are more likely to have severe disease and require hospitalization, putting others at risk. Also, as a result of their more severe illness, they are more likely to be tested for the disease. Moreover, in my experience, in both adult and pediatric acute care, adults tend to visit hospitalized loved ones more.

The authors also found that while children are just as likely to become infected with SARS-CoV-2, they tend to have more gastrointestinal symptoms than adults. Moreover, the majority of children studied who had SARS-CoV presented with fever whereas this was not the case for those with other novel CoVs (eg MERS-CoV and SARS-CoV-2).

The researchers noted that from Chinese data, “most infected children recover 1 to 2 weeks after the onset of symptoms, and no deaths had been reported by February 2020.”

These findings are particularly helpful in that not only point to clinical manifestations and recovery, but also that children tend to present more mildly and less frequently symptomatic.

These last sentiments are important for infection prevention measures. While most cases appear to be in adults, it is important that international response and prevention efforts also address how children can help facilitate the spread of the disease through mild symptoms perceived as common childhood illnesses.

The limited testing for children as a result of their clinical presentations represent a gap in surveillance data of the disease and an understanding of the epidemiology. As more cases are identified in the United States, efforts to rapidly identify, isolate, and prevent COVID-19 must take into account the unique findings of pediatric cases and how they could facilitate community transmission.