Detection of Covid-19 in Children in Early January 2020 in Wuhan, China

Abstract

C o r r e s p o n d e n c e Detection of Covid-19 in Children in Early January 2020 in Wuhan, China To the Editor: A small number of cases of coronavirus disease 2019 (Covid-19) have been described in children, 1,2 and our understanding of the spectrum of illness is limited. 3 We conducted a retrospective analysis involving hospitalized children in Wuhan, China. From January 7 to January 15, 2020, a total of 366 hospitalized children (≤16 years of age) were enrolled in a retrospective study of respiratory infections at three branches of Tongji Hospital, which are located 14 km to 34 km from one another in central Wuhan (Fig. S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). The study was approved by the ethics committee of Tongji Hospital. Among the 366 children, the most frequently detected pathogens were influenza A virus (in 23 patients [6.3%]) and influenza B virus (in 20 [5.5%]). SARS-CoV-2, the virus that causes Covid-19, was detected in 6 patients (1.6%). In

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“…Also, one retrospective study was conducted before mid-January. 11 The result might be representative of the early stage of COVID-19 outbreak. Therefore, more symptomatic or severe cases were reported, the same as adults, 8,9 which make moderate heterogeneity of the pooled data in clinical features.…”

“…In addition, all neonates tested negative for SARS-CoV-2. Liu et al 11 Feng et al 12 Cai et al 13 Xia et al 14 Wang et al 15 Jiang et al 16…”

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“…The low rate of identified infection is somewhat surprising, as it is reasonable to assume that the pediatric patients with cancer would be at least as susceptible to infection with SARS-CoV-2 infection as their healthy peers. The SARS-CoV-2 does infect children in general, although lower severity of the infection makes children prone to be underreported 3,6 . Thus, at least in the countries with high COVID-19 incidence, either the transmission of SARS-CoV-2 was prevented by standard infection prevention measures, or cases remained undiagnosed as the course of the infection did not raise a suspicion of COVID-19.…”

“…In contrast, pediatric patients rarely develop critical illness. [3][4][5][6][7] In one study, only 5% and 0.6% of 2141 evaluable children with confirmed COVID-19 had severe or critical illness respectively. 7 The biology underlying this disparity in severity is unknown.…”

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“…Children account for the minority of laboratory-confirmed cases of COVID-19 in China and appear to be less susceptible to severe disease, possibly due to stronger innate immunity, fewer comorbidities, differences in maturation of viral receptors, and/or prior exposure to other coronavirus species (22). However, moderate-to-severe illness has been described in children as well (23). Moreover, it is not clear how often children were being tested.…”