Abstract
Schools were closed intermittently across Hong Kong to control the COVID-19 outbreak, which led to significant physical and psychosocial problems among children and youths. To compare the clinical characteristics and sources of infection among children and youths with COVID-19 during the 3 waves of outbreaks in Hong Kong in 2020. This cross-sectional study involved children and youths aged 18 years or younger with COVID-19 in the 3 waves of outbreaks from January 23 through December 2, 2020. Data were analyzed from December 2020 through January 2021. Demographic characteristics, travel and contact histories, lengths of hospital stay, and symptoms were captured through the central electronic database. Individuals who were infected without recent international travel were defined as having domestic infections. Among 397 children and youths confirmed with COVID-19 infections, the mean (SD) age was 9.95 (5.34) years, 220 individuals (55.4%) were male, and 154 individuals (38.8%) were asymptomatic. There were significantly more individuals who were infected without symptoms in the second wave (59 of 118 individuals [50.0%]) and third wave (94 of 265 individuals [35.5%]) than in the first wave (1 of 14 individuals [7.1%]) (P = .001). Significantly fewer individuals who were infected in the second and third waves, compared with the first wave, had fever (first wave: 10 individuals [71.4%]; second wave: 22 individuals [18.5%]; third wave: 98 individuals [37.0%]; P < .001) or cough (first wave: 6 individuals [42.9%]; second wave: 15 individuals [12.7%]; third wave: 52 individuals [19.6%]; P = .02). Among all individuals, 394 individuals (99.2%) had mild illness. One patient developed chilblains (ie, COVID toes), 1 patient developed multisystem inflammatory syndrome in children, and 1 patient developed post-COVID-19 autoimmune hemolytic anemia. In all 3 waves, 204 patients with COVID-19 (51.4%) had domestic infections. Among these individuals, 186 (91.2%) reported having a contact history with another individual with COVID-19, of which most (183 individuals [90.0%]) were family members. In the third wave, 18 individuals with domestic infections had unknown contact histories. Three schoolmates were confirmed with COVID-19 on the same day and were reported to be close contacts. This cross-sectional study found that nearly all children and youths with COVID-19 in Hong Kong had mild illness. These findings suggest that household transmission was the main source of infection for children and youths with domestic infections and that the risk of being infected at school was small.
Highlights
In the COVID-19 outbreak, caused by SARS-CoV-2, more than 111 million people have been infected and more than 2.4 million individuals have died worldwide.[1]
This cross-sectional study found that most children and youths with COVID-19 in Hong Kong had mild illness
Three students studying in the same school contracted COVID-19, and few children or youths with no recent international travel reported unknown contact histories. Meaning These findings suggest that households and not schools were the major route of transmission among children and youths with COVID-19 in Hong Kong
Summary
In the COVID-19 outbreak, caused by SARS-CoV-2, more than 111 million people have been infected and more than 2.4 million individuals have died worldwide.[1]. A 2020 large-scale local study[8] found that the prolonged school closures may have been associated with increased risk among children of developing psychosocial problems, which were associated with decreased emotional and social functioning and decreased physical activity levels. Existing inequalities, such as having children with special educational needs, in families with increased risk of psychosocial problems were associated with increased levels of these adverse outcomes. We conducted this study to compare the clinical characteristics and identify the sources of infection among children and youths with COVID-19 during the first 3 waves of outbreaks in Hong Kong
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