COVID-19 pediatric patients fare better than adults, meta-analysis shows

A meta-analysis of 7,780 children in 26 countries published late last week in EClinicalMedicine has found that 19% had no symptoms, 3% required intensive care, and only 0.1% died in the first 4 months of the pandemic.

In the largest known systematic review of pediatric patients with the novel coronavirus, researchers from the University of Texas at San Antonio pored over data from 131 studies, 64% from China, published from Jan 24 to May 14. Mean patient age was 9 years, and 76% of patients had been exposed to the virus by an infected family member.

The investigators found that the 11 patients (0.1%) who met the criteria for the severe multisystem inflammatory syndrome linked to COVID-19 in kids had only 11% of disease-fighting lymphocyte white blood cells, versus 42% in those with milder illness. Nine patients each had kidney or liver failure, and 19 went into shock. Forty-two patients required mechanical ventilation.

The high number of children with excellent outcomes was unexpected, coauthor Alvaro Moreira, MD, MSC, said in a University of Texas at San Antonio news release. "Although we are hearing about severe forms of the disease in children, this is occurring in very rare circumstances," he said.

The most common pediatric symptoms were fever (59%) and cough (56%), similar to patterns in adult, and 6% were also infected with other pathogens. Of the 233 kids with underlying conditions, 152 had compromised immune systems or underlying respiratory or heart disease. Most patients had normal chest radiograph findings. Lab abnormalities included high levels of inflammatory markers such as creatinine kinase, interleukin-6, and procalcitonin.

The authors noted that the study didn't include new surges of pediatric patients with the multisystem inflammatory syndrome in New York, England, and Italy. They called for further research into which patients are most likely to develop the coronavirus-linked multisystem inflammatory syndrome, which can cause unremitting high fever, rash, conjunctivitis, gastrointestinal symptoms, and multiorgan failure.
Jun 26 EClinicalMedicine study
Jun 26 University of Texas at San Antonio news release

A third of parents reluctant to send kids to school in fall, poll finds

One third of parents in three states may not send their kids back to their K-12 classrooms for fear of COVID-19, a University of Michigan at Ann Arbor poll has found.

Findings, released late last week, show that 12% of the 1,193 parents surveyed from Jun 12 to 22 in Illinois, Michigan, and Ohio said they won't send at least one child back to school, most citing health concerns. Another 21% reported that they hadn't decided, saying they were waiting to see if there are more pandemic surges or hear more about their schools' plans.

Respondents with a household member at risk for coronavirus complications were less likely than others to say their children would attend in person.

Sixty percent of parents said they support safety measures such as decreasing the number of children on each bus, using a combination of in-person and online classes, random COVID-19 testing of school staff, and mandating that staff and children in the third grade and up wear masks. Most did not support closing playground structures or canceling extracurricular activities.

Black, Hispanic, and Asian parents were less likely than white parents to say that they would send all their children back to school. And 40% of low-income parents said they hadn't decided or weren't planning to send at least one child back to school.

Report lead author Kao-Ping Chua, MD, PhD, said in a news release that the disparity by income means that less-advantaged students could face educational disruption. "Efforts should especially be made to understand and address barriers to school attendance for these students, and to ensure high-quality education for students who do not attend school in-person," he said.

Chua said that the decision whether to send kids back to school is a difficult one for some parents because their children could contract coronavirus and infect other students and family members, but "some families simply don't have a choice because they need to go to work."
Jun 26 University of Michigan report and news release

Studies highlight symptom screening for COVID-19 in healthcare workers

A study of healthcare workers in the pandemic reveals data that justify excluding at-risk workers from duty for 7 days, and a separate study found that symptom and temperature screening results can predict coronavirus test results.

In the first study, published today in Clinical Infectious Diseases, researchers in Greece followed 3,398 nurses for 14 days after their last exposure to a COVID-19 patient to see if the country's recommended 7-day exclusion-from-work policy after exposure was justified.

They found that 1,599 of 3,398 exposed healthcare workers (47.1%) had low-risk exposures, 765 (22.5%) had moderate-risk exposures, and 1,031 (30.4%) had high-risk exposures. Sixty-six of 3,398 workers (1.9%) developed coronavirus symptoms a mean of 3.7 days after exposure.

Hospitalizations and absenteeism were most common among workers with a high-risk exposure. A logistic regression analysis revealed that men, administrative workers, and those with underlying conditions and high-risk exposure were most likely to develop COVID-19, justifying the 7-day exclusion policy.
Jun 29 Clin Infect Dis study

The second study, published in PLOS One, used data of healthcare workers who called a healthcare system telephone COVID-19 triage system in Massachusetts and were tested for coronavirus from Mar 9 to Apr 15.

Of 592 workers, 83 (14%) tested positive for COVID-19. Among 61 workers with no or only mild symptoms, 59 (97%) had tested negative initially. Those reporting at least three symptoms of coronavirus were twice as likely as those with fewer symptoms to test positive, while those with six or more were 2.6 times more likely to have a positive test result.

The chances of testing positive were also 3.5 times higher for healthcare workers with a temperature of 37.5°C (99.5°F) or higher and 1.8 times higher for those with muscle pain. Although loss of taste or smell was reported in only 16% of those with symptoms and a positive test result, it was associated with a 7.2 times higher likelihood of a positive test.

Of 509 workers with a negative first test result, 9 later developed symptoms and tested positive, yielding a negative predictive value for symptoms of about 98%. The authors said the results could help prioritize testing and increase its accuracy.
Jun 26 PLOS One study