COVID-19 in Children: An Ample Review

Chest Physiotherapy Interventions for Children During SARS-COV-2 Pandemic

Since the first case of Severe Acute Respiratory Syndrome Coronavirus-2/Coronavirus Disease 2019 (SARS-COV-2/COVID-19) was discovered in Wuhan, China, it spread to vast limits globally and became a public health disaster, affecting nearly all countries around the globe. Along with mainstream medical treatment, alternative medicine desperately was the need of the hour for youngsters to manage their symptoms while being self-quarantined and ultimately to improve their chances of survival and recovery from COVID-19. Since the beginning of SARS-COV-2, few studies address the clinical-functional presentation of viral infection and management with physiotherapy for children. Major online electronic databases PubMed, PEDro, and Google Scholar were researched to identify, organize and commission the current review. To create a search strategy, Medical Subject Headings and Descriptors of Science and Health were utilized. The authors looked for other studies by screening the references list of the potentially pertinent papers. These computerized searches turned up studies and those studies' bibliographies with pertinent citations were examined. Personal protective equipment was a crucial component for protection and contact precaution. Following hypoxia, effective oxygen therapy is administered right away. When necessary, under the right circumstances, nasal high-flow oxygen therapy, non-invasive ventilation, lung-protective breathing methods, and prone positioning can be used. Children with SARS-CoV-2/COVID-19 may benefit from physiotherapy interventions with a focus on ventilatory management, airway clearance procedures, early activities, and mobilization.

Epidemiological, Clinical, and Laboratory Features of Children with SARS-CoV-2 in Ukraine

INTRODUCTION

In December 2019, the Chinese city of Wuhan reported the first cases of pneumonia from a new type of beta coronavirus named SARS-CoV-2. In the early days of the COVID-19 outbreak, paediatric patients were thought to be immune to the new virus; however, further studies have shown people of all ages to be susceptible to the virus.

OBJECTIVE

Identify and describe the clinical and epidemiological features of COVID-19 among hospitalized children in Ukraine.

MATERIALS AND METHODS

Retrospective study of 171 children aged 2 months to 18 years who were hospitalized with laboratory-confirmed SARS-CoV-2.

RESULTS

Most patients in the study had a moderate progression of the disease (77.78%, or n=133), whereas a severe course was noted in 22.22% (n=38). Across age groups, children aged 6-12 was the predominant age group affected (35.67%, or n=61). The most common symptoms were fever in 88.2% of patients, sore throat in 69.2% and cough in 60.9%. Symptoms associated with dyspnoea and cyanosis were significantly more common in children with the severe course (p<0.05). Almost half of children had at least one comorbidity, the most prevalent being chronic tonsillitis (11.8% of patients) and anemia (6.5% of patients). A positive correlation (r=0.7 p<0.05) was found between CRP levels and COVID-19 severity. X-ray changes in the lungs were present in 76.61% of examined children and ground-glass opacity symptom was registered in 50.88%.

CONCLUSIONS

COVID-19 among hospitalized children in Ukraine usually has a moderate course of illness and a good prognosis.

Monitoring COVID-19 spread in selected Prague's schools based on the presence of SARS-CoV-2 RNA in wastewater

The COVID-19 pandemic has demanded a broad range of techniques to better monitor its extent. Owing to its consistency, non-invasiveness, and cost effectiveness, wastewater-based epidemiology has emerged as a relevant approach to monitor the pandemic's course. In this work, we analyzed the extent of the COVID-19 pandemic in five primary schools in Prague, the Czech Republic, and how different preventive measures impact the presence of SARS-CoV-2 RNA copy numbers in wastewaters. Copy numbers were measured by reverse transcription-multiplex quantitative real-time PCR. These copy numbers were compared to the number of infected individuals in each school identified through regular clinical tests. Each school had a different monitoring regime and subsequent application of preventive measures to thwart the spread of COVID-19. The schools that constantly identified and swiftly quarantined infected individuals exhibited persistently low amounts of SARS-CoV-2 RNA copies in their wastewaters. In one school, a consistent monitoring of infected individuals, coupled with a delayed action to quarantine, allowed for the estimation of a linear model to predict the number of infected individuals based on the presence of SARS-CoV-2 RNA in the wastewater. The results show the importance of case detection and quarantining to stop the spread of the pandemic and its impact on the presence of SARS-CoV-2 RNA in wastewaters. This work also shows that wastewater-based epidemiological models can be reliably used even in small water catchments, but difficulties arise to fit models due to the nonconstant input of viral particles into the wastewater systems.

