Co-authored by David Rayburn, MD, MPH & Ashley Grigsby, DO
We didn’t feel like we could do any of our planned posts until addressing the giant elephant stomping through the world. Both David and I see adults in our EDs, and as many people know, this illness is more severe in adults, and we have been inundated with information on how to care for adults in our ED as well as keep us and our staff safe. But we felt that our pediatrics colleagues may also be looking for information on COVID-19 infection in children and thought we’d release a quick read. The information on this is incredibly fluid and changes sometimes hour to hour, so please use a reliable source like the CDC to keep up to date on changes to the situation.
Before we get into it… we both want to say to all our readers: We are in this with you. We know this is a hard time, we are on the front lines in the emergency department and we know many of our listeners and readers are as well. We also know the pressure this puts on our outpatient colleagues having to triage visits, limit visits, while still providing care to your patients with limited resources to protect you and your staff. We both have families that we are worried to bring this virus home to, we worry about infection in ourselves and families, and we worry about our patients and our fellow hospital team members. So thank you to all you do – we get it, and we’ll get through this together. Also – STAY HOME!! (had to throw that out there because I’m sick of seeing cars at the mall.) Seriously. STAY HOME!!
Ok, here we go.
Overall, few cases of COVID-19/SARS-CoV-2 infections have been reported in children when compared to the general population. Most of our information on this topic is coming from early reports out of China. As of Februrary 20, 2020, only 2.4% of cases in China had occurred in persons younger than 19 years old (3). Like previous epidemic coronaviruses, COVID-10 seems to cause fewer and less severe symptoms in children compared to adults (4). Predominant signs and symptoms of COVID-19 reported thus far, include fever, cough and difficulty breathing. However, gastrointestinal symptoms such as abdominal pain, diarrhea, nausea and vomiting are reported more often in pediatric patients.
Most pediatric cases seem to be related to close household contacts, further emphasizing the need for good hand hygiene and social distancing. Over 80% of pediatric cases reported a household contact with the disease (6). Children can still shed COVID-19 RNA in respiratory specimens 22 days after symptoms begin and in stool up to 30 days after symptoms start (3). It also appears that children are less likely to be symptomatic with infection and therefore they may play an important role in transmitting the virus as asymptomatic carriers, but the true impact of this remains uncertain (6).
Thus far, reported severity in children has shown that 51% have had mild illness, 39% moderate and 6% severe or critical illness. One child has died who was age 14 (1). This is compared to 18.5% of adults who develop critical illness (1). Infants had higher rates of severe illness than older children (1). The reason for the differences between adults and children with this infection is still not well understood. I have noticed a trend of believing kids with this illness do not get sick and therefore physicians seem less inclined to test or even consider COVID-19 as the source of a child’s viral illness. While there have been no reported deaths in children age 0-9, they can still become critically ill and may need acute interventions and more importantly they can transmit this illness to Grandma and Grandpa.
One big takeaway we hope you’ll remember is that coinfection with more than 1 virus is more common in pediatric patients. Up to 40% of pediatric patients will have an additional viral infection during COVID-19 infection based on nasal viral swab testing. This makes the use of respiratory viral panels less useful l in ‘ruling out COVID’ (5).
It is important when seeing pediatric patients, to use the same safety precautions for you and ancillary staff. Families with suspected infections should be advised to undergo frequent handwashing, social distancing, avoid large crowds, disinfect high touch surfaces like counters, doorknobs, etc., and above all else STAY HOME!!! Especially when sick.
Hereis the current link to the worldwide map with case counts by country.
Hope this helps. Please be safe and unless you’re going to work to take care of patients, STAY HOME! (I had to say it one more time).
1. Jenco, M., 2020. COVID-19 Less Severe In Children Than Adults: Study. [online] American Academy of Pediatrics. Available at: <https://www.aappublications.org/news/2020/03/16/coronavirus031620> [Accessed 17 March 2020].
2. Yale School of Medicine. 2020. Kids And COVID-19: What Parents Should Know. [online] Available at: <https://medicine.yale.edu/news-article/22996/> [Accessed 17 March 2020].
3. Centers for Disease Control and Prevention. 2020. Coronavirus Disease 2019 (COVID-19). [online] Available at: <https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html> [Accessed 17 March 2020].
4. ScienceDaily. 2020. COVID-19 Appears Less Severe In Children. [online] Available at: <https://www.sciencedaily.com/releases/2020/03/200313112145.htm> [Accessed 17 March 2020].
5. Xia, W., Shao, J., Guo, Y., Peng, X., Li, Z. and Hu, D., 2020. Clinical and CT features in pediatric patients with COVID‐19 infection: Different points from adults. Pediatric Pulmonology,.
6. Zimmermann, P. and Curtis, N., 2020. Coronavirus Infections in Children Including COVID-19. The Pediatric Infectious Disease Journal, p.1.