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HOW IS COVID-19 DIFFERENT FOR CHILDREN?

Sarah Livelo 29 Jun 2021
HOW IS COVID-19 DIFFERENT FOR CHILDREN?

Disclaimer: Please note that Mya Care does not provide medical advice, diagnosis, or treatment. The information provided is not intended to replace the care or advice of a qualified health care professional. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen. Also data is based on available information at the time of writing. Please refer to official healthcare organization websites (e.g., CDC, WHO) for the latest information.

Brief Overview of COVID-19

When it started

Towards the end of 2019, there were reports of a strange, new infection in Wuhan, China. Infection control was slow to respond, and the virus that was causing this fatal disease rapidly spread throughout the world. Eventually named as SARS-CoV-2 (COVID-19 infection), it created a pandemic that quickly disrupted daily activities and affected hundreds of lives across many countries.

By January 2020, around 20 children from the province of Zhejiang were positive for the disease. A month later, reports showed that children comprised only 2% of the total number of cases in China. Interestingly, at that time, children who turned out positive did not have any co-morbidities or other diseases, while most adults who tested positive had co-morbidities.

COVID-19 as a disease

COVID-19 is an infectious disease that usually presents with fever, cough, colds, sore throat and difficulty breathing. Some adults and children may also experience a loss of taste or smell, stomach upset, body weakness and headache. However, most children who test positive for COVID-19 either present with mild or no symptoms at all.

As the virus spreads and COVID-19 variants have been identified, new observations show that children with co-morbidities have a higher probability of becoming infected. Some conditions that place certain children at risk for COVID-19 include obesity, diabetes, asthma and other chronic lung diseases, congenital heart disease, an impaired immune system (immunosuppression due to a medical condition or due to certain medications), and other genetic or metabolic conditions.

The main diagnostic method for COVID-19 is through an RT-PCR test. It uses respiratory secretions, which are usually collected through sterile swabs placed at the back of the nose or the throat. The test checks for the genetic material of the virus (called RNA) in the specimen and amplifies any amount that is available in order to properly detect the virus.

Other tests that help support a diagnosis of COVID-19 infection include the following:

  • a complete blood count (usually showing a low white blood count or platelet count)
  • markers of inflammation, such as C reactive protein (CRP) and procalcitonin
  • lactate dehydrogenase (LDH) levels
  • Chest radiograph
  • Chest CT scan

The main goal of treatment is to prevent the disease from getting worse; this condition is called “acute respiratory distress syndrome”. As of this writing, there have not been any specific therapies that can treat COVID-19 in children. In adults, remdesivir has been approved (emergency use authorization) for use in COVID-19 cases.

A significant part of therapy includes supportive treatment. The healthcare team ensures that the child has enough fluids, adequate intake of calories, and oxygen supplementation when it’s needed. If doctors suspect that there is an ongoing bacterial infection alongside COVID-19, a child may also be started on antibiotics.

Prevention rests mainly on vaccination. The World Health Organization (WHO) has approved 6 vaccines, most of which have been distributed worldwide. However, because children are less likely to develop severe disease from COVID-19, priority has been placed on other categories of the population. As of this writing, only the Pfizer/BionTech vaccine has been approved for use on children 12 years and older. More studies are needed on vaccines and children before vaccination guidelines can be made.

How COVID-19 Affects Children Versus Adults

Similarities with adults

COVID-19 has been defined as an infection due to the SARS-CoV-2 virus, a novel type of coronavirus. While typical symptoms are respiratory in nature (cough, colds, fever), some patients may not have any symptoms at all. Most of the characteristics of this infection are similar across children and adults.

Children and adults who test positive for COVID-19 were seen to have the same amount of viruses (viral load) infecting them through their nasopharynx (the area at the back of the nose and throat). The virus stays in the body and multiplies for around 2 to 14 days (average of 6 days), and can easily spread to others afterwards.

Like adults, children who have underlying medical conditions are at risk for severe symptoms. Infants less than 1 year old are more likely to develop severe infection as well. Severe symptoms include respiratory failure, inflammation of the heart (myocarditis), inadequate blood flow across the body (shock), problems with blood clotting (coagulopathy), inadequate blood flow to the kidneys (acute renal failure) and multi-organ system failure.

According to the Centers for Disease Control and Prevention (CDC), clinical criteria for COVID-19 is roughly similar between children and adults. This includes testing strategies, types of tests and types of specimens needed.