Allergic diseases in children in the age of the COVID-19 pandemic

COVID-19 coronavirus infection caused by the SARS-CoV-2 virus has become a real disaster for all of humanity. Today, issues related to diagnostics, clinical presentations, treatment of the complications, preventive measures, including vaccination for a new coronavirus infection, are relevant. It is also important to identify risk factors for a severe course of the disease, features of the development of infection against the background of comorbid conditions and different immunological reactivity of the human body. The comorbidity of allergic and infectious diseases is based on the common humoral and cellular mechanisms of the immune response. The trigger for the development of allergic diseases is often the viruses of measles and chickenpox, influenza, parainfluenza, rhinoviruses, enteroviruses, respiratory syncytial viruses, coronaviruses, and others. Most allergic patients are predisposed to acute respiratory viral infections. COVID-19 occurs in 0.39–12.3% of children. Children tend to have milder disease than adults and have low mortality rates. At the same time, one should not forget about the adequate support for patients with chronic diseases, especially children with allergic diseases. Viruses and preventive hygiene measures associated with a pandemic are triggers of an exacerbation of bronchial asthma and atopic dermatitis. Early diagnosis, adequate treatment of allergic diseases in children, and provision of doctors with information are also problematic. It is important to understand which patients with bronchial asthma are at particular risk and how inhaled glucocorticosteroids may influence the course and outcome of COVID-19. International associations and societies have developed guidelines for the management of children with allergies during the COVID-19 pandemic. Inhaled glucocorticosteroids for bronchial asthma reduce the expression of genes of the main target receptors for the SARS-CoV-2 virus. Anti-inflammatory therapy for asthma, primarily inhaled glucocorticosteroids, should be continued until asthma control is achieved, which will help reduce the risk of an unfavorable course of COVID-19.

How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology?

The COVID-19 pandemic has challenged the continued delivery of healthcare globally. Due to disease risk, clinicians were forced to re-evaluate the safety and priorities of pre-pandemic care. Neuro-oncology presents unique challenges, as patients can deteriorate rapidly without intervention. These challenges were also observed in countries with reduced COVID-19 burden with centres required to rapidly develop strategies to maintain efficient and equitable care. This review aims to summarise the impact of the pandemic on clinical care and research within the practice of Neuro-oncology. A narrative review of the literature was performed using MEDLINE and EMBASS and results screened using PRISMA guidelines with relevant inclusion and exclusion criteria. Search strategies included variations of ‘Neuro-oncology’ combined with COVID-19 and other clinical-related terms. Most adult and paediatric neurosurgical centres experienced reductions in new referrals and operations for brain malignancies, and those who did present for treatment frequently had operations cancelled or delayed. Many radiation therapy and medical oncology centres altered treatment plans to mitigate COVID-19 risk for patients and staff. New protocols were developed that aimed to reduce in-person visits and reduce the risk of developing severe complications from COVID-19. The COVID-19 pandemic has presented many challenges to the provision of safe and accessible healthcare. Despite these challenges, some benefits to healthcare provision such as the use of telemedicine are likely to remain in future practice. Neuro-oncology staff must remain vigilant to ensure patient and staff safety.

Severe pulmonary hemorrhage in a 3‐week‐old neonate with COVID ‐19 infection: A case report

Our patient is a 3‐week‐old female neonate, presented with complaints of low‐grade fever and a congested nose for one day. Eventually, she developed progressive desaturation, hypotension, and poor perfusion due to severe pulmonary hemorrhage. Then, she developed cardiac arrest and was declared dead.

Paediatric hospitalisations due to COVID-19 during the first SARS-CoV-2 omicron (B.1.1.529) variant wave in South Africa: a multicentre observational study

Background

South Africa reported a notable increase in COVID-19 cases from mid-November, 2021, onwards, starting in Tshwane District, which coincided with the rapid community spread of the SARS-CoV-2 omicron (B.1.1.529) variant. This increased infection rate coincided with a rapid increase in paediatric COVID-19-associated admissions to hospital (hereafter referred to as hospitalisations).

