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At the end of March, Harriet discussed data out of China on pediatric COVID-19 cases. That study supported the general observation of the medical community that children have not been hit very hard by SARS-CoV-2 infections and tend to present a bit differently than adults, with more mild and asymptomatic cases. The Chinese study did report that roughly 6% of children had severe (5%) or critical (0.6%) disease, however, and one teenage boy lost his life. Now we have another large data set to look at in the CDC’s Morbidity and Mortality Weekly Report (MMWR) that was released this week.

New data from the CDC on pediatric COVID-19

From February 12th to April 2nd, 149,760 cases of COVID-19 in the United States were confirmed by the CDC. Of the 149,082 cases where age was known, 2,572 (1.7%) of these occurred in children less than 18 years of age. Unfortunately, data on several key variables, such as presenting signs and symptoms, underlying medical conditions, and hospitalization status weren’t available for many of these cases, which is a significant limitation – along with the fact that there are undoubtedly a large number of cases that have been missed because of inadequate testing.

Looking at what was available, we can see that children appear to be less likely to present with specific signs and symptoms when compared to patients aged 18 to 64 years. Most (73%) of the children with COVID-19 had fever, cough, or shortness of breath, which is 20% fewer than cases in the older population. The largest discrepancy found between children and adults was in the presence of shortness of breath, which occurred in 13% of children and 43% of older patients. Again, this is all limited by the absence of documentation of the clinical presentation in a lot of these cases. Also, it isn’t well explained why they stopped at 64 years of age in this report, but it’s safe to assume that patients 65 years and older fared worse in all categories.

Roughly 6% of children were hospitalized, but that assessment is hampered by the lack of specific documentation in 2/3 of cases. That number would be consistent with the Chinese data though. Also consistent is the finding that about 0.6% of children required critical care and that children less than a year old were the most likely to have severe disease. Three pediatric deaths were reported by the CDC, but they did not go so far as to confirm that their deaths were definitely caused by COVID-19.

Boys vs. girls

There have been numerous observations made around the world that men appear to be having a rougher time with SARS-CoV-2 infections, both in incidence and severity. As limited and preliminary as they are, the new CDC data on American kids also demonstrate a consistent difference between boys and girls in all age groups when it comes to COVID-19. The CDC report revealed that 57% of pediatric patients were males.

What isn’t known is what is at the heart of these differences. Environmental and lifestyle factors, such as higher rates of smoking among men, have been bandied about as a possible explanation, but pediatric data, particularly involving children less than a year of age, speaks against that strongly. Biology, and genetics, appear to be a more likely culprit.

Conclusion: The kids are (mostly) alright

So we now have two studies involving a fairly large number of pediatric patients demonstrating that children are considerably less likely than adults to have severe COVID-19 presentations. Still, there have been a number of hospitalizations for severe and critical disease, and survival is not a certainty. Parents should not be panicking over this possibility, but knowing that children are more likely to have asymptomatic or mild disease makes a focus on social distancing and good hygiene practices even more important.

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Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.