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COVID-19 less deadly and causes milder symptoms in children

Published: 28 August 2020

Children and teenagers are less likely than adults to develop severe COVID-19 or die from the disease, according to an NIHR-funded study of hospital patients.

The large observational study analysed data from 651 children and young people (aged less than 19 years) with COVID-19 admitted to hospitals across England, Wales and Scotland between 17 January and 3 July 2020. 

The findings, published in the British Medical Journal (BMJ),  give a detailed picture of the clinical characteristics, risk factors, and outcomes of covid-19 in children

The researchers found that, along with recognised features of COVID-19, children also often suffer a cluster of symptoms including sore throat, nausea, vomiting, abdominal pain, diarrhoea, and rash. They also found obesity, black ethnicity and being under one month old are factors that increase the risk of a child being admitted into intensive care with the condition. 

The study was led by the ISARIC Coronavirus Clinical Characterisation Consortium, a nationwide study characterising and following more than 20,000 hospitalised patients with COVID-19. ISARIC-4C is funded by the NIHR and UK Research and Innovation, and has been given Urgent Public Health Research status to expedite its delivery in the health and care system by the NIHR.

The number of children and young people who died from COVID-19 was relatively low at six in total (1%), compared with 27% across all ages (0-106 years) over the same time period. Three children who died were newborn babies born with other severe health problems. The other three children were aged 15 to 18 years old and also had profound health issues.

Some 18% of hospitalised children and young people were admitted to intensive care. Experts say children most at risk of needing intensive care were those under one month old and those aged 10 to 14 years old. 

Dr Olivia Swann, lead author and Clinical Lecturer in Paediatric Infectious Diseases at the University of Edinburgh, said: “Researchers often want to call attention to large numbers of patients in their studies, however, we want to highlight that children made up only a fraction of a percent of all COVID-19 admissions across the UK in our study and that severe disease was rare.”

The study identified and reviewed 52 patients who had Multisystem Inflammatory Syndrome in Children (MIS-C): a severe inflammation syndrome associated with COVID-19. The symptoms usually seen in children with MIS-C include conjunctivitis, a rash or gastrointestinal problems such as abdominal pain, vomiting and diarrhea. 

The researchers found that these children with MIS-C were five times more likely to be admitted to intensive care. The study also found new COVID-19 symptoms in children with MIS-C such as headaches, tiredness, muscle aches and a sore throat.

The researchers are calling for the WHO’s definition of MIS-C to be updated to help doctors identify more children with the condition and improve their treatment.

Professor Calum Semple, Professor in Child Health and Outbreak Medicine and Consultant Respiratory Paediatrician at the University of Liverpool, said: “The diligent work of our colleagues working in Child Health and the NIHR Clinical Research Network across the UK has led to this report which is the largest and most detailed description of COVID-19 and MIS-C in children and young people. We have provided new understanding about MIS-C which will help manage this rare but serious condition, but parents can now be reassured that severe covid-19 is very rare in children.”

Dr Louisa Pollock, Consultant in Paediatric Infectious Disease at the Royal Hospital for Children, Glasgow, said: “Parents should be reassured by this study, which confirms very few children were seriously affected by COVID-19. As children return to school, and over the winter months, it is important we continue to monitor COVID-19 in children.”



Related research

Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study

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