Background The role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains uncertain. Here, we describe the epidemiological and clinical characteristics of children with COVID-19 in Catalonia (Spain) and investigate the dynamics of household transmission. Methods Prospective, observational, multicenter study performed during summer and school periods (1 July-31 October, 2020), in which epidemiological and clinical features, and viral transmission dynamics were analyzed in COVID-19 patients <16 years. A pediatric index case was established when a child was the first individual infected within a household. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infections. Results The study included 1040 COVID-19 patients <16 years. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (p=0.02), and when compared to adults (p=0.006). No individual or environmental risk factors associated with the SAR were identified. Conclusions Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission.

Importance The rapid pandemic expansion of the disease caused by the new SARS-CoV-2 virus has compromised health systems worldwide. Knowledge of prognostic factors in affected patients can help optimize care. Objective The objective of this study was to analyze the relationship between the prognosis of COVID-19 and the form of presentation of the disease, the previous pathologies of patients and their chronic treatments. Design, participants and locations This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia (Spain). As primary outcomes, severe disease (need for oxygen therapy via nonrebreather mask or mechanical ventilation) and death were studied. Multivariate binary logistic regression models were performed to study the association between the different factors and the results. Results Advanced age, male sex and obesity were independent markers of poor prognosis. The most frequent presenting symptom was fever, while dyspnea was associated with severe disease and the presence of cough with greater survival. Low oxygen saturation in the emergency room, elevated CRP in the emergency room and initial radiological involvement were all related to worse prognosis. The presence of eosinophilia (% of eosinophils) was an independent marker of less severe disease. Conclusions This study identified the most robust markers of poor prognosis for COVID-19. These results can help to correctly stratify patients at the beginning of hospitalization based on the risk of developing severe disease.

The psychological impact of the COVID-19 pandemic on children and adolescents is one of the most prevalent concerns all over the world. Adolescence is a developmental stage of high vulnerability due to the challenges this period entails. Additionally, the health emergency crisis has put adolescents even more at risk of developing mental health problems. The present study aims to examine the influence of socio-demographic and COVID-19 related variables on symptoms of depression, anxiety and stress in adolescents during pandemic-related confinement in Spain. Participants were 523 adolescents (63.1% female), aged between 13 and 17 years (M=14.89 years; SD=1.13 years), who completed an ad hoc questionnaire, the Depression, Anxiety and Stress Scale (DASS-21) and The Oviedo Infrequency Scale (INFO-OV). A descriptive and cross-sectional study design was used, and descriptive statistics and multiple logistic regression analyses were conducted. Results indicate that socio-demographic and COVID-19 related variables play a significant role in the development of emotional symptomatology in adolescents during the current pandemic. Girls more than boys, adolescents who did volunteer work and those who stayed home more often were more likely to experience depression, anxiety or stress symptoms. Experiencing a stressing life event and searching for COVID-19 related information more often was related to psychological distress. On the other hand, adolescents who were in a romantic relationship and had been infected with the coronavirus, were more likely to be mentally healthy. Further research is necessary in order to detect risk and protective variables that impact adolescent’s mental health during the COVID-19 pandemic

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