Only a small proportion of children develop severe COVID-19 disease

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Children (including infants) younger than 18 years generally have only mild COVID-19 disease, and deaths were less than 1%. However, 8% of children develop a severe form of the disease that may require intensive care support and prolonged ventilator support.

A multicentre study involving 82 health-care institutions across 25 European countries carried out between April 1 and April 24 has found that children (including infants) younger than 18 years generally have only mild COVID-19 disease, and deaths were less than 1%. However, 8% of children develop a severe form of the disease that may require intensive care support and prolonged ventilator support.

The study led by Marc Tebruegge of University College London, which addresses the scarce data on COVID-19 in children and adolescents, was published in the journal The Lancet Child & Adolescent Health.

The study involved 582 children who were as young as three days to 18 years with confirmed infection with novel coronavirus. The median age was five years.

Of the 582 children infected, 363 (62%) children required hospitalisation, 48 (8%) needed admission to an ICU, and 25 (4%) needed ventilator support.

However, if those needing an ICU admission among those hospitalised is considered, the percentage increases to 13%. Similarly, those needing ventilator support among those admitted to an ICU is considered, the percentage increases to 52%.

“Our data show that severe COVID-19 can occur both in young children and in adolescents, and that a significant proportion of those patients require ICU support, frequently including mechanical ventilation,” they write.

And children who were put on a ventilator needed the support for a week or more (median duration was seven days) unlike children with respiratory viral infection (RSV) who, on average, needed mechanical ventilation for five-seven days.

The researchers found that being as young as a month is no guarantee that the infection will not cause severe disease requiring ICU admission if the child is a male, has signs or symptoms of lower respiratory tract infection, and has pre-existing medical conditions.

Unlike a greater percentage of adults with co-morbidities, only 25% (145/582) children had a pre-existing condition.

Four of 582 (0.69%) children who were infected by the virus died. “Our data indicate that the case fatality rate (CFR) in children and adolescents across Europe is less than 1%. Considering that many children with mild disease will never have been brought to medical attention, and therefore not diagnosed, it is highly probable that the true CFR is substantially lower than the figure of 0·69% observed in our cohort,” the authors write.

In 22 patients, in addition to coronavirus, one more respiratory virus was detected, while two additional viruses were detected in six patients and three additional viruses were seen in one patient. Children with one or more viral co-infections were more likely to have symptoms of upper or lower respiratory tract infection and were significantly more likely to require ICU admission and  respiratory support, they found.

In 324 of 582 (56%) cases, the parents had spread the virus to the children, while 40% (234) children got the infection from those outside the immediate family. Just 4% (25) children probably got the infection from a sibling.

Published in The Hindu on June 26, 2020

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