Breathe in. Breathe Out. The rhythmic pattern of these two actions, this harmonic process is the culmination of approximately 480 million alveoli working together to give you a moment of peace. A peace many of your pediatric patients are being denied due to COVID-19. Fortunately or unfortunately, you are tasked with helping them and bringing back their peace.
We have put together a 3-part guide covering as much as we can about the SARS-CoV-2 virus to help you out. The parts can be read in any order, based on your topic of interest. The first part illustrates the epidemiology of the SARS-CoV-2 virus in children. The second part covers the pathogenesis of SARS-CoV-2 and its subsequent clinical manifestations in infants, children and adolescents. Lastly, the third part highlights polymorphs of the SARS-CoV-2 virus and enlightening COVID-19 findings in pediatric patients. So let's begin.
EPIDEMIOLOGY OF SARS-CoV-2
Children, especially those younger than 12 years of age, tend to be less susceptible to the virus than adults. After surveying cases from various countries, children typically account for up to 13% of laboratory-confirmed cases.1-8 In the United States alone, children aged less than 18 years account for 10-13% of confirmed cases as reported to the Centers for Disease Control and Prevention (CDC).7,8 The Academy of Pediatrics is providing state-wise counts8 of confirmed cases for pediatricians.
There have been more than 1.2 million positive pediatric cases of COVID-19 between March and December 2020. They are distributed based on age-groups of school-going children below:9
- Preschool (0-4 years) – 17.4%
- Elementary School (5-10 years) – 25.7%
- Middle School (11-13 years) – 18.6%
- High School (14-17 years) – 38.3%
Children from minority groups seem to be disproportionately affected by the SARS-CoV-2 virus. The CDC’s COVID-NET10 demarcates COVID-19-hospitalizations based on race/ethnicity in children. The cumulative hospitalization rate for ethnic and racial groups collected from 14 states (within the United States) by late July 2020, is illustrated below.11
- Hispanic or Latino Children: 16.9 per 100,000 population
- Non-Hispanic black Children: 10.5 per 100,000 population
- White Children: 2.1 per 100,000 population
Additionally, among 121 reported deaths of people younger than 21, 80% occurred within the Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaskan Native racial demographic. This percentage accounts for approximately 40% of the population under 21 years.12
- Household Transmission:
Pediatric index cases have shown variability in rates of transmissions. Some studies show infrequent spread from children to household contacts while others show similar or higher spread rates compared to adult transmissions. This variation can be attributed to community prevalence, sample collection timing, methods used in diagnosing secondary cases and adherence levels to prevention measures taken in homes.
- Educational and Childcare Settings:
The general level of transmission seems to be low within this setting. Transference by preadolescent and adolescents is uncommon. A cohort study conducted within Australia, where schools remained open during the first wave, depicted an uncommonly low spread rate. 12 infected children (24 hours before the onset of symptoms) transmitted the virus to only 3 people (2 children and 1 adult). This is an incredibly low number considering that there were 752 possible contacts (649 children and 103 adults).13 Furthermore, the aggregated incidence of the SARS-CoV-2 was similar among counties offering in-person schooling (kindergarten through 12th grade) and those offering online-only education (kindergarten through 12th grade).9 Other cases within the United States seem consistent with these findings.14
We hope this guide was informative and has lessened some of the load you are currently carrying. We look forward to providing you with more information in parts 2 and 3.
STAY INFORMED! STAY SAFE!
1Munro, Alasdair Peter Stuart, and Saul N Faust. “Addendum to: Children are not COVID-19 super spreaders: time to go back to school.” Archives of disease in childhood vol. 106,2 (2021): e9. doi:10.1136/archdischild-2020-319908
2Li, Fang et al. “Household transmission of SARS-CoV-2 and risk factors for susceptibility and infectivity in Wuhan: a retrospective observational study.” The Lancet. Infectious diseases, S1473-3099(20)30981-6. 18 Jan. 2021, doi:10.1016/S1473-3099(20)30981-6
3Wu, Zunyou, and Jennifer M McGoogan. “Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention.” JAMA vol. 323,13 (2020): 1239-1242. doi:10.1001/jama.2020.2648
4Statista. “Distribution of Coronavirus Cases in Italy as of January 27, 2021, by Age Group.” Statista, Conor Stewart, 1 Feb. 2021, www.statista.com/statistics/1103023/coronavirus-cases-distribution-by-age-group-italy.
7Docherty, Annemarie B et al. “Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study.” BMJ (Clinical research ed.) vol. 369 m1985. 22 May. 2020, doi:10.1136/bmj.m1985
8Stokes, Erin K et al. “Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020.” MMWR. Morbidity and mortality weekly report vol. 69,24 759-765. 19 Jun. 2020, doi:10.15585/mmwr.mm6924e2
9Bixler, Danae et al. “SARS-CoV-2-Associated Deaths Among Persons Aged <21 Years - United States, February 12-July 31, 2020.” MMWR. Morbidity and mortality weekly report vol. 69,37 1324-1329. 18 Sep. 2020, doi:10.15585/mmwr.mm6937e4
13Krass, Polina et al. “COVID-19 Outbreak Among Adolescents at an Inpatient Behavioral Health Hospital.” The Journal of adolescent health : official publication of the Society for Adolescent Medicine vol. 67,4 (2020): 612-614. doi:10.1016/j.jadohealth.2020.07.009
14Deville, Jaime G, et al. “Coronavirus Disease 2019 (COVID-19): Clinical Manifestations and Diagnosis in Children.” UpToDate, 1 Feb. 2021, www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-manifestations-and-diagnosis-in-children#H4155540577.