Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic: A cross-sectional study

Abstract

Background: India saw the largest and the most stringent lockdown in the world when the number of COVID-19 cases reached around 550. With some early benefits in containing the surge and restricting the R0 of the virus, the current relaxation of lockdown norms has witnessed an exponential rise in positive cases. With scarcity of Pediatric data from the Indian subcontinent, early observations in the pandemic are pivotal in improving the understanding of physiologic behaviors, identifying risks, and guiding clinicians in assessing time-tested interventions and augmenting the awareness in the masses about the manifold clinical profiles of an evolving disease.Objective: To assess the epidemiological and clinical characteristics of children admitted with COVID-19 infection early in the pandemic.Study Design: A cross-sectional studyParticipants: Fifty children between one month and 18 years of age whose nasopharyngeal swab tested positive for SARS-CoV-2 by RT- PCR. Results: 28 (56%) children were male. 41 (82%) came from government declared containment zones with only one child having history of travel to affected area. Home overcrowding was observed in 33 (66%). Of the 50 children, 29 (58%) were asymptomatic while 20 (40%) and one (2%) had mild and moderate symptoms respectively. Fever, cough, and sore throat were the most common symptoms. 49 (98%) children had BCG scar. Leucopenia was seen in three (6%) only. Mean (SD) Neutrophil-Lymphocyte-Ratio (NLR) was 0.78 (0.48) while mean (SD) CRP was 10.98 (23.90). All 50 (100%) were cured. Conclusion: Our study reasserts the increasing pediatric burden of COVID-19 with all age groups affected and overcrowding as a risk factor for continued community transmission, thus beckoning that public health policies be directed to ensuring further preventive measures. It also re-iterates the milder disease pattern in children with COVID-19 in the initial phase of the pandemic with a high proportion of asymptomatic and mild illness. Though abnormal CRP values are synonymous with the illness in children; leucopenia may not be a consistent finding.

Nationwide descriptive study of COVID-19 in children below the age of 14 years in Sri Lanka

“…In our study, slightly more than half of the patients were asymptomatic. While a study in India showed 58% of patients were asymptomatic 10 , in China 94.1% and in Italy 97.5% were symptomatic 11,12 . Even the symptomatic children had mild disease, the commonest clinical feature being a dry cough.…”

“…In China the median time from onset to cure was 16 days (6 to 39 days) 11 and in Turkey the median length of hospital stay was 5 days (4 to 10 days) 17 . Several studies have shown that the PCR tests can be positive to a variable length of time 10,18 . However, the test does not differentiate viable from non-viable viral particles 19 and the degree of infectivity after 14 days is not clear.…”

“…Furthermore, the clinical course of the disease may vary in different countries. Only a few studies have been conducted in the paediatric age group 10,11,12 . To the best of our knowledge this is the only study which analysed paediatric COVID-19 patients in Sri Lanka.…”

Outcome of Children Admitted With SARS-CoV-2 Infection: Experiences From a Pediatric Public Hospital

“…Initial studies from China reported 4.1-50% cases to be asymptomatic, while 58% were asymptomatic in a study from Pune [9,10].Fever and respiratory symptoms were the common presenting symptoms as also found by others [8][9][10]. Atypical presentations like seizures (10.6%), gastrointestinal symptoms (12.2%) were more common in this series as compared to other studies [7,10,11]. More children in our cohort had severe disease as compared to only 1% as reported in recent retrospective study from China [12].Children with underlying hemato-oncological, renal or cardiac disorders had severe disease.…”

“…In a study from Columbia Pediatric COVID-19 management group co-morbidities defined as obesity, asthma, infancy or immune suppression were studied [6].Recent data from US studied chronic lung disease, cardiovascular disease and immune suppression as the common co-morbidities [7].Twenty seven (21.7%) children were asymptomatic comparable to the metaanalysis where 23% were asymptomatic [8]. Initial studies from China reported 4.1-50% cases to be asymptomatic, while 58% were asymptomatic in a study from Pune [9,10].Fever and respiratory symptoms were the common presenting symptoms as also found by others [8][9][10]. Atypical presentations like seizures (10.6%), gastrointestinal symptoms (12.2%) were more common in this series as compared to other studies [7,10,11].…”