Abstract
The COVID-19 pandemic led to rapid global spread with far-reaching impacts on health-care systems. Whilst pediatric data consistently shown a milder disease course, chronic lung disease has been identified as a risk factor for hospitalization and severe disease. In Africa, comprised predominantly of low middle-income countries (LMIC), the additional burden of HIV, tuberculosis, malnutrition and overcrowding is high and further impacts health risk. This paper reviewed the literature on COVID-19 and chronic lung disease in children and provides our experience from an African pediatric pulmonary center in Cape Town, South Africa. South African epidemiological data confirms a low burden of severe disease with children <18 years comprising 8% of all diagnosed cases and 3% of all COVID-19 admissions. A decrease in hospital admission for other viral lower respiratory tract infections was found. While the pulmonology service manages children with a wide range of chronic respiratory conditions including bronchiectasis, cystic fibrosis, asthma, interstitial lung disease and children with tracheostomies, no significant increase in COVID-19 admissions were noted and in those who developed COVID-19, the disease course was not severe. Current evidence suggests that pre-existing respiratory disease in children does not appear to be a significant risk factor for severe COVID-19. Longitudinal data are still needed to assess risk in children with immunosuppression and interstitial lung diseases. The indirect impacts of the pandemic response on child respiratory health are notable and still likely to be fully realized and quantified. Ensuring children have access to full preventive and care services during this time is priority.
Highlights
The COVID-19 pandemic caused by the novel coronavirus (SARS-CoV-2), commenced in Wuhan, China in late 2019 with rapid global spread, sparing no continent, with the first African case being reported in Egypt in February 2020
COVID-19 is associated with milder disease in children compared to adults
Despite initial fears over risk for children with chronic lung diseases, current evidence suggests that pre-existing respiratory disease in children does not appear to be a significant risk factor for severe COVID-19
Summary
The COVID-19 pandemic caused by the novel coronavirus (SARS-CoV-2), commenced in Wuhan, China in late 2019 with rapid global spread, sparing no continent, with the first African case being reported in Egypt in February 2020. Chronic lung disease has been one of the commonest pre-existing medical conditions reported in hospitalized pediatric COVID-19 cases, both in Europe and in South Africa [7, 8]. It has been identified as a risk factor for severe COVID-19 disease and death in adults [9, 10]. HIV infected children are at an increased risk for acute and chronic respiratory conditions and may be more susceptible to severe COVID-19 disease. The implications of BCG vaccination, previous TB disease and current co-infection with TB for COVID-19 severity in children requires further investigation
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