April 22, 2020

expert reaction to systematic review of COVID-19 in children

A systematic review, published in JAMA Paediatrics, has looked at cases of COVID-19 in children which led to hospitalisation.

Dr Susan Tansey, Fellow of the Faculty of Pharmaceutical Medicine, said:

“This systematic review selected 18 articles (from an initial 815 identified) that were published between December 1^st 2019 and March 3^rd 2020 reporting confirmed COVID-19 infection in children aged 0 – ≤ 19 years. There are case reports, case series and retrospective studies all from China (other than 1 clinical case from Singapore).

“There are several limitations, the first being that this is a rapidly evolving situation and therefore by limiting inclusion to those articles published up to March 3^rd 2020, more recent articles such as those  by Zheng et al (1) and Dong et al (2) referred to in the FPM’s recent bulletin (3) have been excluded. The Dong et al manuscript reported on 2143 confirmed or suspected COVID19 paediatric patients in China.

“This article in JAMA is limited to hospitalised children and most of the 1065 patients were symptomatic. Symptoms seen were mostly mild respiratory symptoms such as those seen in adults: dry cough, fever, fatigue. While the data confirms that symptomatic infection with COVID-19 does occur in children it does not give us an indication of the proportion of symptomatic vs asymptomatic infection or indeed rates of infection in children. There is no indication as to whether any of the children had underlying conditions, particularly for the severe case reported of a 13-month-old child requiring intensive care. There were no deaths in subjects aged 0- 9 year but 1 death was reported in the older age group, but no more details were available. The Zheng article also reported 2 critical cases also and both had congenital heart disease.

“It appears that severe disease is less frequent in children than in adults but seems to be more common in younger age groups < 5 years as discussed in our FPM bulletin.

“Therefore, my main conclusion is that this systematic review underlines the need for further global well-designed studies to look at the incidence of asymptomatic and symptomatic coronavirus infection in children. Attention needs to be paid to recording data on underlying conditions where present and the potential modes of transmission particularly for the new-born, as transplacental infection has not been reported to date. It is also extremely important to include children in randomised controlled clinical trials of potential therapies and vaccines being developed for COVID-19.”

¹ Zheng F et al. Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Current Medical Science 2020; 40: 1-6

² Dong Y et al. Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics. 2020; doi: 10.1542/peds.2020-0702

³ Ward, P et al. (2020), ‘COVID-19/SARS-CoV-2 Pandemic’, Faculty of Pharmaceutical Medicine blog, 6 April. Available at: https://www.fpm.org.uk/blog/covid-19-sars-cov-2-pandemic/ (Accessed: <date>).

‘Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review’ by Riccardo Castagnoli et al was published in JAMA Pediatrics at 4pm UK time on Wednesday 22 April 2020

DOI:10.1001/jamapediatrics.2020.1467

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

Declared interests

Dr Tansey: “I am a member of Council at the Nuffield Council of Bioethics and I work as an independent consultant pharmaceutical physician via Boyd’s consultancy and also directly for pharmaceutical and biotech companies.”