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Very early on in this coronavirus pandemic, there were hopes - based on initial reports of low hospitalization rates - that children were largely immune to infection by SARS-CoV-2. More recent studies suggest they are equally susceptible to infection, but in general, tend to experience milder illness.
While serious illness has been reported in children and adolescents (see MMWR: COVID-19–Associated Multisystem Inflammatory Syndrome in Children — U.S., March–July 2020), younger cohorts are statistically far less likely to experience serious COVID-19 illness than older adults.
Questions remain, however, over the ability to detect (via overt symptoms) COVID-19 in children, the extent of carriage and shedding of the virus in children, and the role that mildly ill or asymptomatic children may play in the spread of the disease (to other children, and to other more vulnerable adults).
A month ago, in JAMA PEDS: Nasopharyngeal Viral RNA Higher In Young Children Than Adults, we looked at evidence that children may be highly effective vectors of SARS-COV-2.
A day later, in MMWR: SARS-CoV-2 Transmission At A Summer Day Camp - Georgia, June 2020, we looked at a study that found - even when following many (but not all) of the CDC Suggestions for Youth and Summer Camps - the pandemic virus spread efficiently among camp goers.
From the study's conclusion:
These findings demonstrate that SARS-CoV-2 spread efficiently in a youth-centric overnight setting, resulting in high attack rates among persons in all age groups, despite efforts by camp officials to implement most recommended strategies to prevent transmission.
Two weeks ago, in J. Peds: Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses, we looked at a study by Researchers at Massachusetts General Hospital (MGH) and Mass General Hospital for Children (MGHfC) that measured the amount of viral RNA in the upper airway of SARS-CoV-2 positive children and found - even in asymptomatic or mildly symptomatic children - that it was significantly higher than in hospitalized adults with severe symptoms.
The authors made the case that children - even those who are asymptomatic - are likely to be efficient spreaders of the virus, and that a rushed reopening of schools - or an over reliance on temperature and/or symptom checking to screen for the disease - could help exacerbate the pandemic.
In a similar vein, we have a new report (and an accompanying Editorial) - published Friday in JAMA Pediatrics - that examines the clinical presentation and the detectable levels of viral RNA in 91 children diagnosed with COVID-19 during South Korea's first big outbreak last spring
They report that a large percentage of SARS-CoV-2 infected children may be asymptomatic or presymptomatic, and those who do present with mild symptoms may not be easily recognizable as having COVID-19. They also report that asymptomatic and symptomatic children may be capable of shedding the virus for 2 to 3 weeks.
Original InvestigationAugust 28, 2020Mi Seon Han, MD, PhD1; Eun Hwa Choi, MD, PhD2; Sung Hee Chang, MD3; et alByoung-Lo Jin, MD4; Eun Joo Lee, MD5; Baek Nam Kim, MD6; Min Kyoung Kim, MD7; Kihyun Doo, MD8; Ju-Hee Seo, MD, PhD9; Yae-Jean Kim, MD, PhD10; Yeo Jin Kim, MD11; Ji Young Park, MD, PhD12; Sun Bok Suh, MD, PhD13; Hyunju Lee, MD, PhD14; Eun Young Cho, MD15; Dong Hyun Kim, MD16; Jong Min Kim, MD17; Hye Young Kim, MD, PhD18; Su Eun Park, MD, PhD19; Joon Kee Lee, MD, PhD20; Dae Sun Jo, MD, PhD21; Seung-Man Cho, MD22; Jae Hong Choi, MD23; Kyo Jin Jo, MD19; Young June Choe, MD, PhD24; Ki Hwan Kim, MD25; Jong-Hyun Kim, MD, PhD26JAMA Pediatr. Published online August 28, 2020. doi:10.1001/jamapediatrics.2020.3988Key PointsQuestionHow long is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detected in children, and are children with coronavirus disease 2019 (COVID-19) identifiable by symptoms?FindingsIn this case series of 91 children with COVID-19 in Korea, 22.0% were asymptomatic. Only 8.5% of symptomatic cases were diagnosed at the time of symptom onset, while 66.2% had unrecognized symptoms before diagnosis and 25.4% developed symptoms after diagnosis; SARS-CoV-2 RNA was detected for a mean of 17.6 days overall and 14.1 days in asymptomatic cases.MeaningSymptom screening fails to identify most COVID-19 cases in children, and SARS-CoV-2 RNA in children is detected for an unexpectedly long time.(SNIP)Conclusions and RelevanceIn this case series study, inapparent infections in children may have been associated with silent COVID-19 transmission in the community. Heightened surveillance using laboratory screening will allow detection in children with unrecognized SARS-CoV-2 infection.
