Very few COVID-19-positive children require hospitalization, finds case study

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many scientists were left baffled about why and how the illness predominantly affected older adults and those with comorbidities. These groups are at a higher risk of developing severe symptoms and are more likely to die from the infection.

Meanwhile, most children and young people seem to be spared by the severe acute respiratory syndrome coronavirus (SARS-CoV-2)’s severity. As the pandemic evolves, several studies have explored the reasons behind this.

A team of researchers at the Divisions of Infectious Diseases, UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh, USA, sought to characterize the clinical presentation of children with COVID-19 in Western Pennsylvania.

The team has found that pediatric patients tolerate the infection well, with only a small proportion requiring hospital admission. Fewer patients present with a critical illness.

COVID-19 and children

While there had been reports of acute COVID-19 in pediatric patients in many countries, studies on the severity of the infection in children are limited. Some countries reported the emergence of the multisystem inflammatory syndrome in children (MIS-C), similar to Kawasaki disease.

MIS-C is a condition where different body parts become inflamed, including the heart, kidneys, lungs, skin, brain, eyes, or gastrointestinal tract. Though the exact cause of the condition is unknown, many children with MIS-C had COVID-19. If the condition is not treated accordingly, it can be potentially fatal, but most diagnosed with the disease recovered with medical care.

The study

In the study, which was published on the preprint medRxiv* server, the researchers wanted to determine the severity of illness in children caused by COVID-19.

To arrive at the study findings, the researchers included all patients receiving care at the partner facilities who had a conformed SARS-CoV-2 infection. The team established and analyzed a registry of pediatric COVID-19 that includes cases in patients younger than 22 years old.

The team performed a registry-based retrospective chart review of characterized COVID-19 presentation, illness patterns, patterns of healthcare utilization, and short-term outcomes among pediatric cases.

Study findings

Between March and August 2020, there were 955 confirmed pediatric SARS-CoV-2 cases between 0 and 19 in Allegheny County, Pennsylvania (PA). This area is the most populous county in Western PA. Of these, 424 pediatric COVID-19 cases were included.

Around 65% of the cases had exposure to the virus, while 79% developed symptoms. Of all the patients, 4.5% required hospitalization. About 19 patients developed acute COVID-19 disease, and three had MIS-C. Patients who were admitted to the hospital were younger and more likely to have pre-existing conditions.

The team also found that Black/Hispanic patients were 5.8 times more likely to be hospitalized than White patients. Of all the patients followed, five were admitted to the pediatric intensive care unit (PICU), including all three MIS-C patients. Two of those in the PICU needed Bilevel Positive Airway Pressure (BiPAP), and one needed a mechanical ventilator.

The good news is, all of the pediatric cases survived and eventually recovered from the infection.

This report provides a comprehensive overview of the breadth of presentation of pediatric infection with SARS-CoV-2 in a single geographic area. In general, pediatric patients tolerate this infection well, with only a small proportion requiring hospital admission, and even fewer presenting with a critical illness,” the team concluded in the study.

However, it is essential to safeguard the health of younger people amid the coronavirus disease. Many countries do not allow minors to go out, especially for non-essential travel.

Younger people should also understand the importance of infection control measures, such as wearing masks, washing their hands, and maintaining social distance.

Important Notice

*medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.