Methods

The Tshwane Maternal-Child COVID-19 study is a multicentre observational study in which we investigated the clinical manifestations and outcomes of paediatric patients (aged ≤19 years) who had tested positive for SARS-CoV-2 and were admitted to hospital for any reason in Tshwane District during a 6-week period at the beginning of the fourth wave of the COVID-19 epidemic in South Africa. We used five data sources, which were: (1) COVID-19 line lists; (2) collated SARS-CoV-2 testing data; (3) SARS-CoV-2 genomic sequencing data; (4) COVID-19 hospitalisation surveillance; and (5) clinical data of public sector COVID-19-associated hospitalisations among children aged 13 years and younger.

Findings

Between Oct 31 and Dec 11, 2021, 6287 children and adolescents in Tshwane District were recorded as having COVID-19. During this period, 2550 people with COVID-19 were hospitalised, of whom 462 (18%) were aged 19 years or younger. The number of paediatric cases was higher than in the three previous SARS-CoV-2 waves, uncharacteristically increasing ahead of adult hospitalisations. 75 viral samples from adults and children in the district were sequenced, of which 74 (99%) were of the omicron variant. Detailed clinical notes were available for 138 (75%) of 183 children aged ≤13 years with COVID-19 who were hospitalised. 87 (63%) of 138 children were aged 0–4 years. In 61 (44%) of 138 cases COVID-19 was the primary diagnosis, among whom symptoms included fever (37 [61%] of 61), cough (35 [57%]), shortness of breath (19 [31%]), seizures (19 [31%]), vomiting (16 [26%]), and diarrhoea (15 [25%]). Median length of hospital stay was 2 days [IQR 1–3]). 122 (88%) of 138 children with available data needed standard ward care and 27 (20%) needed oxygen therapy. Seven (5%) of 138 children were ventilated and four (3%) died during the study period, all related to complex underlying copathologies. All children and 77 (92%) of 84 parents or guardians with available data were unvaccinated to COVID-19.

Interpretation

Rapid increases in paediatric COVID-19 cases and hospitalisations mirror high community transmission of the SARS-CoV-2 omicron variant in Tshwane District, South Africa. Continued monitoring is needed to understand the long-term effect of the omicron variant on children and adolescents.

Funding

South African Medical Research Council, South African Department of Science & Innovation, G7 Global Health Fund.

Recent Insights into COVID-19 in Children and Clinical Recommendations

Pediatric coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) have been recognized in multiple countries globally. In this review, we provide recent insights into SARS-CoV-2 infection in children from epidemiological, clinical, and laboratory perspectives, including reports on the disease course and therapy. We highlight key features of SARS-CoV-2 infection in children, the relationship between MIS-C and Kawasaki disease, and summarize treatment guidelines for COVID-19 in children from institutional protocols from Colombia, case reports, recommendations based on expert consensus, and official statements from organizations such as the World Health Organization (WHO), United States Center for Disease Control (CDC), Colombian Association of Infectious Diseases, and the Colombian Society of Pediatrics. Finally, we discuss gaps in research with suggestions for future research on the pathogenesis underlying pediatric COVID-19.

Epidemiological, clinical and biomarker profile of pediatric patients infected with COVID-19

BACKGROUND

Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population.

METHODS

For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis.

RESULTS

Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818-24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356-0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48-64%) and cough (35-55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4-61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2-50% and 0.3-67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality.

CONCLUSION

Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population.

Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy)

BACKGROUND

The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available.

OBJECTIVE

This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months.

METHODS

SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2-antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group).

RESULTS

The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period.

CONCLUSIONS

Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2-antibody measurement allows for a unique, representative, population-based sample collection process.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/27739.

Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination for Paediatric Patients With Inflammatory Bowel Diseases

In this communication, the members of the Porto group (the European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN], inflammatory bowel diseases [IBD] working group) provide the current available evidence regarding vaccination of children and young adolescents with IBD against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our intent is to help provide meaningful answers to the concerns that parents and adolescents may have.

Comparison of SARS-CoV-2 serological assays for use in epidemiological surveillance in Scotland

Background

Sero-surveillance of SARS-CoV-2 is crucial to monitoring levels of population exposure and informing public health responses, but may be influenced by variability in performance between available assays.

