Kids and COVID-19: Illness appears mild

The sheer volume of 2019 novel coronavirus disease (COVID-19) media coverage is enough to alarm parents and children alike. According to the World Health Organization (WHO) on February 25, 2020, 80,239 cases of the disease in 33 countries and 2700 deaths have been confirmed, with the vast majority occurring in China. However, a previous study showed that no cases had been found in children aged younger than 15 years, and 2 additional small studies in China show that children aren’t particularly at risk.

Two recent studies on COVID-19

- The first study, published in The Lancet, looked at whether COVID-19 could be transmitted vertically, from mother to child.¹ Researchers examined clinical records, laboratory results, and chest computed tomography scans of 9 pregnant women with COVID-19, with positive swabs samples for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). They accessed vertical transmission by testing for presence of SARS-CoV-2 in the amniotic fluid, cord blood, and neonatal throat swab samples. They also collected breastmilk samples and tested after first lactation.

No neonatal asphyxia was observed in the newborns, and all 9 had a 1-minute Apgar score of 8–9 and 5-minute Apgar score of 9-10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from 6 patients were tested for SARS-CoV-2, and all tested negative for the virus.

The researchers concluded that COVID-19 doesn’t appear to be transmitted vertically, according to current observation.

-  The second study was a research letter published in JAMA and examined data on all hospitalized infants diagnosed with COVID-19 between December 8, 2019, and February 6, 2020, in China.² Samples from nasopharyngeal swabs were collected during the infant’s hospitalization, and the specimen was tested using real-time polymerase chain reaction testing. Two positive test results indicated infection.

The researchers identified 9 infected infants, 7 of which were girls. They ranged in age from 1 month to 11 months. Fever was reported for 4 infants; mild upper respiratory tract symptoms were found in 2 infants; and 1 infant showed no symptoms but tested positive for COVID-19 in a designated screening because of exposure to infected family members. All 9 infants had at least 1 infected family member.

None of the 9 infants required intensive care or mechanical ventilation and had any severe complications.

Researchers stressed that caregivers of young children in infected homes be vigilant in using typical infection control methods like handwashing.

Allaying the fears of families

The sheer volume of headlines regarding COVID-19 is more than enough to alarm parents as well as older children - resulting in calls or visits to your office. As the anti-vax movement has shown, responding to questions and fears with hard facts only may not be the most effective method.

Consider the following to help educate and soothe parents and older children:

• Be understanding of their concerns, and explain that the current risk is low for people in the United States.

• Stress that influenza prevention techniques they already use - washing hands for at least 20 seconds in soap and water, covering coughs and sneezes with tissues that are immediately thrown away - are effective in reducing the risk of COVID-19.

• Avoid using technical jargon - eg, don’t say fomite; instead say, “surfaces that can retain the disease such as cell phones and countertops.”

• Refer parents to the WHO Situation Report, which is produced with updated numbers, as their source for facts on COVID-19. The report also includes the latest recommendations and dvice for the public.

• Print and distribute the WHO’s collection of COVID-19 myth busters.

• For parents or children who indicate they want to use face masks to prevent infection, share WHO guidance on when and how to use masks.

Editor's note: Case count, deaths, and number of countries affected by COVID-19 are accurate as of the date of the publication for this article. For the latest counts, please check the most recent Situation Report from the WHO.

References:

1. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. February 12, 2020. Epub ahead of print. doi: 10.1016/S0140-6736(20)30360-3

2. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. February 14, 2020. Epub ahead of print. doi: 10.1001/jama.2020.2131