Tracking the Footprint of COVID-19 in Pediatric Populations
The FLARE Four
- Children <18 years old continue to account for only small proportions of COVID-19 cases
- For unknown reasons, COVID-19 is generally less severe in pediatric populations than in adults
- Infants may be at slightly higher risk of severe or critical illness than other pediatric age groups
- To date, overall mortality in children is extremely low
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Fortunately, children and adolescents represent only a small proportion of patients infected with SARS-CoV-2. In a fast literature update posted on April 7, 2020, Alexandra K. Wong, MD, a physician in Pulmonary and Critical Care Medicine at Massachusetts General Hospital, adds that the virus rarely causes severe illness in these populations.
Epidemiology
In China, 2.2% of 44,672 initial confirmed COVID-19 cases were in patients <18 years. Research published in Pediatrics reported details of 2,143 pediatric cases (731 confirmed) through February 8, 2020:
- Age range: 1 day to 18 years
- No sex difference in infection rates
- Asymptomatic, mild or moderate disease in 94%
- Slightly higher risk of severe and critical disease in infants than in other pediatric age groups, but some cases in infants were unconfirmed
- One 14-year-old boy died
An additional death of a 10-month-old child with intussusception was reported by the New England Journal of Medicine in a published series of 171 confirmed cases at Wuhan Children's Hospital.
In Italy, 1.2% of 22,512 cases as of March 15, 2020, were in children ≤18 years. No patient <30 has died.
In the U.S., 1.7% of 151,294 cases confirmed by April 2, 2020, were in children <18 years, of whom 15% were <1 year. Three pediatric deaths have occurred, but COVID-19 has not been established as the cause.
Knowledge Gaps
It's unclear whether the low COVID-19 rates in children truly differ from those of adults or reflect lack of testing since the pediatric disease is usually asymptomatic or mild.
The relationship between age and severity of illness is also unknown. Unlike adults with COVID-19, children with the disease seem to retain normal lymphocyte counts, suggesting decreased immune dysregulation.
Last year, evidence was published in Ann. Intensive Care that children have lower rates of acute respiratory distress syndrome than adults because of differences in pulmonary host responses, and this may hold true for respiratory infections related to COVID-19.
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Learn more about pediatric research at the MassGeneral Hospital for Children