How come #COVID19 is mostly mild in children? and at the same time, why do the rare hyperinflammatory syndrome #MISC affect mostly young people, and not the elderly? thread🧵and a hypothesis: cell.com/immunity/fullt… 
2/In other infections, ex mononucleosis, symptomatic disease in teenagers differs from mild/asymptomatic infection in young children by stronger bystander T-cell activation and systemic inflammation.
3/But what limits systemic inflammatory responses in young children? One likely explanation is that energy allocation for growth increases the threshold to mount expensive systemic inflammatory responses unless absolutely required...
4/ In COVID19, kids have been shown to have more efficient local antiviral responses in the airways, but there is also evidence for slower viral clearance in stool from children vs adults. Could a milder systemic immune response lead to viral persistence in the gut of children?
5/ @LaelYonker @ArditiMd and colleagues have shown that #MISC hyperinflammation occurs in rare cases when super-Ag (S1) is released from a leaky gut and triggers T-cell activation
6/ putting all of this together. Can energy allocation theory could explain milder systemic inflammatory responses in children -> viral persistence and increased risks of #MISC ? correlation between energy requirement for growth and MISC incidence supports this idea.
Perspective in @ImmunityCP - Thanks to dr @KavithaSci & dr Fabiola Rivas for editing and thanks to many colleagues for inspiring discussions.
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