A study conducted yesterday in the Journal of Pediatrics found that 49 children from Massachusetts and young adults 0 to 22 years with COVID-19 had significantly higher levels of Virus RNA in their airways than infected adults in intensive care units, suggesting that the new coronavirus did not spare young people and that they could spread it just as easily.
In addition to the 49 subjects who tested positive for COVID-19, another 18 had the delayed, coronavirus-linked multisystem inflammatory syndrome in children (MIS-C).
Regardless of the age of a child, viral RNA load from the airways of those with COVID-19 was highest in the first 2 days of symptoms, much higher than in severely ill adults (P = 0.002), and some had high viral load even before symptoms appeared. But unlike subjects with COVID-19, those with MIS-C did not have high viral loads. The researchers did not attempt to isolate live virus.
Non-specific symptoms, ACE2 expression
Subjects aged 11 to 16 years made up 33% of the coronavirus-positive cohort, while 37% were younger than 27 and older. The mean age was 13, and the authors did not specify the age of 2 of the 49 SARS-CoV-2 positive patients.
In contrast, children 1 to 4 years old had 39% of the MIS-C group, which had a male predominance (78%). Adolescents with severe MIS-C had a tendency to have strong immune responses to various respiratory viruses, including other coronaviruses, respiratory syncytial virus, and influenza.
COVID-19 patients 10 years of age and older had higher expression of angiotensin-converting enzyme 2 (ACE2), which was not correlated with viral respiratory load but could have made them more vulnerable to infection. However, children younger than 10 years tend to have lower ACE2 expression, which probably provided some protection against infection.
Twenty-five children (51%) had a fever, 23 (47%) had a cough, 17 (35%) had congestion, 17 (35%) had a sore throat, 14 (29%) had a runny nose, 13 (27)% had headache, and 10 (20%) had loss of smoking. These nonspecific symptoms suggest that it would be a mistake to rely on symptoms like temperature controls to detect COVID-19 infection, the authors said.
Thirteen patients (27%) were obese, and 29 (19%) had asthma. Nine (18%) of children with COVID-19 and 10 (56%) of those with MIS-C had no known infected membership. Twenty-six (53%) follow school time.
‘Healthy children’ with high viral load
High viral RNA loads may indicate a larger infection, the authors said. And because children have most if any symptoms of SARS-CoV-2 infection, the virus that causes COVID-19, and many symptoms overlap with common childhood diseases such as the flu and the common cold, they were able to spread the virus undetected. —What diagnosis could complicate in the coming season allergy and flu season.
In a news release from Massachusetts General Hospital, lead author Lael Yonker, MD, said she was surprised by the study’s findings. You think of a hospital, and of all the precautionary measures taken to treat seriously ill adults, but the viral loads of these hospital patients are significantly lower than a ‘healthy child’ that has a high SARS-CoV-2- viral round loads, “she said.
The authors said that the number of young people who develop MIS-C after coronavirus infection is growing. As a result of an abnormal immune response to the virus, the syndrome can cause serious heart problems and shock. “Children can develop serious illness during the post-infection stage with a hyperinflammatory antibody response,” she wrote. “Potential transmission of SARS-CoV-2 between children and families should be considered when designing strategies to reduce the COVID-19 pandemic.”
Last month, a research letter arrived JAMA Pediatrics showed that children younger than 5 years with mild or moderate COVID-19 have much higher levels of viral RNA in their nose and throat than older children and adults.
The findings have important implications for reopening of schools, day care centers, and other full-fledged institutions where children and teachers work closely together. In the news release, senior author Alessio Fasano, MD, said children should not be discounted as potential transmitters of the virus.
“During this COVID-19 pandemic, we have been investigating mainly symptomatic subjects, so that we have reached the wrong conclusion that the vast majority of people are infected adults,” he said. “However, our results show that children are not protected against this virus.”
This is particularly relevant for low-income families with low incomes, especially those in multigenerational households with vulnerable older adults. In the study, 51% of children infected with COVID-19 came from low-income communities, versus 2% from high-income weeks.
To prevent further spread to afternoon reopening of schools this fall, the authors called for physical distance, universal masking, strict handwashing protocols, routine screening of students, and a hybrid system of distance and personal learning.
