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Children and Coronavirus: Research Finds Some Become Seriously Ill Children and Coronavirus: Research Finds Some Become Seriously Ill
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The coronavirus raging around the globe has tended to tread gently with children, who account for the smallest percentage of the infections identified so far.The coronavirus raging around the globe has tended to tread gently with children, who account for the smallest percentage of the infections identified so far.
Now, the largest study to date of children and the virus has found that while most develop mild or moderate symptoms, a small percentage — especially babies and preschoolers — can become seriously ill.Now, the largest study to date of children and the virus has found that while most develop mild or moderate symptoms, a small percentage — especially babies and preschoolers — can become seriously ill.
The study, published online in the journal Pediatrics, looked at more than 2,000 ill children across China, where the pandemic began. It provides a clearer portrait of how the youngest patients are affected by the virus, knowledge that experts say can help influence policies like school closures, hospital preparedness and the deployment of an eventual treatment and vaccine.The study, published online in the journal Pediatrics, looked at more than 2,000 ill children across China, where the pandemic began. It provides a clearer portrait of how the youngest patients are affected by the virus, knowledge that experts say can help influence policies like school closures, hospital preparedness and the deployment of an eventual treatment and vaccine.
[10 questions parents may have about coronavirus.][10 questions parents may have about coronavirus.]
The researchers analyzed 2,143 cases of children under 18 that were reported to the Chinese Centers for Disease Control and Prevention as of Feb. 8. Just over a third of those cases were confirmed with laboratory testing. The rest were classified as suspected cases based on the child’s symptoms, chest X-rays, blood tests and whether the child had been exposed to people with coronavirus.The researchers analyzed 2,143 cases of children under 18 that were reported to the Chinese Centers for Disease Control and Prevention as of Feb. 8. Just over a third of those cases were confirmed with laboratory testing. The rest were classified as suspected cases based on the child’s symptoms, chest X-rays, blood tests and whether the child had been exposed to people with coronavirus.
About half of the children had mild symptoms, such as fever, fatigue, cough, congestion and possibly nausea or diarrhea. More than a third — about 39 percent — became moderately sick, with additional symptoms including pneumonia or lung problems revealed by CT scan, but with no obvious shortness of breath. About 4 percent had no symptoms at all.About half of the children had mild symptoms, such as fever, fatigue, cough, congestion and possibly nausea or diarrhea. More than a third — about 39 percent — became moderately sick, with additional symptoms including pneumonia or lung problems revealed by CT scan, but with no obvious shortness of breath. About 4 percent had no symptoms at all.
But there were 125 children — nearly 6 percent— who developed very serious illness, and one 14-year-old boy with confirmed coronavirus infection died, said Shilu Tong, the study’s senior author, who is director of the department of clinical epidemiology and biostatistics at Shanghai Children’s Medical Center. Thirteen of those were considered “critical," on the brink of respiratory or organ failure. The others were classified as “severe” because they had dire respiratory problems.But there were 125 children — nearly 6 percent— who developed very serious illness, and one 14-year-old boy with confirmed coronavirus infection died, said Shilu Tong, the study’s senior author, who is director of the department of clinical epidemiology and biostatistics at Shanghai Children’s Medical Center. Thirteen of those were considered “critical," on the brink of respiratory or organ failure. The others were classified as “severe” because they had dire respiratory problems.
“Effectively, what this tells us is that hospitals should prepare for some pediatric patients because we can’t rule out children altogether,” said Dr. Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia, who was not involved in the study.“Effectively, what this tells us is that hospitals should prepare for some pediatric patients because we can’t rule out children altogether,” said Dr. Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia, who was not involved in the study.
“The main conclusion,” Dr. Murthy continued, “is that children are infected at rates that may be comparable to adults, with severity that’s much less, but that even within the kids, there’s a spectrum of illness and there’s a handful that require more aggressive therapy.”“The main conclusion,” Dr. Murthy continued, “is that children are infected at rates that may be comparable to adults, with severity that’s much less, but that even within the kids, there’s a spectrum of illness and there’s a handful that require more aggressive therapy.”
More than 60 percent of the 125 children who became severely ill or critically ill were age 5 or younger, the study reported. Forty of those were infants, under 12 months old.More than 60 percent of the 125 children who became severely ill or critically ill were age 5 or younger, the study reported. Forty of those were infants, under 12 months old.
Dr. Tong said he believed that younger children were more susceptible to infection because their respiratory systems and other body functions are rapidly developing.Dr. Tong said he believed that younger children were more susceptible to infection because their respiratory systems and other body functions are rapidly developing.
