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COVID-19 Outcome Severity in Children

A study of children positive for COVID-19 found the overall risk of developing severe disease to be low, but risk factors included age, underlying chronic illness, and symptom duration.

Children are generally believed to experience less severe COVID-19 outcomes than older persons. A study, published today in JAMA Network Open, followed children infected with COVID-19 and admitted to hospital emergency departments to understand the risk of severe disease outcomes for young people.

The international study was collaboratively led by researchers from the University of Calgary’s Cumming School of Medicine (CSM), Ann & Robert H. Lurie Children’s Hospital of Chicago, and the University of California-Davis Medical Center. The study incldued 41 emergency departments across 10 countries, including the US, Canada, Italy, Spain, and Australia.

Investigators enrolled 3221 COVID-19-positive children aged 0-10 years old (average age was 3 years). 53.6% of children were male, and 15% self-reported a chronic illness.

“Fortunately, the risk of developing severe disease in children with COVID-19 discharged from the emergency department is very low,” said study co-lead author Todd Florin, MD, MSCE. Florin is a director of Research in Emergency Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago and an associate professor of Pediatrics at Northwestern University Feinberg School of Medicine.

Approximately 3% (n=107) of the children experienced severe COVID-19 within 2 weeks of their visit to an emergency department. An additional 22.8% (n=735) were hospitalized for treatment.

The most common severe outcomes included cardiac or cardiovascular complications, such as myocarditis, as well as neurologic, respiratory, or infectious problems. Of the study population, 4 children died.

The investigators found that children determined to be healthy at their initial emergency department visit rarely had significantly worsening COVID-19.

Characteristics linked to severe outcomes included being 5-18 years old, self-reporting a chronic illness, having had a prior episode of pneumonia, and having symptoms that began 4-7 days after seeking emergency department care.

Asthma has been previously suggested as a risk factor for severe COVID-19 outcomes, but this study was unable to find any correlation. Additionally, it did not find very young infants to be at higher risk of severe COVID-19.

The investigators concluded that the identified risk factors warrant pediatrician attention, but overall, Florin said, “Our findings can provide reassurance to parents and clinicians for children well enough to be managed in the community, while also providing important insights on which children may be at particular risk for severe outcomes."