Methods

Five commercial immunoassays and a neutralising activity assay were used to detect antibodies to SARS-CoV-2 in routine primary care and paediatric samples collected during the first wave of the pandemic in NHS Lothian, Scotland as part of ongoing surveillance efforts. For each assay, sensitivity and specificity was calculated relative to consensus results (majority of immunoassays positive = overall positive) and neutralising activity. Quantitative correlation was performed between serological and neutralising titres.

Results

Seroprevalence ranged from 3.4-7.3 % in primary care patients and 3-5.9 % in paediatric patients according to different immunoassays. Neutralising activity was detectable in 2.8 % and 1.3 % respectively. Relative assay performance changed depending on comparison to immunoassay consensus versus neutralising activity and qualititative versus quantitative agreement. Cross-reactivity with endemic seasonal coronaviruses was confirmed by neutralising assay in false positives for one immunoassay. Presence of false positives for another assay was found specifically in paediatric but not adult samples.

Conclusions

Five serological assays show variable accuracy when applied to the general population, impacting seroprevalence estimates. Assay performance may also vary in detection of protective neutralising antibody levels. These aspects should be considered in assay selection and interpretation in epidemiological studies.

COVID-19: potential therapeutics for pediatric patients

The global spread of COVID-19 has imparted significant economic, medical, and social burdens. Like adults, children are affected by this pandemic. However, milder clinical symptoms are often experienced by them. Only a minimal proportion of the affected patients may develop severe and complicated COVID-19. Supportive treatment is recommended in all patients. Antiviral and immunomodulatory medications are spared for hospitalized children with respiratory distress or severe to critical disease. Up till now, remdesivir is the only USFDA-approved anti-COVID-19 medication indicated in the majority of symptomatic patients with moderate to severe disease. Dexamethasone is solely recommended in patients with respiratory distress maintained on oxygen or ventilatory support. The use of these medications in pediatric patients is founded on evidence deriving from adult studies. No randomized controlled trials (RCTs) involving pediatric COVID-19 patients have assessed these medications' efficacy and safety, among others. Similarly, three novel monoclonal anti-SARS-CoV-2 spike protein antibodies, bamlanivimab, casirivimab and imdevimab, have been recently authorized by the USFDA. Nonetheless, their efficacy has not been demonstrated by multiple RCTs. In this review, we aim to dissect the various potential therapeutics used in children with COVID-19. We aspire to provide a comprehensive review of the available evidence and display the mechanisms of action and the pharmacokinetic properties of the studied therapeutics. Our review offers an efficient and practical guide for treating children with COVID-19.

Clinical features and outcome of COVID-19 positive children from a tertiary healthcare hospital in Karachi

 

As the coronavirus disease 2019 (COVID‐19) pandemic continues to evolve, differences in epidemiological and clinical features among pediatrics have been noticed across different countries. We describe the spectrum of COVID‐19 in pediatric patients treated in tertiary health care. We conducted a retrospective chart review of pediatric patients admitted to Indus Hospital & Health care network, Korangi campus, Karachi; from April 1st, 2020 to July 31st, 2020. A total of 141 COVID‐19 cases were reported, males were 81 (57%) and the median age was 8 (0.3–17) years. Moderate and severe infections were noted in 36(26%), and 17(12%) children respectively. Fever (50%) was the most common clinical feature. The SF ratio less than 264 was significantly associated with severe disease (p < .05). Lab investigations that differed significantly across disease severity groups included IL‐6 levels (p < .01) and Prothrombin time (p < .05). Majority of children were advised home isolation 89 (63%), 29 (20.5%) were admitted while mortality was observed in 10 (7%) children. No significant difference was observed between children with and without malignancy. Pre‐existing comorbidities are significantly associated with COVID‐19 infections among children. Reduced SF ratio, elevated Prothrombin time, and interleukin‐6 levels are associated with greater disease severity.

