Some children with COVID-19 become seriously ill, study finds

Children of all ages are susceptible to COVID-19 and while their symptoms are generally less severe than those of adults, a small percentage — particularly preschoolers and infants — can become seriously ill, according to a new study.

A pre-publication version of the report has been posted on the Pediatrics journal’s website “to expedite access to these findings” as the global pandemic continues to spread.

Researchers analyzed 2,143 confirmed or suspected cases of novel coronavirus in children under the age of 18 reported in China between Jan. 16 and Feb. 8.

More than half of the children (1,091) had mild symptoms of acute upper respiratory tract infections, such as fatigue, fever, cough, congestion, and in some cases digestive symptoms, such as nausea, vomiting and diarrhea.

About 39 per cent (831) were moderately sick, with pneumonia or lung lesions, but no obvious shortness of breath, according to the report, Epidemiology of COVID-19 among Children in China.

Of the 125 children (5.8 per cent) classified severely or critically ill because of a lack of oxygen or risk of organ failure, 76 were aged five or younger.

Nearly a third (40) were under the age of one.

One child died — a 14-year-old boy in Hubei, the province where the outbreak originated.

The report comes as New Brunswick has its first presumptive case involving a child, a boy under the age of 10 in the central part of the province who is linked to a previous travel-related case.

There are now 11 confirmed or presumptive cases in the province after three new presumptive cases were reported Wednesday.

Although some children have been affected in other jurisdictions across Canada in recent weeks, including in Alberta and Ontario, they have been largely spared to date.

People aged 65 and older are considered among the most vulnerable, along with those who have compromised immune systems, or underlying medical conditions.

Children may be more likely to pass the virus on to others, however, according to an infectious diseases specialist at the Saint John Regional Hospital.

“Firstly, it appears that they generally have less severe illness and therefore identifying a child as infected may be challenging,” said Dr. Duncan Webster.

They may be “shedding virus” even if they’re not exhibiting any symptoms, he said, adding more data is needed.

The other challenge is getting children to follow the same public health recommendations as adults to help prevent the spread of the virus, including regular hand washing, not touching your face, and maintaining a social distance of six feet, said Webster.

On Wednesday, New Brunswick’s chief medical officer of health Dr. Jennifer Russell said some people are ignoring the government’s advice to stay home to protect themselves and the health-care system from the “serious health threat.”

She expects there will be “many” cases within the next few days, she said.

Premier Blaine Higgs urged residents to heed Russell’s advice and said the government could adopt emergency powers to force them to.

“We’ve seen what happens … in other countries where social distancing measures were not taken, or were taken too late,” he said. “We must ask that you listen to this advice now to protect the health of all New Brunswickers.”

“That means don’t go joyriding in full cars. That means don’t find reasons to get together in the den and watch a movie with all your friends. It means no play dates, no sleepovers.”

Russell has declined to release any additional details about the boy diagnosed as a presumptive, or probable, case of COVID-19. It’s unclear, for example, whether he is school-aged or an infant.

Earlier this week, Russell urged all daycares to close, with the exception of those that provide services to essential workers, such as those in health care.

Public schools closed Monday for two weeks because of the outbreak. The closure could be extended, the premier has said.

Webster said it’s too soon to discuss outcomes in New Brunswick or anywhere else in Canada because many cases are still active and data is still being gathered.

Data out of China is likely the most reliable source at this point, he said, “as they have more complete data pertaining to large cohorts and more complete clinical outcomes given their temporal involvement in this pandemic.”

The pediatrics study has a number of strengths, according to its authors, including the fact it is the first nationwide study, to date.

Might have had other infections

It also has “a number of limitations,” they said.

For example, more of the severe and critical cases appeared in children with suspected — rather than confirmed coronavirus — which suggests some of the suspected cases might have been caused by other respiratory infections.

Only about a third of the studied cases were lab-confirmed, while the rest were suspected, based on the child’s symptoms, chest X-rays, blood tests, and whether the child had been exposed to someone with coronavirus.

In addition, the researchers noted they were unable to study incubation period because they didn’t have information on the children’s exposure history.

“To gain a better understanding of children’s COVID-19, more detailed patient information, particularly clinical outcomes (e.g., discharge, transferred to intensive care unit, or death), should be collected in future studies,” they conclude.

Another recent report, from the WHO-China Joint Mission on Coronavirus Disease, found that of 44,672 laboratory-confirmed cases, as of Feb. 11, only 965 (2.2 per cent) were under the age of 20. And only one death (0.1 per cent) was recorded in this age group.

“So much less common in the young and a much less severe illness overall,” said Webster.

“However, individual cases may fall outside of the norm and so each case must be monitored very closely, including the young.”