Even as America's coronavirus taskforce member Dr Anthony Fauci recently said that one must not be "cavalier" in thinking that children are completely immune to the harmful effects of Covid-19, a new analysis by US researchers shows that children can also face the risk for severe complications and even death from coronavirus.
The study is one of the most detailed pictures yet of children who were treated in intensive care units in the US. The vast majority of the patients — 40 children, including two who died — had pre-existing medical conditions. Over 20% experienced failure of two or more organ systems due to coronavirus, and nearly 40% required a breathing tube and ventilator. At the end of the follow-up period, nearly 33% of the children were still hospitalized due to Covid-19, with three still requiring ventilator support and one on life support. Two of the children admitted during the three-week study period died.
Based on their findings, the researchers warn that children, teens and young adults are at greater risk for severe complications from Covid-19 than previously thought and those with underlying health conditions are at even greater risk.
"The idea that Covid-19 is sparing of young people is just false. While children are more likely to get very sick if they have other chronic conditions, including obesity, it is important to note that children without chronic illness are also at risk. Parents need to continue to take the virus seriously," says study co-author Lawrence C Kleinman, professor and vice-chair for academic development, in the analysis published in JAMA Pediatrics. Kleinman is also chief of the Department of Pediatrics' Division of Population Health, Quality and Implementation Science at Rutgers Robert Wood Johnson Medical School.
During his testimony before the US Senate on May 12, Dr Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said that experts still do not know everything about this virus, and one should be very careful, particularly when it comes to children. "Because the more and more we learn, we’re seeing things about what this virus can do that we didn’t see from the studies in China, or in Europe. For example, right now, children (are) presenting with Covid-19 who have a very strange inflammatory syndrome, very similar to Kawasaki syndrome. I think we better be careful if we are not cavalier in thinking that children are completely immune to the deleterious effects," he cautioned.
In the current study, researchers followed 48 children and young adults — from newborns to 21 years old — who were admitted to pediatric intensive care units (PICUs) in the US and Canada for Covid-19 in March and April.
The analysis shows that 40 patients (83%) had significant underlying conditions such as immune suppression, obesity, diabetes, seizures or chronic lung disease. Of those, 40% depended on technological support due to developmental delays or genetic anomalies.
"35 (73%) presented with respiratory symptoms and 18 (38%) required invasive ventilation. Eleven patients (23%) had failure of 2 or more organ systems. Extracorporeal membrane oxygenation was required for 1 patient (2%). Targeted therapies were used in 28 patients (61%), with hydroxychloroquine being the most commonly used agent either alone (11 patients) or in combination (10 patients)," says the study.
It further says, "At the completion of the follow-up period, 2 patients (4%) had died and 15 (31%) were still hospitalized, with 3 still requiring ventilatory support and 1 receiving extracorporeal membrane oxygenation. The median (range) PICU and hospital lengths of stay for those who had been discharged were 5 (3-9) days and 7 (4-13) days, respectively."
The researchers say that they are "cautiously encouraged by hospital outcomes" for the children studied, citing the 4.2% mortality rate for PICU patients compared with 50% to 62% in adults admitted to the ICUs. Even if the subset of patients with mild or moderate symptoms at presentation are excluded, the adjusted mortality rate (6%) remains low compared with adults, they add.
"This early study shows that COVID-19 can result in a significant disease burden in children but confirms that severe illness is less frequent, and early hospital outcomes in children are better than in adults," says the research team.
According to Hariprem Rajasekhar, a pediatric intensivist involved in conducting the study at Robert Wood Johnson Medical School's Department of Pediatrics, the findings provide a baseline understanding of the early disease burden of Covid-19 in pediatric patients. "The findings confirm that this emerging disease was already widespread in March and that it is not universally benign among children," says Rajasekhar in the analysis.
None of those studies experienced the mysterious illness in children potentially related to Covid-19, with symptoms similar to Kawasaki disease and toxic shock syndrome. The researchers say that while data collection for this study has ended, they continue to develop collaborations with colleagues across the country to try and understand these more severe complications, citing concerns such as heart failure and the Kawasaki disease-like condition termed pediatric multi-system inflammatory syndrome, as examples.
Meanwhile, another recent study has warned that coronavirus infection in children may not start with a cough. Children suffering from sickness and diarrhea, coupled with a fever or history of exposure to coronavirus, should be suspected of being infected with Covid-19, recommend researchers in their findings published in the Frontiers in Pediatrics. The research team also suggests that the gastrointestinal symptoms first suffered by some children hint at potential infection through the digestive tract, as the type of receptors in cells in the lungs targeted by the virus can also be found in the intestines.