As COVID-19 cases surge across the globe, many scientists are surprised by an unusual observation: children seem to be largely unharmed by the disease. In the US, only 2% of confirmed coronavirus cases have been children under age 18. The Yale New Haven Children’s Hospital (YNHCH), for instance, has hospitalized 20 children with COVID-19, none of whom died. For the most part, the disease has been less severe in children.
“We don’t know why children get less severe disease with COVID, but it probably is because they are younger and healthier. With other respiratory infections, like pneumonia and influenza, it is mostly the elderly who get very sick,” Marietta Vázquez, MD, a Yale Medicine pediatric infectious disease specialist, said.
A recent report from the Centers for Disease Control and Prevention, however, said that clinicians should still maintain a high index for COVID-19 infection in children and monitor for progression of illness, particularly among infants and children with underlying conditions. After all, they can still be infected by the virus. A new study published in the journal Pediatrics found out that majority of COVID-19 cases in children — more than 90% — were mild or moderate. They experienced symptoms such as fever, cough, sore throat, runny nose, sneezing, and sometimes pneumonia.
According to Live Science, a science news website that features groundbreaking developments in science, space, technology, health, the environment, our culture and history, the researchers examined the severity of COVID-19 in children. They analyzed information from more than 2,000 confirmed and suspected cases of coronavirus in kids that were reported to CDC between Jan. 16 and Feb. 8.
The findings also revealed that about 6% of children developed severe or critical illness, with symptoms such as shortness of breath and hypoxia, or low levels of oxygen in body tissues. "What this [study] tells us is that hospitals should prepare for some pediatric patients because we can't rule out children altogether," Dr. Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia, said.
A Rare Inflammatory Disease
Recently, medical professionals advise parents to be on the lookout for symptoms of a new inflammatory syndrome in children that appears to be linked to COVID-19. While they aren’t sure how it could be related to the disease, the condition called pediatric multisystem inflammatory syndrome (PMIS) can cause dangerous levels of inflammation throughout the entire body. Most patients with PMIS have tested positive for the new coronavirus or have antibodies to it, which means they were infected by it—even if they didn’t show symptoms.
“This seems to be a new manifestation associated with COVID-19. There is much we still don’t know, but it appears to occur in children after they have gotten better from COVID, and it has a lot of similarities to other diseases we see in pediatrics, including Kawasaki disease and toxic shock syndrome,” Marietta Vázquez, MD, a Yale Medicine pediatric infectious disease specialist, said.
According to Yale Medicine, the largest academic multispecialty practice in New England, the first US cases of PMIS emerged in New York City in early May. Now, it appears that the rare inflammatory disease has affected at least 102 children in NYC and 18 children in New Jersey. This has prompted health officials to ramp up awareness campaigns and spur new health protocols in response to the mysterious disease. A CDC spokesperson recently warned doctors to be on the lookout for symptoms of PMIS in children. The CDC said it is working with the Council of State and Territorial Epidemiologists and other domestic and international partners to better understand the syndrome and develop a case definition to keep track of PMIS.
Some experts said that PMIS is similar to Kawasaki disease, which is linked to issues with the heart and other organs and can sometimes require hospital support in an intensive care unit. A recent study provides the strongest evidence that it is also linked to coronavirus. Medical professionals in Bergamo, Italy evaluated the incidence and features of patients with Kawasaki-like disease diagnosed during the COVID-19 pandemic.
After studying 15 girls and 14 boys age 7 and younger, the doctors concluded: "The SARS-CoV-2 epidemic was associated with a high incidence of a severe form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected in countries involved in the SARS-CoV-2 epidemic."
How to Recognize PMIS
PMIS can be life-threatening. Medical professionals say that parents or guardians should seek professional help immediately if their child becomes ill and has a continued fever of 100.4 degrees Fahrenheit (38 degrees Celsius) lasting several days. According to MarketWatch, an online site that provides the latest stock market, financial and business news, common symptoms include severe abdominal pain, diarrhea or vomiting; lethargy, irritability, sluggishness or confusion; rashes; conjunctivitis, or red or pink eyes; patchy blue or pale skin discoloration, and more.
"Until we know more, hospitals in NYC that are treating children with PMIS are taking the same precautions they take for patients with COVID-19," writes the New York City Department of Health.
While the health officials believe PMIS is not contagious, its connection to COVID-19 suggests that a child may be infected with the virus or another underlying infection that may be contagious. Clifford Bogue, MD, chair of Yale Medicine Pediatrics and chief medical officer of YNHCH, said that early treatment is important. “Based on our experience with this and other conditions in which there is a severe inflammatory response that could lead to organ injury or failure, we want to identify and treat patients as soon as we can,” he said.
“Parents should be aware of symptoms of this syndrome, even if there is no history of COVID—because many kids have COVID with no symptoms. This can also appear weeks after a COVID infection,” Dr. Bogue added.
According to EcoWatch, a leading environmental news site engaging millions of concerned individuals every month, there’s currently no cure for PMIS. But, health professionals say that children affected by the rare inflammatory disease are being treated with different therapies and drugs that help reduce the body's immune response. Experts also recommend taking similar precautions as well as practicing proper hand hygiene and social distancing measures.
“It is crucial to reiterate—for parents and health-care workers alike—that children remain minimally affected by SARS-CoV-2 infection overall,” Russell Viner, president of the Royal College of Pediatrics and Child Health, said.