Thread by @apsmunro

Ok a few things have been moving in the world of paediatric #COVIDー19 literature

Time for an updated #tweetorial on SARS-CoV-2 infection in children!

#FOAMped #FOAMed #PedsICU #PedsID #IDtwitter

1/12

So there are fewer cases in children. How much fewer?

Children consistently make up <2% of confirmed COVID-19 cases. These are usually ascertained by testing sick people in hospital

US: dx.doi.org/10.15585/mmwr.…
Italy: jamanetwork.com/journals/jama/…
Madrid: jamanetwork.com/journals/jamap…

2/12

COVID-19 is less severe in children, but often is it severe?

From a Chinese cohort 0.6% needed PICU but lots of community testing involved
pediatrics.aappublications.org/content/early/…

US CDC data has 2% of admissions in PICU (limited data)
dx.doi.org/10.15585/mmwr.…

3/12

So why aren't we seeing kids with COVID-19? Is it because they're not getting it, or just not sick enough to go to hospital?

Iceland tested 6% of their whole population. In community testing (random), 0/848 of children <10yrs were positive

nejm.org/doi/full/10.10…

4/12

Also in Italy, where a town screened 70% of its residents. Of the general population, 2.6% were positive. Of children <10yrs, 0%.

doi.org/10.1101/2020.0…

Japanese contact tracing data found lower attack rate in kids

medrxiv.org/content/10.110…

Seems they catch it less

5/12

So are they not the super spreaders we thought?

Household transmission is now the most common mode, and children appear to rarely be the index case (5-10%)

medrxiv.org/content/10.110…

medrxiv.org/content/10.110…

6/12

OK but when they DO get symptoms, what does it look like?

Cough and fever much less frequent than in adults (both ~50% of cases) with about 10% having GI symptoms

No reports of anosmia or rashes as yet...

7/12

Neonates - can't trust 'em right? What about with COVID-19?

Essentially all reported cases in newborns so far very mild disease needed limited support!

erj.ersjournals.com/content/early/…

8/12

How about vertical/intrauterine transmission? This is complicated

ALL swabs of placenta/amniotic fluid/vaginal fluid negative so far

But some babies have been IgM +ve positive at birth. IgM doesn't cross the placenta so implies infection

jamanetwork.com/journals/jama/…

9/12

Now we know SARS-CoV-2 serology is not great so far, and IgM has high cross-reactivity, so remains to be seen whether this will be born out in future research.

So what about kids with comorbidities/immunosuppression?

10/12

Numbers are small, but all reported cases mild so far in children with IBD
journals.lww.com/jpgn/Abstract/…

And cancer
ssrn.com/abstract=35595…

But higher rates of resp/cardiac comorbidity in admitted children in US (23%)
dx.doi.org/10.15585/mmwr.…

11/12

That's all, thanks for reading!

For a comprehensive review of the literature, check out the @DFTBubbles rapid review page here

dontforgetthebubbles.com/evidence-summa…

12/12