Coronavirus: some children can develop serious complications

In the early days of the Covid-19 pandemic, when the virus first began to spread outside of China, parents took heart in studies that showed children were less susceptible to the infection. Evidence is emerging that under-18s can, and do, contract the illness, and occasionally are at risk of developing serious complications. But only four children are known to have died from the disease so far. They were a 10-month-old baby and teenagers aged 13, 14 and 17. More than 17,000 adults are known to have died. The study, Epidemiological Characteristics of 2,143 Paediatric Patients with 2019 Coronavirus Disease in China, found that children of all ages were susceptible to Covid-19, but the clinical manifestations in paediatric patients were generally less severe than those of adults. Young children, particularly infants, are more vulnerable to the infection, the researchers found. Of the studied cases, there were 731 (34.1 per cent) laboratory-confirmed and 1,412 (65.9 per cent) suspected ones. More than 90 per cent of all patients were asymptomatic, or had only mild or moderate symptoms. The researchers found that the proportion of severe and critical cases was the highest (10.6 per cent) for those under the age of one. This was followed by 7.3 per cent for aged 1 to 5; 4.2 per cent for children aged 11 to 15 and 3 per cent for older teenagers. “It shows that, compared with the adults’ cases, the severity of children’s cases was milder, and the case fatality rate was much lower,” the report said. “To date, there have been very few deaths in children,” said Dr Rathinabalan Indiran, a specialist in paediatrics at NMC Hospital in Abu Dhabi. “Compared to others, as of now, children seem to have milder illness.” Mild cases are defined as “symptoms of acute upper respiratory tract infection, including fever, fatigue, myalgia, cough, sore throat, runny nose and sneezing”. Moderate cases included pneumonia, frequent fever and cough, with possible wheezing but no shortness of breath. Another study, Sars-CoV-2 Infection in Children , published in The New England of Journal of Medicine , also found that children are less likely to develop severe features of the disease. The study reviewed 72,314 cases and showed that fewer than 1 per cent were in children younger than 10 years of age. Of the 1,391 children assessed and tested from January 28 to February 26, 2020, 171 (12.3 per cent) were confirmed to have the infection. Only three children required intensive care support and invasive mechanical ventilation. One patient, a 10-month-old baby with a coexisting condition died because of multi-organ failure after four weeks. Experts said several factors may explain why children may be less susceptible to the disease. Children are better cared for at home and are less likely to be exposed to pathogens. One theory is that the ACE2 receptor, a protein in human cells to which the virus binds, may be less prominent or shaped differently, making it harder for it to enter the body. Moreover, children experience more respiratory illness in winter, which could mean they have higher levels of antibodies against other coronaviruses, which may offer them better protection against this new one. The immature immune system of children may not attack the virus strongly, which surprisingly, may be for the better. “When the immune system and the virus are fighting each other, say in the lungs, when the fight is strong, the damage is greater,” Dr Indiran said. Paediatricians also said studies show children do catch and spread the disease, which provides further impetus for governments to shut schools. Parents must emphasise the importance of handwashing and cough etiquette to help youngsters protect themselves and those around them.