Does coronavirus affect children differently?
So far, Covid-19 was believed to have largely spared young children, with most hospitalisations and deaths being reported in older adults and those with chronic conditions.Updated: May 29, 2020 13:00 IST
Clinicians are investigating the possible link of a potentially-lethal inflammatory syndrome characterised by high fever and swollen blood vessels and guts in young children that appears to be linked with coronavirus disease (Covid-19).
So far, Covid-19 was believed to have largely spared young children, with most hospitalisations and deaths being reported in older adults and those with chronic conditions. But over the few weeks, around 100 cases of young children being admitted to intensive care units with toxic shock and symptoms similar to Kawasaki disease in the US, UK, France, Italy, Spain and Switzerland, which has led the World Health Organisation (WHO) to begin investigating the possibility of its link with coronavirus disease.
Kawasaki syndrome is an illness of unknown cause that affects the blood vessel, heart and other organs. The symptoms include high fever, low blood pressure, rash and difficulty breathing and it usually affects children under five years, though a third of the cases in India are in older children. After rheumatic fever, it is the most common cause for acquired heart disease in children.
“We are aware of this newly described syndrome from a number of countries in Europe and potentially a small number of cases in North America,” Dr Adam Finn, chair of the WHO’s European Technical Advisory Group, said at a news briefing. “We are urgently conducting a surveillance study in the United Kingdom to establish what is going on,” he added.
The incidence rate of Kawasaki syndrome is 150 per 100,000 children below 5 years, but it remains largely undiagnosed in India, according to a study published in Global Cardiology Science and Practice. Boys are at a slightly higher risk, with the male to female ratio being around 1.5:1 in India.
Many of the children being treated for the new syndrome in Europe and the US have tested positive for coronavirus, but some have not. That could mean that the syndrome is not related to coronavirus, that the children had cleared the virus before they were tested, or that the test missed the infection. There have been no coronavirus-linked Kawasaki syndrome cases reported from India,
Experts say what Covid-19 and Kawasaki syndrome have in common is the acute immune response, or cytokine storm, that they trigger, which makes in the body go into shock.
“These children have had a severe and prolonged inflammatory response to Covid-19 infection and they have not had severe lung disease, unlike the majority of cases in adults,” Dr Nazima Pathan, a consultant in paediatric intensive care in Cambridge, told The Guardian.
“Whilst this is an evolving situation, it is clear that these symptoms are reported in only handfuls of cases. The important message is that if parents are worried about their children’s health, they should seek medical advice,” said Dr Pathan.
Whilst children are not invulnerable to Covid-19 infection, most of them get mild disease. Initial data from China showed children were largely spared, but cases detected though contact tracing showed 13% of confirmed cases had no symptoms, and when confirmed and suspected cases were combined, almost a third of children ages 6 to 10 years were asymptomatic. Considering both confirmed and suspected cases, 32% of children aged 6-10 years were asymptomatic, shows data from China Centers of Disease Control.
“Children may not even develop severe symptoms, but they are potential carriers of the virus and can spread it to others, so it is important to minimise their contact with people at risk, such as grandparents and people with existing diseases like severe asthma, diabetes, hypertension, kidney disease, among others,” said Dr Yatin Mehta, head of critical care, Medanta-The Medicity, Gurugram, which was the first private hospital to begin treating Covid-19 patients in India.
A new study from Germany has found that children are as infectious as adults. Researchers at Charite, one of Europe’s largest university hospital in Berlin, found the virus in the respiratory tract, which is the main route of virus transmission, is not significantly different across age groups.
chidlren account for less than 1% (0.6%) of people hospitalised with severe illness. According to US Centers for Disease Control and Prevention data, infants appear most likely to be hospitalised, but death remains extremely rare.
Signs of trouble in young children
Abnormally cold to the touch
Paused or irregular breathing (apnoea), grunting sounds
Difficulty in breathing
Rash that does not disappear with pressure (Glass test)