1. COVID-19 in Children: Initial Characterization of the Pediatric Disease DOI: 10.1542/peds.2020-0834 Journal: Pediatrics Citation: Cruz A, Zeichner S. COVID-19 in children: initial characterization of the pediatric disease. Pediatrics. 2020; doi: 10.1542/peds.2020-0834

Highlights:

1. 13% of virologically-confirmed cases had asymptomatic infection, a rate that almost certainly understates the true rate of asymptomatic infection, since many asymptomatic children are unlikely to be tested.
2. Among symptomatic children, 5% had dyspnea or hypoxemia (a substantially lower percentage than what has been reported for adults) and 0.6% progressed to acute respiratory distress syndrome (ARDS) or multiorgan system dysfunction, a rate that is also lower than that seen in adults.
3. Preschool-aged children and infants were more likely to have severe clinical manifestations than older children.
4. Younger age, underlying pulmonary pathology, and immunocompromising conditions have been associated with more severe outcomes with nonCOVID-19 coronavirus infections in children. Proving true for COVID-19 also.
5. Children from whom coronaviruses are detected from the respiratory tract can have viral co-infections in up to two-thirds of cases. Seattle Children’s communication stated about 40% co-infection rates from that area.

https://urldefense.proofpoint.com/v2/url?u=https-3A__northwestern.zoom.us_rec_share_5dB2IJPsqkBIRoHuwU3Ee40ZDL2mX6a8hCdP-5FPoIz0kdwl-5F1agmWzSybHW16MquX&d=DwMFaQ&c=aBkXpkKi7gN5fe5MqrMaN-VmRugaRb1IDRfSv2xVRy0&r=g7MpXCOUq-9H1tvFgkwKPz3CdFuGgI_Cb3H5KO72arO–TMixiXmnqP7b-rioAWX&m=Zqpk2VBobLTvDnNEx345lSBqSS028TcvBSfmaRZVfAM&s=0YifGJRpCwVYVLsReBe6rR69K0qKl4aZrQc_nhIRXVw&e=

1. Children may play a major role in community-based viral transmission. Available data suggest that children may have more upper respiratory tract (including nasopharyngeal carriage), rather than lower respiratory tract involvement. There is also evidence of fecal shedding in the stool for several weeks after diagnosis, leading to concern about fecal-oral transmission of the virus, particularly for infants and children who are not toilet-trained, and for viral replication in the gastrointestinal tract. Prolonged shedding in nasal secretions and stool has substantial implications for community spread in daycare centers, schools, and in the home.
2. Vertical transmission not yet reported but most mothers were delivered via CS and separated immediately from their positive mothers.

2. Other nuggets
   1. Families with children with a central line should continue to follow normal guidelines for management of fever.
   2. In MMWR, an analysis of some 4200 U.S. cases reported through mid-March finds that adults aged 65 and older accounted for 31% of the cases — but for 45% of related hospitalizations, 53% of ICU admissions, and 80% of deaths. Meanwhile, there were no ICU admissions or deaths among those aged 19 and younger.
   3. The New England Journal of Medicine, researchers report outcomes in some 170 children in Wuhan, China, who tested positive for SARS-CoV-2 after contact with a confirmed COVID-19 case. Roughly 16% had neither symptoms nor radiologic evidence of pneumonia. Three patients with underlying conditions required intensive care; one of these patients, a 10-month-old with intussusception, died after 4 weeks. At last check, 12% of the patients were hospitalized but in stable condition, and the remainder had been discharged.
   4. Resources:
      1. NIH’s LitCOVID

https://www.ncbi.nlm.nih.gov/research/coronavirus/

1. NEJM’s Journal Watch COVID-19 Summaries

https://www.jwatch.org/na51020/2020/03/20/covid-19-nejm-journal-watch-coverage

• JAMA Network’s COVID-19 Coverage

https://jamanetwork.com/journals/jama/pages/coronavirus-alert

1. Lancet’s Hub

https://www.thelancet.com/coronavirus

1. AAP’s Red Book Online COVID-19

https://redbook.solutions.aap.org/selfserve/ssPage.aspx?SelfServeContentId=rbo_outbreaks_page_3

1. Dynamed’s COVID-19

https://www.dynamed.com/condition/covid-19-novel-coronavirus/

*Includes an “Updates” tab, which is kind of nice compared with UpToDate

UtD COVID-19

https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19

Feel like I should include these:

WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

CDC: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

And, Maine Health has a nice guide for their clinicians that might be of interest:

http://mainehealth.libguides.com/coronavirus/resourceguide