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Despite Low Severity in Children, COVID-19 Is Risky for Some Pediatric Patients

Few serious cases and deaths have occurred in children during the COVID-19 pandemic. A new article in the journal Pediatrics cautions, however, that healthcare professionals should remain vigilant because the infection can be more serious in infants and in children with underlying chronic conditions. Here are more details.

GAINESVILLE, FL – One of the many surprises in the COVID-19 pandemic is how few serious cases and deaths have occurred in children.

An article in JAMA Pediatrics notes that while children are typically more susceptible to influenza complications, at this point, they have experienced lower-than-expected rates of COVID-19 disease, with deaths being quite rare.

Authors from the University of Florida College of Medicine authors point out that, in more than 72 000 total cases from China, explaining, “1.2% were in patients aged 10 to 19 years, and even fewer (0.9%) were in patients younger than 10 years. Only 1 death in this study was in the adolescent age range, and no children in the age range of 0 to 10 years died.”

They also cite a separate analysis of 2,143 confirmed and suspected pediatric cases from China showing that infants were at the highest risk of severe disease (10.6%), compared with older children -- 4.1% for those aged 11 to 15 years; 3.0% in those 16 years and older.

The report advises that COVID-19 manifests similarly in children who become ill to adults. Chinese studies suggest that some children are asymptomatic, while others had fever, fatigue, dry cough and other respiratory symptoms. Interestingly, the authors note, they found gastrointestinal symptoms to be rare.

At the same time, the article notes, “Thus far, no convincing evidence of intrauterine transmission has been identified, but only a small number of pregnancies have been described.” In addition, the authors write that it is unknown whether COVID-19 can be transmitted through breastfeeding. They write that, among six mothers whose breastmilk samples were tested forSARS-CoV-2, all specimens, were negative.

The authors caution, however, that, despite the low frequency of illness and death from COVID-19 in children in China, pharmacists and other healthcare professionals should remain vigilant about infection in children in this country.

“The lower-than-expected rates of children affected by COVID-19 in China might be because of decreased exposure to the virus, decreased infection with the virus because of immunity to other coronaviruses, or decreased likelihood of illness, even when infected with the virus.”

There also is the issue of infected children being a source of transmission. The article discusses a situation where an asymptomatic child with high SARS-CoV-2 viral load infected others.

“How U.S. children experience COVID-19 remains to be detailed, although no intensive care unit admissions or deaths were reported among persons younger than 19 years among 4226 patients with COVID-19 in the United States through March 16, 2020,” they write. Since then, a handful of severe cases have been reported among children, including the death of an infant from the novel coronavirus.

The authors also raise concerns because research has suggested that children with underlying illness might be more susceptible to poor outcomes. That is especially significant in the U.S. because about 10% of pediatric patients have asthma and many others suffer from pulmonary, cardiac, neuromuscular, or genetic diseases that affect their ability to handle respiratory disease. They also warn about children who are immunosuppressed because of illness or drug therapy, adding, “It is possible that these children will experience COVID-19 differently than counterparts of the same ages who are healthy.”