Dr. Andrea Cruz, an associate professor of pediatrics of Baylor College of Medicine and co-author of a commentary about the study, said that preschoolers and babies likely get sicker because of their “immune system immaturity.”Dr. Andrea Cruz, an associate professor of pediatrics of Baylor College of Medicine and co-author of a commentary about the study, said that preschoolers and babies likely get sicker because of their “immune system immaturity.”
“They haven’t been exposed to viruses before and therefore they can’t mount an effective immune response,” she said in an interview.“They haven’t been exposed to viruses before and therefore they can’t mount an effective immune response,” she said in an interview.
Scientists are actively trying to determine why so many children appear to emerge relatively unscathed by the new coronavirus, a pattern that also characterized the earlier outbreaks of the closely-related SARS virus in China and MERS in the Middle East. Cases of children with the new coronavirus infection in Italy, Singapore and South Korea seem to be similar, Dr. Murthy said.Scientists are actively trying to determine why so many children appear to emerge relatively unscathed by the new coronavirus, a pattern that also characterized the earlier outbreaks of the closely-related SARS virus in China and MERS in the Middle East. Cases of children with the new coronavirus infection in Italy, Singapore and South Korea seem to be similar, Dr. Murthy said.
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A theory that is gaining increasing currency is that the receptor or protein in human cells that the viral particles bind to, called the ACE2 receptor, is not expressed as prominently in young children or might be a different shape, Dr. Murthy said.A theory that is gaining increasing currency is that the receptor or protein in human cells that the viral particles bind to, called the ACE2 receptor, is not expressed as prominently in young children or might be a different shape, Dr. Murthy said.
Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
“It might not be as developed in children as in adults,” he said, which might make it tougher for the spikes on the tiny viral particles to bind and gain entry to the cells so the virus can replicate.“It might not be as developed in children as in adults,” he said, which might make it tougher for the spikes on the tiny viral particles to bind and gain entry to the cells so the virus can replicate.
Another theory is that “most kids have healthier lungs” than adults, Dr. Cruz said. Adults have likely been more exposed to pollution over their lifetime and adults with severe coronavirus disease have tended to have underlying health conditions or weakened or aging immune systems.Another theory is that “most kids have healthier lungs” than adults, Dr. Cruz said. Adults have likely been more exposed to pollution over their lifetime and adults with severe coronavirus disease have tended to have underlying health conditions or weakened or aging immune systems.
It’s also possible, experts say, that children’s immune systems don’t rev up to attack the virus as much as adult immune systems do. Doctors have found that some of the serious damage infected adults have endured has been caused not just by the virus itself, but by an aggressive immune response that creates destructive inflammation in the body’s organs.It’s also possible, experts say, that children’s immune systems don’t rev up to attack the virus as much as adult immune systems do. Doctors have found that some of the serious damage infected adults have endured has been caused not just by the virus itself, but by an aggressive immune response that creates destructive inflammation in the body’s organs.
The new study, while large and including cases across China, not just where the outbreak originated in Wuhan, leaves many unanswered questions. For example, the researchers found that more of the severe and critical cases were in children with suspected — instead of confirmed — coronavirus infection, raising the possibility that other infections wreaked havoc on their bodies, in addition to or possibly even instead of Covid-19.The new study, while large and including cases across China, not just where the outbreak originated in Wuhan, leaves many unanswered questions. For example, the researchers found that more of the severe and critical cases were in children with suspected — instead of confirmed — coronavirus infection, raising the possibility that other infections wreaked havoc on their bodies, in addition to or possibly even instead of Covid-19.
It’s also unclear whether the United States can expect the relatively small numbers of child cases reported in China or should brace for more.It’s also unclear whether the United States can expect the relatively small numbers of child cases reported in China or should brace for more.
“The age pyramid in China is really different than the U.S. — they have a lot fewer kids than we do,” said Dr. Cruz, who believes, as other experts do, that large numbers of people with mild or asymptomatic disease have not been recorded because testing was not done in those cases. “You’ve had a lot of under-testing in children because the focus has been on adults. It’s likely we’ve been underestimating the disease burden in kids.”“The age pyramid in China is really different than the U.S. — they have a lot fewer kids than we do,” said Dr. Cruz, who believes, as other experts do, that large numbers of people with mild or asymptomatic disease have not been recorded because testing was not done in those cases. “You’ve had a lot of under-testing in children because the focus has been on adults. It’s likely we’ve been underestimating the disease burden in kids.”
Answering questions about coronavirus in children could reverberate well beyond the pediatric population. It could shed light why some patients are most at risk. And, said Dr. Murthy, studying the physiology of those who are less affected could help in the development of treatment and a vaccine.Answering questions about coronavirus in children could reverberate well beyond the pediatric population. It could shed light why some patients are most at risk. And, said Dr. Murthy, studying the physiology of those who are less affected could help in the development of treatment and a vaccine.