Can Asymptomatic or Non-Severe SARS-CoV-2 Infection Cause Medium-Term Pulmonary Sequelae in Children?

Abstract

Pulmonary complications in adults who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported even in minimally symptomatic patients. In this study, lung ultrasound (LUS) findings and pulmonary function of children who recovered from an asymptomatic or mildly symptomatic SARS-CoV-2 infection were evaluated. We prospectively followed up for at least 30 days patients younger than 18 years who recovered from SARS-CoV-2 infection at the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan (Italy). All enrolled patients underwent LUS. Airway resistance measured by the interrupter technique test was assessed in subjects aged 4–6 years, whereas forced spirometry and measurement of diffusing capacity of the lungs for carbon monoxide were performed in subjects older than 6 years. To evaluate a possible correlation between pulmonary alterations and immune response to SARS-CoV-2, two semiquantitative enzyme immune assays were used. We enrolled 16 out of 23 eligible children. The median age of enrolled subjects was 7.5 (0.5–10.5) years, with a male to female ratio of 1.7. No subject presented any abnormality on LUS, airway resistance test, forced spirometry, and diffusing capacity of the lungs for carbon monoxide. On the other hand, all subjects presented Ig G against SARS-CoV-2. In contrast in adults, we did not detect any pulmonary complications in our cohort. These preliminary observations suggest that children with an asymptomatic or mildly symptomatic SARS-CoV-2 infection might be less prone to develop pulmonary complications than adults.

Inflammatory Markers, Pulmonary Function, and Clinical Symptoms in Acute COVID-19 Among Non-Hospitalized Adolescents and Young Adults

“…In some follow-up studies of hospital-based adult COVID-19 cohorts, persistent alterations of dynamic pulmonary function have been reported (41)(42)(43)(44). Results are conflicting though, as a relatively large adult study did not find any substantial alterations of spirometry tests results despite persistent radiological abnormalities (45), and two small cases series reported spirometry to be normal or near-normal in the aftermath of COVID-19 in children (46,47). The present study confirms that pulmonary function appears to be normal in non-severe cases of COVID-19 in adolescents and young adults, and there were no associations to inflammatory markers nor clinical symptoms.…”

Validity of reported post-acute health outcomes in children with SARS-CoV-2 infection: a systematic review

“…Six studies had a control group 29-34 and 15 were uncontrolled 35-49 . Twelve studies were conducted in Europe 29-33,36,38-40,44,47,49 and 18 published in 2021 29-33,35-37,39-48 . Thirteen studies used data that were specifically collected for the purpose of the study 29,31-33,35-40,42,45,47,48 , 5 studies used routinely collected data 30,34,41,44,49 and the type of data was unclear in 2 studies 43,46 .…”

“…Twelve studies were conducted in Europe [29][30][31][32][33]36,[38][39][40]44,47,49 and 18 published in 2021 [29][30][31][32][33][35][36][37][39][40][41][42][43][44][45][46][47][48] . Thirteen studies used data that were specifically collected for the purpose of the study 29,[31][32][33][35][36][37][38][39][40]42,45,47,48 , 5 studies used routinely collected data 30,34,41,44,49 and the type of data was unclear in 2 studies 43,…”

“…Outcome data were collected over 2 to 7 months (median 5.3; IQR 3-6) in the 12 studies starting follow-up at infection or onset [29][30][31][32][33][34]39,44,[46][47][48][49] and over 2 to 11.5 months (median 5; IQR 3.5-8) in the 9 studies starting follow-up at recovery [35][36][37][38][40][41][42][43]45 (Table 2; Supplementary material: ). Outcome data were collected by phone in 8 studies 33,35,37,38,40,42,45,47 , per clinical visit in 5 36,39,43,46,48 , routinely collected in 4 30,34,44,49 , online in 2 30,31 , by personal interview in 1 29 , or by a mix of case reports, medical records, and self-reports in 1 40 .…”

“…The main outcome was a composite of any symptom in 16 studies [29][30][31][32][33]35,[37][38][39][40][41][42][43]46,47,49 ; the main outcome in the remaining studies was fatigue 48 , respiratory 36 , gastrointestinal 44 , cardiac symptoms 34 , and olfactory symptoms 45 . The 3 symptoms most frequently assessed across studies were headache (n=13) [29][30][31][32][33]35,37,[40][41][42]46,47,49 , fatigue or tiredness (n=12) [30][31][32]34,35,37,41,42,[46][47][48][49] , and cough (n=10) [29][30][31]…”