-  In a review of 178 children with cancer from a single institution in New York City, 20 tested positive for SARS-CoV-2, and only one required admission (noncritical) for symptoms related to COVID-19. COVID-19 was similarly mild in small surveys of children who developed COVID-19 while receiving immunosuppressive medications for kidney disease or inflammatory bowel disease 
-  In multicenter studies of children admitted to pediatric ICUs, most children had one or more underlying conditions
-  Among children hospitalized with COVID-19 from 14 states by late July 2020, 42 percent had ≥1 underlying condition, the most common of which were obesity (38 percent of children ≥2 years), chronic pulmonary disease (18 percent), and prematurity (15 percent of children <2 years) 

What this means for children

-  Medical complexity
-  Congenital heart disease
-  Neurologic, genetic, or metabolic conditions
-  Chronic kidney disease

-  Immune compromise from solid organ transplant

 -  Obesity

-  Sickle cell disease

-  Type 2 diabetes mellitus
Cerebrovascular disease

-  Chronic pulmonary disease (eg, cystic fibrosis, moderate to severe asthma, pulmonary fibrosis)

-  Hypertension
-  immune compromise from hematopoietic cell transplant, primary immune deficiency, HIV, medications (eg, glucocorticoids)

-  Liver disease

-  Pregnancy

-  Smoking

-  Thalassemia

-  Type 1 diabetes mellitus

Ohio State University, Columbus

-  Frequency of severe disease in kids
-  Risk factors for severe disease
-  potential markers
-  Multi-system inflammatory syndrome in kids

Severe disease in kids

Deville, J. (2020, August 7). Coronavirus disease 2019 (COVID-19): Clinical manifestations and diagnosis in children. Retrieved August 13, 2020, from https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-clinical-manifestations-and-diagnosis-in-children?topicRef=127535

Coronavirus disease 2019 (COVID-19): Clinical manifestations and diagnosis in children

-   most children appear to have asymptomatic, mild, or moderate disease and recover within one to two weeks of disease onset
-  review of 7480 children <18 years of age with laboratory-confirmed COVID-19 infection, information about symptoms and severity was available for 1475
-   Among these, 15 percent of cases were asymptomatic, 42 percent were mild, 39 percent were moderate (eg, clinical or radiographic evidence of pneumonia without hypoxemia), 2 percent were severe (eg, dyspnea, central cyanosis, hypoxemia), and 0.7 percent were critical (eg, acute respiratory distress syndrome, respiratory failure, shock)
- A total of six deaths were reported

Frequency of severe disease in kids

Risk factors for severe disease

 In observational studies, elevated inflammatory markers (eg, CRP, procalcitonin, interleukin 6, ferritin, D-dimer) at admission or during hospitalization have been associated with severe disease in children

Potential markers

MIS-C is a rare but serious condition associated with COVID-19 that has been reported in children from Europe and North America. The clinical features of MIS-C may be similar to those of Kawasaki disease, Kawasaki disease shock syndrome, and toxic shock syndrome

They include persistent fever, hypotension, gastrointestinal symptoms, rash, myocarditis, and laboratory findings associated with increased inflammation; respiratory symptoms may be lacking

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