What’s the sample of COVID-19 signs in youngsters?

A large study looked at hospital cases to assess the pattern of COVID-19 symptoms in children and the factors that lead to a higher risk of serious illness.

Initial studies on the COVID-19 pandemic show that, in contrast to other respiratory viruses, children and adolescents seem to have a lower risk of infection with the SARS-CoV-2 virus than adults. Children only make up about 1-2% of COVID-19 cases worldwide, and most of these cases are mild or asymptomatic. However, a very small number of children will develop a more severe illness and may need intensive care assistance. Pediatricians have also identified small groups of children who developed a condition known as multisystem inflammatory syndrome (MIS-C) following SARS-CoV-2 infection. Children with MIS-C may develop a rash, very low blood pressure, heart failure, bleeding disorders, and gastrointestinal problems.

As part of a larger study examining the clinical characteristics of COVID-19 patients, researchers in the UK analyzed COVID-19 symptoms in children hospitalized for SARS-CoV-2 infection. They looked for factors that increase the risk of needing intensive care assistance, mortality, or developing MIS-C. The study results were recently published in the BMJ.

COVID-19 symptoms in children are milder than in adults

The study was part of the WHO International Consortium on Severe Acute Respiratory Diseases and Emerging Infections (ISARIC) (CCP-UK), a global collaborative study examining various aspects of COVID-19. The researchers analyzed data from 651 children (<19 years) admitted to 138 hospitals across the UK with confirmed SARS-CoV-2 infection. They examined the children's clinical characteristics and risk factors for critical care admission, hospital mortality, and the development of MIS-C.

Overall, children accounted for less than 1% of hospital admissions in the ISARIC CCP-UK study. The mean age of the children in the hospital was 4.6 years. Forty-two percent of the children had at least one other disease – most commonly neurological disease or asthma. There was a low death rate, with six deaths – all in children with other significant health problems. Eighteen percent of children hospitalized required critical treatment. Age <1 month, ages 10-14, black ethnicity, and obesity were risk factors for critical care admission.

A total of 52 children developed MIS-C, and these children were five times more likely to need intensive care. Aside from the MIS-C symptoms noted in previous reports, this study found that headache, fatigue, muscle aches, and sore throats were also related to MIS-C. In addition, children with MIS-C had low platelet counts (a component of the blood that helps blood clot).

The study results should reassure parents when the children return to school

The researchers concluded that children and adolescents have less severe COVID-19 than adults. "We want to highlight that children in our study accounted for a fraction of a percent of all COVID-19 admissions in the UK and that serious illnesses were rare," commented Dr. Olivia Swann, co-lead author of University of Edinburgh's Studies. The researchers hope their results will reassure parents, especially when children go back to school – although it is important to continue to monitor COVID-19 in children.

While the overall risk of COVID-19 is lower for young people than adults, obesity and black ethnicity are risk factors for more severe illnesses. The researchers want to learn more about the reasons for this and why a small number of children develop the MIS-C inflammatory syndrome after SARS-CoV-2 infection. The additional symptoms and low platelet counts seen in MIS-C cases in this study may help identify future cases.

Prof. Calum Semple, University of Liverpool, co-lead author, added: “This report is the largest and most detailed description of COVID-19 and MIS-C in children and adolescents. We have gained new knowledge about MIS-C that will help manage this rare but serious condition. "

Written by Julie McShane, MA MB BS

References:

1. Swann OV, Holden KA, Turtle L. et al. Clinical features of children and adolescents hospitalized with Covid-19 in the UK: prospective multicenter observational cohort study. BMJ 2020; 370: m3249 doi: https://doi.org/10.1136/bmj.m3249

2. University of Edinburgh, press release August 27, 2020. COVID-19 is less fatal and causes milder symptoms in children. https://www.eurekalert.org/pub_releases/2020-08/uoe-cld082620.php

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