The emergence of a coronavirus disease not previously seen in humans, now called coronavirus disease 2019 (COVID-19), has captured the attention of the US and the world. The virus was first identified in Wuhan, China, after an outbreak of pneumonia of unknown cause was identified in December 2019, with most early cases reporting exposure to a live animal market.
The COVID-19 situation is evolving rapidly with an increasing number of cases and countries involved. As of March 25, 2020, more than 425,000 cases have been confirmed globally in 170 countries and regions, including more than 55,000 cases in the United States.
Background
Coronaviruses cause a wide range of illnesses, ranging from the common cold to severe and fatal illness. Three coronaviruses that cause serious illness in humans have emerged in the past 20 years: the virus that causes SARS, which emerged in China in 2002; the virus that causes Middle East respiratory syndrome (MERS), which emerged in the Arabian Peninsula in 2012; and the virus that causes COVID-19 (SARS-CoV-2).
Common manifestations of COVID-19 in adults include fever, cough, myalgia, shortness of breath, headache, and diarrhea. According to data from more than 72,000 patients in China, the majority (81%) were mildly affected, 14% had severe manifestations (e.g., with dyspnea or blood oxygen saturation ≤93%), and 5% were seriously ill (e.g. respiratory failure or septic shock).
Risk factors for severe disease were older age and underlying diseases. The case fatality rate in China was 2.3%, although this number could be an overestimate because mild or asymptomatic cases could have been missed.
Transmission of COVID-19 is thought to occur primarily through respiratory droplets formed when a person with an infection coughs or sneezes, which can be inhaled by close contacts, who then become infected.
Other types of transmission (eg, fomite transmission, fecal-oral transmission) could be possible. The median incubation period is 5 days (range, 2-14 days).
At this time, care for patients with serious illness is supportive as no US FDA-approved therapies are available. Although vaccine development is ongoing, it is expected that a vaccine will not be ready for use. wide distribution for at least one year.
What is known about COVID-19 in children?
Children are typically more susceptible to flu complications, however, so far, they have experienced lower than expected rates of COVID-19 illness, and deaths in children appear to be rare. In more than 72,000 total cases in China, 1.2% were patients aged 10 to 19 years, and even fewer (0.9%) were patients younger than 10 years.
Only 1 death in this study was in the adolescent age range, and no children died in the 0 to 10 year age range. In a separate analysis of 2,143 confirmed and suspected pediatric cases from China, infants had the highest risk of severe disease (10.6%), compared with older children (4.1% for those aged 11 to 15 years; 3 .0% in those aged 16 or over).
Among children who become ill, the manifestations of COVID-19 appear to be similar to those of adults. Among 28 pediatric patients reported by Shen and Yang, the age ranged from 1 month to 16 years .
- Several patients were asymptomatic at diagnosis and identified as part of contact investigations.
- Several patients had fever, fatigue, dry cough, and other respiratory symptoms; Gastrointestinal manifestations were rare.
Transmission is probably the same as that seen in adults.
- So far, no convincing evidence of intrauterine transmission has been identified, but it has only been described in a small number of pregnancies.
- It is unknown if COVID-19 can be transmitted through breastfeeding.
- Among 6 mothers whose breast milk samples were tested for SARS-CoV-2, all samples were negative.
Despite the low frequency of illness and death from COVID-19 in children in China, there are reasons to remain vigilant about infection in children. The lower-than-expected rates of children affected by COVID-19 in China could be due to less exposure to the virus, less infection with the virus due to immunity to other coronaviruses, or a lower chance of illness even when infected with the virus.
If children are infected but asymptomatic, they could serve as a source of transmission to adults.
At least 1 child was reported without symptoms but with a high SARS-CoV-2 viral load, suggesting that transmission from asymptomatic children is possible.
How American children experience COVID-19 has not yet been detailed, although no intensive care unit admissions or deaths were reported among people under the age of 19 among 4,226 COVID-19 patients in the U.S. as of on March 16, 2020.
In a small study from China, 7 of 20 pediatric patients who were sick with COVID-19 had a history of a congenital or acquired disease, leading the authors to suggest that children with underlying illnesses might be more susceptible.
About 10% of children in the United States have asthma; Many children live with other lung, heart, neuromuscular, or genetic diseases that affect their ability to manage respiratory illnesses, and other children are immunocompromised due to an illness or its treatment. These children may experience COVID-19 differently than their healthy counterparts of the same age.
Considerations for pediatric care physicians
Pediatric care physicians can help prepare their offices, facilities, and communities for the surge of COVID-19 disease.
Special accommodations should be made to isolate children who are potentially sick with COVID-19 from those who are well in the waiting room, especially focusing on minimizing exposures for those with special health care needs.
In communities with widespread transmission, it may be justified to limit the visit of healthy children to the health care system for non-urgent reasons (e.g., non-urgent surgeries), while continuing to see newborns and infants for preventive care and children younger than They need vaccines. This action will require strong telephone screening and increased remote consultations.
Differentiating possible COVID-19 illness from other illnesses, such as influenza, will be difficult until testing for COVID-19 is more widely available. In communities with widespread transmission, community mitigation interventions, such as closing schools, canceling mass gatherings, and closing public places, are appropriate.
If these measures are required, pediatricians should advocate to alleviate unintended consequences or inadvertent expansion of health disparities in children, such as finding ways to maintain nutrition for those who rely on school lunches and providing mental health services. online for stress management for families, whose routines may be severely disrupted for an extended period of time.
Conclusions
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