Multisystem Inflammatory Syndrome in Children and Adolescents (MIS-C) under the Setting of COVID-19: A Review of Clinical Presentation, Workup and Management

Earlier in its course, SARS-CoV-2 was primarily identified to cause an acute respiratory illness in adults, the elderly and immunocompromised, while children were known to be afflicted with milder symptoms. However, since mid-April of 2020, latent effects of the virus have begun emerging in children and adolescents, which is characterised by a multisystem hyperinflammatory state; thus, the term Multisystem Inflammatory Syndrome in Children (MIS-C) was introduced by the WHO and CDC. The syndrome manifests itself approximately 4 weeks after COVID-19 infection, with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome. Demographically, MIS-C peaks in children aged 5 to 14 years, with clusters in Europe, North and Latin America seen, later followed by Asia. Although the exact pathophysiology behind the syndrome is unknown, recent studies have proposed a post-infectious immune aetiology, which explains the increased levels of immunoglobulins seen in affected patients. Patient presentation includes, but is not limited to, persistent fever, rash, gastrointestinal symptoms and cardiac complications including myocarditis. These patients also have raised inflammatory markers including C reactive protein, ferritin and interleukin-6. In poorly controlled patients, the syndrome can lead to multiorgan failure and death. The mainstay of treatment includes the use of intravenous immunoglobulins, steroids, immune modulators and aspirin. Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation. Currently very little is known about the syndrome, highlighting the need for awareness amongst healthcare workers and parents. Moreover, with increased cases of COVID-19 as a result of the second wave, it is essential to keep MIS-C in mind when attending patients with a past history of COVID-19 exposure or infection. Additionally, once these patients have been identified and treated, strict follow-up must be done in order carry out long term studies, and to identify possible sequelae and complications.

Immune Response to SARS-CoV-2 in an Asymptomatic Pediatric Allergic Cohort

Disease-specific COVID-19 pediatric comorbidity has not been studied effectively to date. Atopy and food anaphylaxis disease states require improved characterization of SARS-CoV-2 infection risk. To provide the first such characterization, we assessed serum samples of a highly atopic, food anaphylactic, asymptomatic pediatric cohort from across the US during the height of the pandemic. From our biobank, 172 pediatric patient serum samples were characterized specific to atopic, food anaphylactic, and immunologic markers in the US at the beginning of the pandemic, from 1 February to 20 April 2020. Clinical and demographic data were further analyzed in addition to sample analysis for SARS-CoV-2 IgM and IgG ELISA. SARS-CoV-2 antibody results were positive in six patients (4%). Nearly half of the pediatric patients had a history of asthma (49%). Total IgE, total IgG, and IgG1-3 were similar in those positive and negative to SARS-CoV-2. Median total IgG4 in the SARS-CoV-2 positive group was nearly three times (p-value = 0.02) that of the negative group. Atopy controller medications did not confer additional benefit. Our data suggest that food anaphylaxis and highly atopic children are not at increased risk for SARS-CoV-2 seropositivity. This specific population appears either at equal or potentially less risk than the general population. Total and specific IgG4 may be a novel predictor of SARS-CoV-2 infection risk specific to the allergic pediatric population.

Clinical characteristics and evolution of pediatric patients with acute leukemia and SARS-COV2 virus infection in a third level hospital in Mexico

Introduction

Reports have revealed that people susceptible to severe forms of COVID-19 are older adults with comorbidities; However, the pediatric population has also been affected, considering children with underlying conditions such as onco-hematological conditions to be high risk. We present a cases series in a third level hospital.

Material and methods

We conducted a retrospective study in children under the age of 16 years with a diagnosis of acute leukemia and infection with the SARS-CoV2 virus. Descriptive statistics with means and percentages were used. To show differences between the groups, Chi-square test, Student t test and Mann-Whitney U test were used depending on the type of variable and its distribution.

Results

SARS-CoV2 virus infection was confirmed in 15 children diagnosed with acute leukemia, at different stages of treatment. The mean age was 7.5 years, 8 male and 7 female, 11 of them diagnosed with acute B-cell lymphoblastic leukemia, one with acute T-cell lymphoblastic leukemia and 3 with acute myeloid leukemia. The mean days of hospital stay at the diagnosis of COVID-19 was 22. Thirteen of the children had fever and neutropenia. 7 patients died. There was a statistically significant correlation with the outcome in patients who presented a prolongation of aPTT, an increase in D-dimer, an increase in liver enzymes and severe respiratory distress with the need for mechanical ventilation.

Conclusion

The risk of death in children with leukemia and COVID-19 was associated with prolonged aPTT, increased D-dimer, increased liver enzymes, respiratory distress, and the need for mechanical ventilation.

