Study: Majority of Children with COVID-19 Have Mild Disease, Mortality is Rare

In the first multinational study, a majority of children and adolescents with coronavirus 2019 (COVID-19) experienced mild disease and the mortality rate was extremely rare.

Marc Tebruegge, PhD, UCL Great Ormond Street Institute of Child Health, London, led a team of investigators whose findings were published in The Lancet Child & Adolescent Health today.

Study participants included 582 children and adolescents from 3 days old up to 18. It was conducted from April 1 to April 24 in 82 healthcare facilities in 25 European countries.

While a majority of the participants (62%, 363/582) were admitted to hospitals, fewer than 1 in 10 patients (8%, 48/582) need intensive care treatment.

“Overall, the vast majority of children and young people experience only mild disease,” Tebruegge stated.

A majority of the hospitalized patients (87%, 507/582) did not need oxygen or other support to assist with breathing. And mechanical ventilation was needed in just 25 patients (4%, 25/582). The investigators noted for those on ventilation, breathing support was required for a week or more.

"Of note, we found that children in whom additional viruses were detected in the respiratory tract at the same time as SARS-CoV-2 were more likely to be admitted to intensive care,” Begoña Santiago-Garcia, MD, PhD, study co-author, University Hospital Gregorio Marañón, Madrid. "This could have important implications for the upcoming winter season, when cold and flu infections will be more common.”

A total of 4 patients died within the study timeline, and two of them had pre-existing medical conditions. All 4 of the patients were older than 10 years old.

Different countries were using different criteria to screen for the SARS-CoV-2 virus. Some were screening all children admitted to the hospital while others were more selective in which patients were offered a test. This lack of standardization makes it difficult to generalize the findings to the wider population, the authors say, but the true case fatality rate in children (0.69%, 4/582) is likely substantially lower than that observed in this study.

In terms of antiviral or immunomodulatory therapies, not enough patients were treated with these medications to gather any meaningful results. And the investigators said clinical trial data is needed to help clinicians make decisions regarding treatment strategies.

Along with a lack of therapy data, the team acknowledged their study was “skewed towards more severe cases as the study was hospital-based.” Specifically, all the participants had sought medical help and were tested for the virus. Therefore, milder cases were not included.