Severe and fatal COVID-19 is rare in children

Children's Health

The coronavirus disease (COVID-19) is known to be particularly severe and even fatal for the elderly, those with underlying medical conditions, and those with weakened immune systems. Children and adolescents, if infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are known to be mostly asymptomatic or only develop mild to moderate symptoms.

Now, a new study by researchers at the Universities of Edinburgh and Liverpool, Imperial College London, and the Royal Hospital for Children, Glasgow in the United Kingdom has shown that children and teenagers are less likely than adults to develop severe COVID-19 or die from the disease.

The study, published in the British Medical Journal, aimed to characterize the clinical features of children and young individuals admitted to the hospital with laboratory-confirmed COVID-19. The researchers also wanted to explore factors tied to admission to critical care, death, and the development of the multisystem inflammatory syndrome in children and adolescents temporarily related to COVID-19, also called Multisystem Inflammatory Syndrome in Children (MIS-C).

Even though the U.S. Centers for Disease Control and Prevention (CDC) reports that the number of children getting the infection is steadily increasing, the new study reveals that they are less likely to develop severe symptoms.

Transmission electron micrograph of SARS-CoV-2 virus particles, isolated from a patient. Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Credit: NIAID

The study

In the study, the researchers recruited 651 children and young people below the age of 19 who had been admitted to the hospital due to COVID-19. The researchers, who are part of the ISARIC4C, a global group of clinicians working to prevent death from respiratory disease, spanned 148 hospitals across Wales, England, and Scotland.

The work was part of the ISARIC4c COVID-19 study that includes two-thirds of all people admitted to hospital with the disease from January to July, the time when the coronavirus pandemic is spreading across Europe.

The team has found that a strikingly low 1 percent of the 651 children and young people, or only six, had died in hospital with COVID-19, compared to 27 percent across all other age groups. Further, the six children and teens who died had profound underlying medical conditions, worsening their COVID-19 symptoms.

About 18 percent of hospitalized children and teenagers were admitted to intensive care. Health experts said that those who needed intensive care were those who were below one-month-old and those who are between 10 and 14 years old. Similar to adults, those who are obese or of Black ethnicity were at a higher risk of severe symptoms.

The team also identified 52 patients who developed MIS-C, wherein the children were more likely to be admitted to intensive care. The children with MIS-C had reported symptoms such as abdominal pain, diarrhea, vomiting, conjunctivitis, and a rash. Also, the team noted additional COVID-19 symptoms in children with MIS-C, including a sore throat, muscle aches, headaches, and tiredness.

Children and young people have less severe acute COVID-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that share features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition,” the researchers concluded.

“Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive),” they added.

What is MIS-C?        

Multisystem inflammatory syndrome in children (MIS-C) is a rare systemic inflammatory disease that affects children and adolescents due to SARS-CoV-2 infection.

The illness has been described as akin to Kawasaki disease, which is a rare disease that affects children who are below 5 years old. The common signs and symptoms of Kawasaki disease include rash, swollen glands, red eyes, and red fingers and toes.

On the other hand, the symptoms of MIS-C include a fever that lasts for more than three days, a rash on the face, hands or feet, low blood pressure, gastrointestinal problems, such as abdominal pain, vomiting, and diarrhea, and heart problems, including valvulitis, myocarditis, and pericarditis.

“The diligent work of our colleagues working in Child Health and the NIHR Clinical Research Network across the UK has led to this report which is the largest and most detailed description of COVID-19 and MIS-C in children and young people,” Professor Calum Semple, Professor in Child Health and Outbreak Medicine and Consultant Respiratory Paediatrician at the University of Liverpool, said.

“We have provided new understanding about MIS-C, which will help manage this rare but serious condition, but parents can now be reassured that severe COVID-19 is very rare in children,” he added.

Journal reference:
  • Swann Olivia V, Holden Karl A, Turtle Lance, Pollock Louisa, Fairfield Cameron J, Drake Thomas M et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study BMJ 2020; 370 :m3249,

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