Characteristics and outcomes of SARS‐CoV‐2 infection in Victorian children at a tertiary paediatric hospital

Abstract

Aim: Victoria experienced two 'waves' of COVID-19 between March and September 2020 and more cases than any other jurisdiction in Australia. Although world-wide reports of COVID-19 reflect that children are less likely to experience severe disease compared with adults, hospitalisations and deaths have been reported. We report testing and outcomes of children with SARS-CoV-2 infection presenting to a tertiary paediatric hospital in Melbourne. Methods: We conducted a prospective cohort study at The Royal Children's Hospital (RCH), including all children and adolescents (aged 0-18 years) who presented and were tested for SARS-CoV-2 over a 6-month period, between 21 March 2020, up to the 21 September 2020. Detailed epidemiological and clinical data were recorded. Results: A total of 19 708 tests for SARS-CoV-2 were performed in 14 419 patients. One hundred and eighty patients tested positive for SARS-CoV-2 (1.2%). 110 (61%) were symptomatic, 60 (33%) were asymptomatic and 10 (6%) were pre-symptomatic. Close contacts of a positive case were associated with a higher risk of a testing positive for SARS-CoV-2 (120/2027 (6%) vs. 60/14589 (0.4%), RD 5.5 (95% CI 4.5 to 6.5), P < 0.001). Eighteen (10%) SARS-CoV-2-positive patients were admitted to hospital with one patient requiring intensive care. All patients recovered fully with no deaths. Conclusion: In Victorian children presenting to a tertiary hospital, SARS-CoV-2 infection caused predominantly mild or asymptomatic infection, with most children not requiring hospitalisation.

COVID ‐19 in New South Wales children during 2021: severity and clinical spectrum

“…Our findings are consistent with overseas evidence that a large proportion of SARS‐CoV‐2 infections in children are asymptomatic, and that clinical illness in those who develop symptoms is typically mild. 2 , 15 This reassuring finding suggests that we need to carefully consider both the harms of infection and those caused by population‐level shielding of children from infection, which could be considered as disproportionate with respect to disease risk, although the long term effects of infection are still poorly characterised. 16 Why COVID‐19 is less severe in children than adults is unclear, but a number of explanations have been proposed, including altered expression and affinity of SARS‐CoV‐2‐binding receptors, and more effective innate immunity in the upper airways.…”

“…We found that medical hospitalisation was more common for children who had other medical conditions, consistent with other reports. 2 , 3 , 18 Immunodeficiency was recorded for few children admitted to hospital; eight of 14 children admitted to intensive care had overweight, an important risk factor for severe COVID‐19 in adults and children, 19 but this factor was not included in our multivariable model because individual weight data were not available for children receiving virtual care. Non‐asthmatic respiratory disease was associated with greater likelihood of hospitalisation, but not asthma/viral induced wheeze, as also found by other investigators.…”

“…1 In children, SARS‐CoV‐2 infections are typically asymptomatic or associated with mild disease, and hospitalisation is uncommon. 2 , 3 Correspondingly, mortality is lower than in adults; the estimated infection fatality rate for people under 18 years of age in England during 2020–21 was five deaths per 100 000 infections 4 (adults: 2300 deaths per 100 000 infections 5 ).…”

“…Two single centre studies in the United States found that almost half the children admitted to hospital with SARS‐CoV‐2 infections had been admitted for other reasons, 8 , 9 as were 21% of children in a large multicentre study in the United Kingdom. 2 …”

“…Since the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged in Wuhan in December 2019, coronavirus disease 2019 (COVID‐19) has caused more than 6.3 million deaths 1 . In children, SARS‐CoV‐2 infections are typically asymptomatic or associated with mild disease, and hospitalisation is uncommon 2,3 . Correspondingly, mortality is lower than in adults; the estimated infection fatality rate for people under 18 years of age in England during 2020–21 was five deaths per 100 000 infections 4 (adults: 2300 deaths per 100 000 infections 5 ).…”