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COVID-19 Clinical Outcomes

CDC Report on COVID-19 Cases in the US Pediatric Population

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BACKGROUND AND PURPOSE:

  • COVID-19 cases in children (<18 years old) appear to be less severe than adult cases, and may present with different symptoms
  • The CDC response team (MMWR, 2020) describes COVID-19 cases in children in the US

METHODS:

  • Data sources (February 12 to April 2, 2020)
    • 50 states, the District of Columbia, New York City, and four U.S territories
    • Cases were submitted through an electronic case-based COVID-19 surveillance database
  • Participants
    • Laboratory confirmed COVID-19 cases in the US
    • Children: <18 years old
  • There were limited data available for some important variables
    • Data on symptoms were available for 9.4% of cases
    • Underlying conditions: 13%
    • Hospitalization status: 33%
  • Data analysis
    • Due to missing data and the fact that severe cases are more likely to have hospitalization status reported, percentages of patients hospitalized were estimated as a range
    • Severity of COVID-19 in pediatric group was compared to adults
    • No statistical comparisons were performed due to large amounts of missing data

RESULTS:

  • 149,760 positive COVID-19 cases in the US
  • <18 years: 2,572 (1.7%) | Median age of pediatric cases :11 years | 57% were males
    • New York City: 33%
    • Rest of New York state: 23%
    • New Jersey: 15%
    • Other jurisdictions: 29%
  • Pediatric cases broken out by age
    • Age <1 year: 15%
    • Ages 1-4 years: 11%
    • Ages 5-9 years: 15%
    • Ages 10-14 years: 27%
    • Ages 15-17 years: 32%

Symptoms

  • Children with COVID-19 might not report fever or cough compared to adults
    • 73% of pediatric patients had symptoms of fever, cough, or shortness of breath
      • Fever: 56% | Cough: 54% | Shortness of breath: 13%
    • 93% of adults aged 18–64 years had these same symptoms
      • Fever: 71% | Cough: 80% | Shortness of breath: 43%
  • Additional symptoms in the pediatric population: Myalgia, sore throat, headache, and diarrhea were less commonly reported

Hospitalization Rates

  • Overall
    • Pediatric patients: 5.7% hospitalized | 0.58% in ICU
    • Adult patients: 10% hospitalized | 1.4% in ICU
  • Of patients whose hospitalization status was known
    • Pediatrics patients: 20% hospitalized | 2.0% in ICU
    • Adult patients: 33% hospitalized | 4.5% in ICU
  • Children <1 year accounted for the highest percentage of hospitalization among pediatric patients
    • Among those <1 year with known hospitalization status, 62% were hospitalized (5 admitted to an ICU) vs 14% in those 1 to 17 years (with little variation among age groups)

Pediatric Underlying Conditions

  • ≥1 underlying condition (with data on underlying conditions): 23%
    • Most common chronic lung disease (including asthma), cardiovascular disease, and immunosuppression
  • ≥1 underlying condition among hospitalized patients: 77% | All 6 six patients admitted to an ICU had ≥1 underlying condition
  • Pediatric Deaths
    • 3 deaths reported

CONCLUSION:

  • Fewer cases of COVID-19 have been reported in children <18 years than in adults in the US
    • Few pediatric COVID-19 cases were hospitalized, supporting previous reports that the disease is less severe in children
    • Most pediatric hospitalizations occurred in children <1 years of age
  • Pediatric patients may be less likely to report symptoms of fever, cough and shortness of breath
  • Limitations on this analysis
    • Missing data
    • Final outcomes for many patients remain unknown
    • Many areas are prioritizing testing cases requiring hospitalization, which may lead to overestimation of hospitalization rates
    • Young adults (those closer to 18 than 65 years) may experience symptoms more similar to pediatric cases than cases in older adults
  • Social distancing and everyday preventive behaviors remain important for all age groups
    • Children likely play an important role in disease transmission

Learn More – Primary Sources:

Coronavirus Disease 2019 in Children — United States, February 12 to April 2, 2020

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Related ObG Topics:

MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes 
COVID-19 Case Series: Pregnancy and Infant Outcomes
COVID-19 in Newborns: What are the Clinical Features and Outcomes?
NEJM Correspondence: Clinical Course of COVID-19 in Children

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