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Children with COVID-19 behaving milder may challenge the public policies: a systematic review and meta-analysis
1Department of Neonatology, Children's Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, People's Republic of China.
Insights
Children infected with the emerging virus (COVID-19) rarely experience severe illness or death, but they can transmit the virus. Public health policies must balance transmission control with the well-being of children, considering prolonged school closures.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- The global spread of a novel virus has led to an increase in reported pediatric cases.
- Understanding the characteristics and impact of the virus on children is crucial for effective public health strategies.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of pediatric patients diagnosed with Coronavirus Disease 2019 (COVID-19).
- To assess the impact of public health interventions, such as school closures, on children during the pandemic.
Main Methods:
- A single-arm meta-analysis of 29 studies involving 4300 pediatric patients diagnosed with COVID-19.
- Data were collected from December 2019 to May 2020, with quality appraisal and bias analysis.
- Subgroup analysis by geographic region and review of educational disruption policies were conducted.
Main Results:
- The mean age of infected children was 7.04 years.
- 18.9% of pediatric cases were asymptomatic, and 37.4% had no radiographic abnormalities.
- Severe outcomes were rare, with 0.1% ICU admission and four reported deaths among the analyzed cases. Nationwide school closures affected over 70% of students globally.
Conclusions:
- Children are susceptible to SARS-CoV-2 but typically present with mild illness, with critical cases and deaths being infrequent.
- The potential for children to act as asymptomatic spreaders presents a public health dilemma.
- Strict management strategies, including prolonged school closures, pose risks to children's well-being, challenging current public policies.
Background:
The emerging virus is rampaging globally. A growing number of pediatric infected cases have been reported. Great efforts are needed to cut down the transmission.
Methods:
A single-arm meta-analysis was conducted. We searched PubMed, Google Scholar, Web of Science, and several Chinese databases for studies presenting characteristics of children confirmed with Coronavirus Disease 2019 (COVID-19) from December 12, 2019 to May 10, 2020. Quality Appraisal of Case Series Studies Checklist was used to assess quality and publication bias was analyzed by Egger's test. Random-effect model was used to calculate the pooled incidence rate (IR) or mean difference (MD) with 95% confidence intervals (CI), or a fixed model instead when I2 < 50%. We conducted subgroup analysis according to geographic region. Additionally, we searched United Nations Educational Scientific and Cultural Organization to see how different countries act to the education disruption in COVID-19.
Results:
29 studies with 4300 pediatric patients were included. The mean age was 7.04 (95% CI: 5.06-9.08) years old. 18.9% of children were asymptomatic (95% CI: 0.121-0.266), 37.4% (95% CI: 0.280-0.474) had no radiographic abnormalities. Besides, a proportion of 0.1% patients were admitted to intensive care units (0, 95% CI: 0.000-0.013) and four deaths were reported (0, 95% CI: 0.000-0.000). Up to 159 countries have implemented nationwide school closures, affecting over 70% of the world's students.
Conclusion:
Children were also susceptible to SARS-CoV-2, while critical cases or deaths were rare. Characterized by mild presentation, the dilemma that children may become a potential spreader in the pandemic, while strict managements like prolonged school closures, may undermine their well-beings. Thus, the public policies are facing challenge.
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