- By ORM Staff

There is reassuring evidence that children with COVID-19 have fewer symptoms and less severe disease, according to Petra Zimmerman, MD, PhD, of the University of Fribourg, in Switzerland, and Nigel Curtis, FRCPCH, PhD, of the University of Melbourne, in Australia (Ped Infect Dis J 2019 Mar 12. [Epub ahead of print]).

The risk to children is a pressing question for pediatric infectious disease specialists and concerned parents alike. Children appear to have milder clinical symptoms than adults and be at substantially lower risk for severe disease, which was also true in the earlier SARS (severe acute respiratory syndrome; 2002) and MERS (Middle East respiratory syndrome; 2012) outbreaks, they said.

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Four coronaviruses circulate in humans, mostly causing respiratory and gastrointestinal symptoms—ranging from the common cold to severe disease. 

In Chinese data from February 2020, children and adolescents accounted for only 2% of SARS-CoV-2 hospitalizations. However, as children are less frequently symptomatic and have less severe symptoms, they are tested less often, so the actual number of cases might be underestimated, they wrote. 

Infected children in China recovered within two weeks of the onset of symptoms, and they had a documented household contact who was infected. 

Children with COVID-19 may be more likely to develop gastrointestinal symptoms, they said. 

For now, treatment is supportive just as it is in adults.

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Although most children fare pretty well, there are those with risk factors, such as immunocompromising conditions, which put them at risk for serious disease, and some children have died since the COVID-19 pandemic began, according to Maria Van Kerkhove, PhD, MS, who heads the World Health Organization’s emerging diseases and zoonoses unit.

In related news, there does not appear to be maternal–fetal transmission, according to a study from the journal Frontiers in Pediatrics (2020 March 13 https://doi.org/10.3389/fped.2020.00104).

The study is the second out of China within the last month to show that mothers infected with COVID-19 during pregnancy did not infect their babies.
All four mothers in the current study, which focused on the health of the newborns, gave birth at Wuhan's Union Hospital while infected. None of the infants developed any serious symptoms associated with COVID-19, such as fever or cough, although all were initially isolated in neonatal ICUs and fed formula. Three of the four tested negative for the respiratory infection following a throat swab, while the fourth child's mother declined permission for the test.

One newborn experienced a minor breathing issue for three days that was treated by noninvasive mechanical ventilation. Two babies, including the one with a respiratory problem, developed  rashes that eventually disappeared on their own.

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It's impossible to conclude whether there’s a connection between these other medical issues and COVID-19. “We are not sure the rash was due to the mother’s COVID-19 infection,” said study co-author Dr. Yalan Liu at Huazhong University of Science and Technology, in Wuhan. She also works in the Department of Pediatrics at Union Hospital.

All four infants remain healthy, and their mothers also fully recovered.

In the previous retrospective study on nine pregnant mothers infected with COVID-19, researchers also found no evidence of maternal–fetal transmission. All nine births were done by cesarean delivery. Three of the four pregnancies in the current study were also cesarean deliveries.

“To avoid infections caused by perinatal and postnatal transmission, our obstetricians think that C-section may be safer,” Dr. Liu said. “Only one pregnant mother adopted vaginal delivery because of the onset of the labor process. The baby was normal. Maybe vaginal delivery is OK. It needs further study.”
In previous coronavirus outbreaks, scientists found no evidence of viral transmission from mother to child, but SARS and MERS were both associated with “critical maternal illness, spontaneous abortion or even maternal death,” Dr. Liu said.