COVID Children Puzzlers

"There is a lot we don't know yet, but what we do know is that there are fewer children infected compared to adults and the children are less severely affected if they are infected."
"It has surprised everybody. The good thing is at least there is one group that isn't getting hit as much."
"Why children aren't infected as often is a really good question. Hopefully, there will be lots of research and we will figure it out."
Dr.Nicole LeSaux, infectious disease physician, Children's Hospital of Eastern Ontario

"Over the last two to three weeks, we have seen about 20 children presenting with a combination of high fever and signs of inflammation, affecting one or more organs, quite similar to what has been reported internationally."
"I have to say that the 20 children that we have seen have not been as sick or as severe as some of the reports that we've heard about."
“I think that's the million-dollar question [that the children often test negative for COVID-19, but later show antibodies to the virus]. I would have to say that all 20 cases we've seen have all tested negative for COVID-19 on the nasal swab."
"What has been found internationally -- certainly in Europe and now in the United States -- is that many of these children who are tested for antibodies will test positive, which suggests that they were infected, maybe weeks before they presented at SickKids." 
Dr. Jeremy Friedman, associate paediatrician-in-chief, Hospital for Sick Children, Toronto

Child with multisystem inflammatory syndrome (MIS-C) in this image.

There has latterly been news in the media of rare and serious complications where COVID-19 may be implicated, an uncertainty yet to be clarified, of small and alarming clusters of children being admitted to hospital with symptoms more commonly seen in Kawasaki disease, of inflammatory symptoms which if not successfully treated can lead to heart damage and even death. That's the unfolding news that COVID-19 has serious effects on some children. The more palatable news is that most children suffer few effects when infected by the disease.

According to Dr. LeSaux of CHEO, while reported cases of severe illness around the world among young children is alarming -- causing doctors everywhere to be on alert for such cases of a rare hyper-inflammatory syndrome, even in children who have tested negative for the disease, and these  unusual symptoms have been causing severe illness and occasionally death, in the worst-impacted parts of the world -- initial fears that children would become social vectors of the disease, transmitting it to others while themselves experiencing few symptoms, have not been borne out.

Doctors are puzzled by the demonstrated fact that for the most part, against all expectations,  children have been less seriously impacted by COVID symptoms than the general population as a whole. Children under age 19 represented merely 5.69 percent of all COVID cases confirmed to the present time. Across Canada a total of 34 children have been hospitalized for COVID-19 for treatment, only two of whom have required intensive care.

Children appear less likely to die from COVID  Science Photo Library

No children or teens under 19 have died from the novel infectious disease up to the present, while over 6,500 people in Canada have died from COVID to date. The conventional pattern of seasonal influenza was used initially as a guide by the medical community in their expectations of how this new virus would impact on children and by extension the entire community. With seasonal flu, children are frequently affected severely, and have been recognized as 'super-spreaders', where schools become epicentres of infection as children bring flu home and infect their parents and grandparents.

"It does not appear that way so far with COVID. The epidemiology appears different", pointed out Dr.LeSaux. According to evidence gathered globally, family clusters tend not to be launched with an infected child; furthermore only a small minority of children become infected, even when a household is infected with COVID-19, according to research out of Wuhan, China, where the SARS-CoV-2 virus initially emerged.

Fewer asymptomatic children are seen to test positive for COVID-19 in comparison to adults, and regions that have tested their entire populations have discovered that up to 2.6 percent of asymptomatic adults were seen as COVID-infected, yet no asymptomatic children were infected; whether attributable to children having a low viral load, is as yet unknown to health officials. Children's lungs have attracted some research, with their fewer receptors for the virus to attach to as compared to an adult.

The CPSP has launched a study that will collect data from 2,800 paediatricians across the country every week