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

OBJECTIVE

The aim of this review was to summarize the most common extrapulmonary manifestations in pediatric patients with COVID-19, as well as to discuss clinical, epidemiological, and pathophysiological aspects of these clinical presentations in children.

SOURCE OF DATA

An extensive search of literature was performed in order to identify pediatric cases with extrapulmonary manifestations between January 1, 2020 and June 21, 2020. Generic keywords, such as "Novel coronavirus" or "Novel coronavirus 2019" or "2019 nCoV" or "COVID-19" or "SARS-CoV-2" were searched on PubMed database, associated either with age filters or generic pediatric terms.

SUMMARY OF FINDINGS

A total of 28 articles, including 199 patients, were considered suitable to review and data extraction. The main findings were summarized in tables. The main non-pulmonary manifestations in pediatric patients, in decreasing order of frequency, were gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, cutaneous, hepatic, ocular, olfactory, and gustatory. Multisystem impairment and Kawasaki-like disease were also described.

CONCLUSIONS

Differences in immune response of children and variations of tissue expression of angiotensin converting enzyme 2, the virus receptor, are likely to influence clinical, epidemiological, and pathophysiological patterns of the disease.

Impact of the COVID-19 pandemic on children with psoriasis

Background

Children with psoriasis may have been directly impacted by the COVID-19 pandemic and their illness may also have affected their ability to follow preventive measures.

Objective

To investigate the impact of the COVID-19 pandemic on children with psoriasis.

Methods

A survey of children (< 18 years) with psoriasis, conducted from June 10 to June 29, 2020.

Results

In total, 92 children were included: 71.7% had psoriasis lesions at the time of home lockdown while 45.2% were receiving systemic treatments, and two contracted COVID-19. During lockdown, psoriasis worsened in 47.3% of the children and 18.8% stopped their systemic treatments, mainly for reasons linked to the pandemic. A total of 41.3% had a consultation for psoriasis during lockdown (71.1% by teleconsultation): 39.5% due to worsening of their psoriasis and 21.1% for pandemic-related issues. Among patients not having a consultation during lockdown, 27.5% had a cancellation by the doctor and 9.3% had concerns over going to see the doctor. Finally, 22.8% of patients reported finding it difficult to respect hygiene measures because of their psoriasis, e.g., application of alcohol-based hand sanitizers (47.6%), handwashing routines (42.9%), and wearing a mask (28.6%).

Conclusions

This study demonstrates the major clinical impact of the COVID-19 pandemic on children with psoriasis. Teleconsultations played a key role in patient management as regards patient monitoring, provision of information, and renewal of treatments. It is vital that we learn from these data to improve and adapt the monitoring of chronic dermatoses in both children and adults in the event of a future health crisis.

Managing children with brain tumors during the COVID-19 era: Don't stop the care!

The COVID-19 pandemic has substantially stressed health care systems globally, subsequently reducing cancer care services and delaying treatments. Pediatric populations infected by COVID-19 have shown mild clinical symptoms compared to adults, perhaps due to decreased susceptibility. Several scientific societies and governments have released information on the management of patients with cancer, wherein they warn against exposure to SARS-CoV-2 infection and suggest continuing treatment. To determine the best diagnostic and therapeutic approach, multidisciplinary tumor boards should convene regularly, including through conference calls and telematics platforms. A prompt diagnostic workup may reduce children's suffering and prevent loss of confidence in the health care system among parents. Moreover, ensuring adequate support and information regarding measures for preventing SARS-CoV-2 infection in pediatric patients and their families is essential for avoiding panic and excessive stress, allowing early reporting of any suspected symptoms of cancer and, in turn, facilitating early diagnosis and prompt modulation of treatment.

