A picture of severe COVID-19 in US children and youth emerges

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The reports of Chao et al and DeBiasi et al from the Children’s Hospital at Montefiore in New York City (NYC) and Children’s National Hospital in Washington, DC (DC) provide their SARS-CoV-2 experience over 4- and 6-week periods, respectively, beginning on March 15, 2020. Although SARS-CoV-2 generally has been said to be a mild infection in the pediatric age group, a picture of severe COVID-19 in US children and youth emerges through these reports. Together, 91 hospitalized patients with 22 critically ill are reported, with demographic and other patient characteristics compared between groups. Hospitalized patients were representative of the Bronx, NYC, and DC communities served, with high proportion of Hispanic/Latinos in NCY and Hispanic/Latinos and African Americans in DC. Obesity (BMI >30kg/m2) was present in 26% of Bronx patients and 2% of DC patients. Although underlying medical conditions were common in hospitalized patients, 37% of hospitalized and 22% of critically ill patients in DC had no underlying condition. Of the combined studies’ 22 critically ill patients, 63% were male and 82% were >10 years of age. PICU admission predominantly was due to respiratory compromise and was associated with briskly elevated inflammatory markers, lung opacities on chest radiograph, and systemic inflammatory response syndrome (SIRS). Both reports show that approximately 20% of COVID-19 hospitalizations were comprised of patients with asthma, but neither shows an excess of asthmatics among the critically ill. Because substantial SAR-CoV-2 testing of symptomatic outpatients was occurring in DC (1804 tests over 6 weeks), we also know that 21% of infected outpatients had asthma. Taken together, there likely is a signal that SARS-CoV-2 may exacerbate asthma but itself is not a major risk factor for the severe COVID-19 pulmonary syndrome. Additionally, from the DC study, we see that although children 15 years of age were over-represented among hospitalized patients with COVID-19, only those >15 years were overrepresented among the critically ill (Figure).

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FigureAge Distribution of SARS-CoV-2- Infected, Hospitalized, and Critically Ill Cases.

These 2 reports have limitations of small numbers. Characteristics of COVID-19 in these dense urban populations of special racial/ethnic groups where there is known high transmission of SARS-CoV-2 may not be generalizable to all pediatric and US populations. They provide, however, a sobering reality check that is vital to our current and upcoming considerations of social distancing. Children and youth are susceptible to life-threatening COVID-19.

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