Answers to frequently asked questions about COVID-19 coronavirus infection in children.
❓ Do children have COVID-19?
Children of any age can get COVID-19, but the disease in children is much less common than in adults. In general, according to data from different countries, cases of the disease in children account for 1 to 5% of all confirmed cases of this infection.
As of April 2, 2020, of the 149,760 confirmed cases in the US, only 1.7% were in children (although children make up about 22% of the US population).
❓ Is this virus transmitted through breast milk?
It is not known exactly whether the virus can be transmitted through breast milk. There is a report from China that the virus was not detected in breast milk in women with a confirmed diagnosis of COVID-19, but this work examined breast milk from only 6 women.
❓ Is intrauterine transmission of the virus possible?
In the description of 38 cases of the disease in pregnant women from China, not a single case of intrauterine transmission of this infection was recorded.
In a later work, 3 cases (out of 33) of SARS-CoV-2 positive pneumonia were described that developed in newborn children of the first two days of life, who were surgically born from women with a confirmed diagnosis of COVID-19. All sick babies, including the premature baby born at 31 weeks, recovered.
❓ Are the symptoms of the disease different in children and adults?
In general, the symptoms of COVID-19 are similar in children and adults, but in children, the infection is more often mild and asymptomatic, although cases of a severe course of the disease have also been described.
Of 291 children and 10,944 adults with confirmed infection in the United States, 56% of children and 71% of adults had fever, 54% of children and 80% of adults had cough, difficulty breathing in 13% of children and 43% of adults; 73% of children and 93% of adults had at least one of these symptoms.
Other symptoms were: muscle pain (23% of children and 61% of adults), runny nose (7%), sore throat (24% of children and 35% of adults), headaches (28% of children and 58% of adults), nausea and vomiting ( 11% of children and 16% of adults), abdominal pain (6% of children and 12% of adults), diarrhea (13% of children and 31% of adults).
Of the 171 children with confirmed infection in China, 16% of children had no symptoms, 42% had fever, 49% had cough; 19% of children had symptoms of an upper respiratory tract infection and 65% had pneumonia, and some children had only intestinal symptoms.
❓ Is it possible for children to have severe disease?
Most children have an asymptomatic infection or mild to moderate illness and recover within 1–2 weeks.
However, there are reports of severe and critical cases of the disease and isolated deaths among children.
Risk factors for a severe course of the disease in the United States among children were age under 1 year and the presence of concomitant diseases: chronic lung and heart disease, immunosuppression (malignant neoplasms, chemotherapy and radiation therapy, organ transplantation, treatment with high doses of glucocorticosteroids).
❓ Why do children get COVID-19 less than adults and their infection is more mild than adults?
There is no exact answer to this question. Possible explanations include: 1) differences in the immune response to coronavirus in children and adults; 2) more frequent presence of other respiratory viruses in children that can compete with coronavirus, thereby reducing viral load; 3) differences in the amount of ACE2 protein (which is a receptor for the virus) on the surface of cells in different parts of the respiratory tract and other organs in children and adults.
❓ How often do children need hospitalization for COVID-19?
In the USA, out of 2,572 cases of confirmed infection in children, the need for hospitalization was in 6-20% of children, and in intensive care in 0.58-2% of children.
In China, 3 children required intensive care in 171 pediatric cases; all of them had concomitant diseases (hydronephrosis, leukemia, intestinal intussusception).
In a study from Lombardy, Italy, of the 1,591 patients admitted to the intensive care unit, only 4 were under the age of 20.
❓ How important is laboratory confirmation of the disease?
Laboratory confirmation of the disease in children is of little clinical value, since the treatment of children with COVID-19 is generally no different from the treatment of children with other respiratory infections.
There is a fairly high frequency of false negative results in the study by RT-PCR. In China, when examining material from the nasopharynx, the frequency of false negative results was 37%, and from the oropharynx - 68%.
False positive results are also possible.
Isolation of other respiratory viruses and bacteria (influenza virus, respiratory syncytial virus, mycoplasma and others) does not exclude COVID-19. In one study in China, 8 out of 20 children were isolated from other respiratory pathogens in addition to the SARS-CoV-2 coronavirus.
❓ What treatment is given to children with COVID-19?
Treatments for COVID-19 in children are generally no different from those for other viral respiratory infections.
Symptomatic and supportive treatment is performed. As with many other viral infections, a large number of drugs are known that affect the virus in vitro, but it is not known whether these drugs affect the course and prognosis of the disease in a living person. Experimental studies of such drugs are currently being carried out on sick people. At the moment, the published results of completed clinical trials are not very encouraging.
Hopes are pinned on the use of blood plasma transfusions from recovered people to treat severe cases.
❓ What about ibuprofen for symptomatic treatment of COVID-19?
There have been reports from doctors from Europe working in the focus of infection that the use of ibuprofen may be associated with a more severe course of the disease.
WHO believes that there is currently no conclusive evidence to recommend against ibuprofen use.
However, under conditions of uncertainty, it is probably prudent to use paracetamol rather than ibuprofen as the antipyretic agent of first choice, and if it is necessary to use ibuprofen, use it at the lowest effective dose.
❓ When is the COVID-19 vaccine available?
The optimistic forecasts are that the development and testing of the vaccine will take at least 18 months.
❓ Can I get vaccinated during the COVID-19 pandemic?
WHO recommends not to postpone vaccination during the COVID-19 pandemic, as any disruption to immunization services, even for a short time, will lead to an increase in the number of susceptible individuals and an increase in the likelihood of outbreaks of vaccine-preventable infections. Such outbreaks can cause deaths and an increase in the burden on health systems already under great strain in the COVID-19 outbreak response.
This is especially true for the vaccination of newborns in maternity hospitals, primary vaccination (especially against measles and poliomyelitis) and vaccination against pneumococcal infection in susceptible populations.
Roman Shiyan