Differences with adults

1. Children have a lower risk of infection

Tracing the origins of the pandemic, adults were more likely exposed to areas where the virus started to develop and spread. There were less children roaming around hospitals and treatment centers. They were less exposed to the main sources of the infection, as well as areas for transmission.

Some studies have found a link between the risk of infection and a certain type of receptor found in the nose and throat. The angiotensin-converting enzyme 2, or ACE2 receptor, is a protein found on the surface of human cells. It’s the protein that SARS-CoV-2 uses to gain access into cells to replicate inside our bodies. Conditions such as diabetes, hypertension and coronary heart disease may increase the number of ACE2 receptors in the body. Adults are more prone to develop these diseases than children; having more ACE2 receptors may be linked to a higher chance of getting infected.

The immune system of a child has more naive T cells — these cells have not been exposed to other infections yet, so they may be “trained” to target new infections such as the SARS-CoV-2 virus. In this sense, it can be deduced that children can mobilize their immune system to easily target SARS-CoV-2, a new type of virus, as compared to adults whose T cells have already been more exposed to other infections throughout the years.

Children need to build their immune system as they grow older; they have a more active immune system that is constantly being exposed to seasonal viruses such as the flu. These perennial viruses have some similarities to the common cold in terms of structure. This leads to the concept of “crossover immunity”, which helps children fight off the virus more readily than adults can.

2. Children have milder or less symptoms

Children who do get infected mostly have mild to no symptoms. Most newborns who test positive usually get infected from respiratory secretions during delivery. However, most babies don’t have symptoms and are unlikely to need respiratory support, as compared to adults. There are some theories and observations as to why this happens.

Adults have accumulated inflammation in their bodies due to their lifestyle and environmental exposure. More inflammation leads to damage in certain areas of the body, such as the lining of blood vessels. This also affects how their immune system functions, leading to a less optimal response to the COVID-19 infection as compared to children.

Even the chronic effects of an unhealthy diet affects the body’s response to COVID-19. Some studies show that adults with low Vitamin D levels lead to worse symptoms. There is a higher chance of blood clots in patients with low Vitamin D levels; this event is noticeably one of the clinical manifestations in COVID-19 cases as well. Children, on the other hand, are more likely to be provided a complete set of nutrients due to guidance from parents and the community.

Because children have mild to no symptoms, the rate of hospitalization is lower as compared to adults (2.5% versus 16.6%). Children with severe symptoms are usually those who are admitted to a hospital for further management.

3. Children have a lower mortality

Because children are less likely to get infected and are less likely to have serious symptoms, there are fewer deaths as compared to adults. According to the CDC, there were only <0.1% of deaths in children who tested positive, as compared to 5% of deaths in adults with the disease.

Summary

The burden of COVID-19 in terms of health is much less on children in comparison to adults. Children have a more responsive and adaptive immune system that helps fight off the infection. This leads to less risk for infection, a smaller number of cases, less severe symptoms, and a lower risk for death. Nevertheless, since children can still spread the virus to other people, proper safety measures and guidelines should still be practiced for children, when applicable.

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About the Author:
Sarah Livelo is a licensed physician with specialty training in Pediatrics. When she isn't seeing patients, she delves into healthcare and medical writing. She is also interested in advancements on nutrition and fitness. She graduated with a medical degree from the De La Salle Health Sciences Institute in Cavite, Philippines and had further medical training in Makati Medical Center for three years.

Sources

  • https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/
  • MAY 2020 study - https://journals.lww.com/pidj/fulltext/2020/05000/coronavirus_infections_in_children_including.1.aspx
  • https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/symptoms.html
  • https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html
  • https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html
  • https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/science-in-5/episode-22---children-covid-19
  • https://www.healthline.com/health-news/kids-are-half-as-likely-get-covid-19-as-adults-heres-what-we-know
  • https://adc.bmj.com/content/106/5/429
  • https://www.nature.com/articles/d41586-020-03496-7
  • https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-05786-5
  • https://theconversation.com/what-is-the-ace2-receptor-how-is-it-connected-to-coronavirus-and-why-might-it-be-key-to-treating-covid-19-the-experts-explain-136928
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385774/
  • https://www.cdc.gov/mmwr/volumes/70/wr/mm7003e1.htm
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