Abstract
Abstract Most Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in children are mild or asymptomatic. Severe Coronavirus Disease 2019 (COVID-19) in children is infrequent. An estimated 0.3–1.3% of children with SARS-CoV-2 infection were admitted to hospital, and of these 13–23% needed critical care. SARS-CoV-2 related deaths were very rare in children, estimated at 2 per million. The vast majority of admitted children had one of shortness of breath, fever, and cough, but atypical symptoms are more common in children. Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) have been linked to SARS-CoV-2 infection. Cardinal symptoms include prolonged fever, clinical signs of inflammation, gastro-intestinal symptoms, and cardiac dysfunction. Twenty two to 80% of patients with MIS-C needed critical care; mortality of MIS-C is around 2%. Six to 24% of children with MIS-C had coronary artery dilatation or cardiac aneurysms. Equipoise still exists between first-line treatment with immunoglobulins and steroids. Outcomes for children with MIS-C are generally very good in those recognised early and started on appropriate treatment. Vaccination schemes for children are rapidly expanding, with the benefits of preventing severe COVID-19 disease and MIS-C and reducing community transmission outweighing the risks of adverse events of, amongst others, myocarditis temporally related to COVID-19 vaccination in children and young adults. The imposed social distancing measures reduced the overall number of children with acute illness or injury presenting to urgent and emergency care facilities worldwide. No clear signal was seen that large numbers of children had a delayed presentation to emergency care departments with a serious illness. The social distancing measures negatively impacted the mental health of children.
Highlights
Data from China already signalled low numbers of children presenting to hospitals with severe respiratory Illness during the initial Coronavirus Disease 2019 (COVID-19) outbreak [1]
As the risks of severe COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C) are very small in children and as vaccines are typically administered in healthy individuals, these risks need to be balanced against the benefits of being vaccinated against SARS-CoV-2 and the potential risks associated with such a vaccination
As severe COVID-19 disease is rare in children, societies and governments have focussed on adult COVID-19 disease for the majority of the COVID-19 pandemic
Summary
Data from China already signalled low numbers of children presenting to hospitals with severe respiratory Illness during the initial Coronavirus Disease 2019 (COVID-19) outbreak [1]. Typical symptoms of fever (69%), cough (48%) and shortness of breath (23%) were present amongst hospitalised children 18 years and under who tested positive for SARS-CoV-2, according to data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC), a prospective multinational observational study; with 85% of admitted children having at least one of these [12]. In the COVID-NET study from the US that included data from over 250 acute-care US hospitals in 14 States, the median duration of admission of children was two days (IQR 1–4 days) for the period June 20th 2021 – July 31st 2021; and of these, 23.2% of admitted children needed critical care, and 1.8% died during hospitalisation [25].
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