Children and COVID-19: Research Finds Some Become Seriously Ill

A study of more than 2,000 children with the virus in China found that babies were especially vulnerable to developing severe infection.

The coronavirus raging round the globe has attended tread gently with children, who account for the littlest percentage of the infections identified thus far .

Now, the most important study so far of youngsters and therefore the virus has found that while most develop mild or moderate symptoms, alittle percentage — especially babies and preschoolers — can become seriously ill.

The study, published online within the journal Pediatrics, checked out quite 2,000 ill children across China, where the pandemic began. It provides a clearer portrait of how the youngest patients are suffering from the virus, knowledge that experts say can help influence policies like school closures, hospital preparedness and therefore the deployment of an eventual treatment and vaccine.

The researchers analyzed 2,143 cases of youngsters under 18 that were reported to the Chinese Centers for Disease Control and Prevention as of Feb. 8. Just over a 3rd of these cases were confirmed with laboratory testing. the remainder were classified as suspected cases supported the child’s symptoms, chest X-rays, blood tests and whether the kid had been exposed to people with coronavirus.

About half the youngsters had mild symptoms, like fever, fatigue, cough, congestion and possibly nausea or diarrhea. quite a 3rd — about 39 percent — became moderately sick, with additional symptoms including pneumonia or lung problems revealed by CT scan, but with no obvious shortness of breath. About 4 percent had no symptoms in the least .

But there have been 125 children — nearly 6 percent— who developed very serious illness, and one 14-year-old boy with confirmed coronavirus infection died, said Shilu Tong, the study’s senior author, who is director of the department of clinical epidemiology and biostatistics at Shanghai Children’s center . Thirteen of these were considered “critical," on the brink of respiratory or organ failure. The others were classified as “severe” because that they had dire respiratory problems.

“Effectively, what this tells us is that hospitals should steel oneself against some pediatric patients because we can’t rule out children altogether,” said Dr. Srinivas Murthy, an professor of pediatrics at the University of British Columbia , who wasn't involved within the study.

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“The main conclusion,” Dr. Murthy continued, “is that children are infected at rates which will be like adults, with severity that’s much less, but that even within the youngsters , there’s a spectrum of illness and there’s a couple that need more aggressive therapy.”

More than 60 percent of the 125 children who became severely ill or critically ill were age 5 or younger, the study reported. Forty of these were infants, under 12 months old.


ImageA baby with coronavirus was treated at the Wuhan Children’s Hospital in China earlier this month.
A baby with coronavirus was treated at the Wuhan Children’s Hospital in China earlier this month.Credit...China Daily/Reuters
Dr. Tong said he believed that younger children were more vulnerable to infection because their respiratory systems and other body functions are rapidly developing.

Dr. Andrea Cruz, an professor of pediatrics of Baylor College of drugs and co-author of an article about the study, said that preschoolers and babies likely get sicker due to their “immune system immaturity.”

“They haven’t been exposed to viruses before and thus they can’t mount an efficient immune reaction ,” she said in an interview.

Scientists are actively trying to work out why numerous children appear to emerge relatively unscathed by the new coronavirus, a pattern that also characterized the sooner outbreaks of the closely-related SARS virus in China and MERS within the Middle East . Cases of youngsters with the new coronavirus infection in Italy, Singapore and South Korea seem to be similar, Dr. Murthy said.

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A theory that's gaining increasing currency is that the receptor or protein in human cells that the viral particles bind to, called the ACE2 receptor, isn't expressed as prominently in young children or could be a special shape, Dr. Murthy said.

“It won't be as developed in children as in adults,” he said, which could make it tougher for the spikes on the small viral particles to bind and gain entry to the cells therefore the virus can replicate.

Another theory is that “most kids have healthier lungs” than adults, Dr. Cruz said. Adults have likely been more exposed to pollution over their lifetime and adults with severe coronavirus disease have attended have underlying health conditions or weakened or aging immune systems.

It’s also possible, experts say, that children’s immune systems don’t rev up to attack the virus the maximum amount as adult immune systems do. Doctors have found that a number of the intense damage infected adults have endured has been caused not just by the virus itself, but by an aggressive immune reaction that makes destructive inflammation within the body’s organs.

The new study, while large and included cases across China, not just where the outbreak originated in Wuhan, leaves many unanswered questions. for instance , the researchers found that more of the severe and important cases were in children with suspected — rather than confirmed — coronavirus infection, raising the likelihood that other infections wreaked havoc on their bodies, additionally to or possibly even rather than Covid-19.

It’s also unclear whether the us can expect the relatively small numbers of kid cases reported in China or should brace for more.

“The age pyramid in China is basically different than the U.S. — they need tons fewer kids than we do,” said Dr. Cruz, who believes, as other experts do, that enormous numbers of individuals with mild or asymptomatic disease haven't been recorded because testing wasn't wiped out those cases. “You’ve had tons of under-testing in children because the main target has been on adults. It’s likely we’ve been underestimating the disease burden in kids.”

Answering questions on coronavirus in children could reverberate well beyond the pediatric population. It could shed light why some patients are most in danger . And, said Dr. Murthy, studying the physiology of these who are less affected could help within the development of treatment and a vaccine.