Abstract
There is limited information describing the full spectrum of coronavirus disease 2019 (COVID-19) and the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection in children. To analyze the full clinical course and the duration of SARS-CoV-2 RNA detectability in children confirmed with COVID-19 in the Republic of Korea, where rigorous public health interventions have been implemented. This case series of children with COVID-19 was conducted in 20 hospitals and 2 nonhospital isolation facilities across the country from February 18, 2020, to March 31, 2020. Children younger than 19 years who had COVID-19 were included. Confirmed COVID-19, detected via SARS-CoV-2 RNA in a combined nasopharyngeal and oropharyngeal swab or sputum by real-time reverse transcription-polymerase chain reaction. Clinical manifestations during the observation period, including the time and duration of symptom occurrence. The duration of SARS-CoV-2 RNA detection was also analyzed. A total of 91 children with COVID-19 were included (median [range] age, 11 [0-18] years; 53 boys [58%]). Twenty children (22%) were asymptomatic during the entire observation period. Among 71 symptomatic cases, 47 children (66%) had unrecognized symptoms before diagnosis, 18 (25%) developed symptoms after diagnosis, and only 6 (9%) were diagnosed at the time of symptom onset. Twenty-two children (24%) had lower respiratory tract infections. The mean (SD) duration of the presence of SARS-CoV-2 RNA in upper respiratory samples was 17.6 (6.7) days. Virus RNA was detected for a mean (SD) of 14.1 (7.7) days in asymptomatic individuals. There was no difference in the duration of virus RNA detection between children with upper respiratory tract infections and lower respiratory tract infections (mean [SD], 18.7 [5.8] days vs 19.9 [5.6] days; P = .54). Fourteen children (15%) were treated with lopinavir-ritonavir and/or hydroxychloroquine. All recovered, without any fatal cases. In this case series study, inapparent infections in children may have been associated with silent COVID-19 transmission in the community. Heightened surveillance using laboratory screening will allow detection in children with unrecognized SARS-CoV-2 infection.
Highlights
Children were tested for COVID-19 when they had a history of close contact with confirmed cases, were epidemiologically linked to COVID-19 outbreaks, arrived from abroad, or had symptoms suspicious of COVID-19 as judged by physicians
Epidemiology of COVID-19 in Children This study included 91 patients, accounting for 76.5% of all 119 children younger than 19 years in Korea whose cases were not connected to the outbreak of a specific religious group in Daegu, as reported by the Korea Centers for Disease Control and Prevention, and confirmed with COVID-19 from February 18 to March 31, 2020
Children with COVID-19 in this study presented with a wide range of symptoms and signs, which were not specific enough for COVID-19 to prompt diagnostic testing or anticipate disease severity
Summary
Study Population This study included children younger than 19 years who had confirmed COVID-19 in Korea from February 18 to March 31, 2020. Children were tested for COVID-19 when they had a history of close contact with confirmed cases, were epidemiologically linked to COVID-19 outbreaks, arrived from abroad, or had symptoms suspicious of COVID-19 as judged by physicians.. All children with confirmed COVID-19 were placed in isolation at 20 hospitals and 2 nonhospital isolation facilities across the country. Cases linked to a specific religious group in Daegu were excluded, given limited clinical information. Cases of COVID-19 were diagnosed by detecting SARS-CoV-2 RNA in a combined nasopharyngeal and oropharyngeal swab or sputum by real-time reverse transcription–polymerase chain
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