COVID-19 and Pediatric Lung Disease: A South African Tertiary Center Experience

Abstract

The COVID-19 pandemic led to rapid global spread with far-reaching impacts on health-care systems. Whilst pediatric data consistently shown a milder disease course, chronic lung disease has been identified as a risk factor for hospitalization and severe disease. In Africa, comprised predominantly of low middle-income countries (LMIC), the additional burden of HIV, tuberculosis, malnutrition and overcrowding is high and further impacts health risk. This paper reviewed the literature on COVID-19 and chronic lung disease in children and provides our experience from an African pediatric pulmonary center in Cape Town, South Africa. South African epidemiological data confirms a low burden of severe disease with children <18 years comprising 8% of all diagnosed cases and 3% of all COVID-19 admissions. A decrease in hospital admission for other viral lower respiratory tract infections was found. While the pulmonology service manages children with a wide range of chronic respiratory conditions including bronchiectasis, cystic fibrosis, asthma, interstitial lung disease and children with tracheostomies, no significant increase in COVID-19 admissions were noted and in those who developed COVID-19, the disease course was not severe. Current evidence suggests that pre-existing respiratory disease in children does not appear to be a significant risk factor for severe COVID-19. Longitudinal data are still needed to assess risk in children with immunosuppression and interstitial lung diseases. The indirect impacts of the pandemic response on child respiratory health are notable and still likely to be fully realized and quantified. Ensuring children have access to full preventive and care services during this time is priority.

Rapid rise in paediatric COVID-19 hospitalisations during the early stages of the Omicron wave, Tshwane District, South Africa

“…In terms of clinically significant paediatric COVID-19 disease, the paediatric disease burden has not been severe during the first three COVID-19 waves, which occurred from June to September 2020 (first wave), November 2020 to February 2021 (second wave; Beta variant predominance) and June to October 2021 (third wave; Delta variant predominance). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In marked contrast therefore were reports of the rapid rise in paediatric COVID-19 admissions, starting from mid-November 2021 onwards, in the Tshwane District, which is an urban district in the Gauteng Province of South Africa. The district has a population of 3,552,452 and a population density of 527 people/km 2 .…”

A Pandemic within Other Pandemics. When a Multiple Infection of a Host Occurs: SARS-CoV-2, HIV and Mycobacterium tuberculosis

“…Similarly, another study in Nigeria pointed to a higher mortality rate in states with high TB prevalence (with a weak association though), and the opposite finding for HIV infection: a negative correlation between HIV prevalence and COVID-19 mortality [ 98 ]. However, other reviews, even those aimed at children, did not find a significant risk factor for severe COVID-19 in pre-existing respiratory diseases [ 99 ]. Furthermore, our collection of specific case series after the literature review ( Supplementary File S4 ), did not show any significant difference at clinical management or future scenario of healing.…”

Chronic respiratory diseases other than asthma in children: the COVID-19 tsunami

“…To our knowledge, no data is available on COVID-19 in children with non-CF and non -PCD bronchiectasis or interstitial lung disease. In the case of the latter, studies on mortality in adults suggest caution, and longitudinal studies are needed to assess the risks for children on immunosuppressive agents [32].…”