Lessons From COVID-19 in Children: Key Hypotheses to Guide Preventative and Therapeutic Strategies

Abstract

The current pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), reveals a peculiar trend of milder disease and lower case fatality in children compared with adults. Consistent epidemiologic evidence of reduced severity of infection in children across different populations and countries suggests there are underlying biological differences between children and adults that mediate differential disease pathogenesis. This presents a unique opportunity to learn about disease-modifying host factors from pediatric populations. Our review summarizes the current knowledge of pediatric clinical disease, role in transmission, risks for severe disease, protective immunity, as well as novel therapies and vaccine trials for children. We then define key hypotheses and areas for future research that can use the pediatric model of disease, transmission, and immunity to develop preventive and therapeutic strategies for people of all age groups.

Shoring up the safety net for children in the COVID-19 pandemic

“…The initial phase of this pandemic found that coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, affected children less severely compared to adults. 3 Serious COVID-19 illness occurs in <10% of infected children, although severe illness is likely in identifiable subpopulations: the very young and those with underlying pulmonary pathology or immunocompromising conditions. Additionally, multisystem inflammatory syndrome in children has emerged as a dangerous manifestation of COVID-19 infection in some children.…”

Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak

“…Children are underrepresented in confirmed SARS-CoV-2 case counts [3][4][5] . Since SARS-CoV-2-infected children often experience little or no disease 3,[6][7][8][9] , one possibility is that pediatric infections are oftentimes missed by symptom-based administration of viral tests. Therefore, we sought to identify infections using an approach independent of symptom-based viral testing.…”

Diferencias entre niños y adultos por el nuevo coronavirus 2019, SARS-CoV-2/COVID-19

“…La mayoría tienen un curso leve que podría aludir al papel sustancial que el sistema inmunitario del huésped juega en el desarrollo de enfermedades graves. 4…”

“…El aumento observado en la patología pulmonar en lactantes menores de www.medigraphic.org.mx un año puede deberse a niveles inapropiados de actividad de las células T CD8+, que juegan un papel importante en la eliminación viral, y esta inmadurez del sistema inmune puede ser explicado por el efecto de la inmunidad fetal tolerogénica. 4 Las nuevas preocupaciones en niños es la descripción de un síndrome inflamatorio multisistémico asociado temporalmente a SARS-CoV-2 (PIMS-TS) que podría representar un síndrome inflamatorio postinfeccioso mediado por anticuerpos o inmunocomplejos. La comprensión de este fenómeno inflamatorio podría proporcionar información vital sobre las respuestas inmunes al SARS-CoV-2 y podría tener relevancia tanto para adultos como para niños.…”

“…En la mayoría de los reportes pediátricos informan que aproximadamente 50% de los niños sintomáticos cursan con fiebre y 54% con tos, mientras que la fiebre y la tos se identificaron en 71 y 80% de los adultos, respectivamente, y faringitis en 30% de los casos. 4 Es decir, la ausencia de fiebre no descarta COVID-19.…”