Why do some children get sicker from Covid-19 than others?

As schools in South Africa are set to reopen for Grades 7 and 12, there is a debate whether children are less at risk from Covid-19 than adults and those with underlying conditions.

While the general consensus has been that children are not as severely affected by Covid-19 as the elderly, more severe cases in children have been recorded throughout the world.

A new report from paediatric anaesthesiologists, infectious disease specialists and paediatricians at the Children’s Hospital at Montefiore and Albert Einstein College of Medicine describes some of the most significant clinical characteristics of children hospitalised with severe Covid-19.

This report was published in the Journal of Pediatrics and compared the cases of 46 Covid-19 patients aged between one month and 21 years. These patients were either admitted to the general unit or the Pediatric Critical Care Unit (PCCU) at Montefiore.

Inflammation, obesity, asthma as factors

According to the study, the most common symptoms at the time of admission among these children were coughing and a fever. Those who required treatment in intensive care had higher levels of inflammation and required ventilation and breathing support.

About 80% of these children who required intensive care in the PCCU had Acute Respiratory Distress Syndrome (ARDS) and of these, 50% required ventilators.

The researchers found that obesity and asthma were highly prevalent in this study, but there was no evidence that these conditions increased the likelihood of the patients needing higher intensity care, although the presence of obesity could explain the fact that they were sicker than other children.

"We know that in adults, obesity is a risk factor for more severe disease, however, surprisingly, our study found that children admitted to the intensive care unit did not have a higher prevalence of obesity than those on the general unit," said lead author Prof Jerry Y. Chao in a press release.

According to the study, more than half the children had no known contact with another patient with Covid-19, which emphasised that the virus could be spread by asymptomatic people.

Children are not immune

It is important to note that the study had several limitations as it only analysed cases from one medical centre in an urban setting. As this is a new virus, paediatric data is still limited, and it was the goal of the authors to add to the data.

"Thankfully most children with Covid-19 fare well, and some do not have any symptoms at all, but this research is a sobering reminder that children are not immune to this virus and some do require a higher level of care," stated senior author Prof Svanand S. Medar.

^{Image credit: Aditya Romansa, Unsplash}