Clinical Pediatric Screening for COVID-19

Background: Due to the increasing prevalence of covid-19, the World Health Organization declared on 30 January 2020, the spread of the new coronavirus as a 6th public health emergency of international concern. Objectives: To assess the extent of the disease in the pediatric population in our region, we conducted a clinical pediatric screening for Covid-19 and evaluated factors that affected its manifestation in children. Methods: In this study, 474761 children under 19 years of age were screened in two phases. In the first phase, 680 cases were considered as suspect and referred to the health centers, where the second phase of screening took place. Finally, 230 probable cases were referred to specialized centers for further investigation. Results: Almost all of the cases had pneumonia and symptoms of shortness of breath, cough, and fever over 38°C (56.7%). Other clinical symptoms included hypotension (17.4%), Hemoptysis (16.1), sore throat (11.6%) and difficult breathing (6.7%). 26% of patients had a history of chronic disease (mainly pulmonary and cardiac). There was a statistically significant relationship between the probable causes and the symptoms of the disease (P < 0.05), between age and probable cases (P < 0.05), and between death and underlying disease (P < 0.05). However, of all the cases, only 15 (6.5%) had a positive PCR test, 39 patients were hospitalized (17%), 173 cases (75%) received outpatient treatment and 18 cases (7.8%) died. Conclusions: Children with shortness of breath, cough, pneumonia, fever over 38 and underlying disease are suspicious for Covid-19 and should be hospitalized to be evaluated with laboratory tests.

Human Coronaviruses SARS-CoV, MERS-CoV, and SARS-CoV-2 in Children

The novel coronavirus, known as 2019-nCoV or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an epidemic with high mortality and morbidity since December 2019, in Wuhan, China. The infection has now been transmitted to more than 210 countries worldwide and caused more than 200,000 deaths. Similar to other coronaviruses such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), SARS-CoV-2 appears to less commonly affect pediatrics and to cause less severe disease along with fewer symptoms compared to adults. Available data suggest that the pediatric population is just as likely as adults to become infected with SARS-CoV-2. However, they may be asymptotic or have milder symptoms than adults; they can be potential carriers of the disease. This article reviews the present understanding of SARS-CoV-2 infection in the pediatric age group in comparison with MERS-CoV and SARS-CoV.

Atypical Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children: A Systematic Review

BACKGROUND

In December 2019, a local outbreak of pneumonia was presented in Wuhan (China) and quickly identified to be caused by a novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The disease caused by SARS-CoV-2 was named COVID-19 and was soon declared a pandemic because of the millions of infections and thousands of deaths worldwide. Children infected with SARS-CoV-2 usually develop the asymptomatic or mild type of disease compared to adults. They are also more likely to have atypical and non-specific clinical manifestations than adults.

METHODS

A literature search was performed through PubMed and Scopus to summarize the extrapulmonary manifestations of SARS-CoV-2 infection in children since the beginning of the pandemic. Peer-reviewed papers in English were retrieved using the following keywords and combinations: 'pediatric,' 'child,' 'infant,' 'neonate,' 'novel coronavirus,' 'SARS-CoV-2,' 'COVID 19' and 'gastrointestinal,' 'renal,' 'cardiac,' 'dermatologic' or 'ophthalmologic'. We included published case series and case reports providing clinical symptoms and signs in SARS-CoV2 pediatric patients.

RESULTS

Although fever and symptoms of upper respiratory infection are the most frequently presented, a variety of other atypical presentations has also been reported. The clinical spectrum includes dermatological, ophthalmological, neurological, cardiovascular, renal, reproductive, and gastrointestinal presentations. In addition, a rare multi-inflammatory syndrome associated with SARS-- CoV-2 infection has been reported in children, often leading to shock and requiring inotropic support and mechanical ventilation.

CONCLUSION

Clinicians need to be aware of the wider range of extrapulmonary atypical manifestations of SARS-CoV-2 infection in children, so that appropriate testing, treatment, and public health measures can be implemented rapidly.

Can CFD establish a connection to a milder COVID-19 disease in younger people? Aerosol deposition in lungs of different age groups based on Lagrangian particle tracking in turbulent flow

To respond to the ongoing pandemic of SARS-CoV-2, this contribution deals with recently highlighted COVID-19 transmission through respiratory droplets in form of aerosols. Unlike other recent studies that focused on airborne transmission routes, this work addresses aerosol transport and deposition in a human respiratory tract. The contribution therefore conducts a computational study of aerosol deposition in digital replicas of human airways, which include the oral cavity, larynx and tracheobronchial airways down to the 12th generation of branching. Breathing through the oral cavity allows the air with aerosols to directly impact the larynx and tracheobronchial airways and can be viewed as one of the worst cases in terms of inhalation rate and aerosol load. The implemented computational model is based on Lagrangian particle tracking in Reynolds-Averaged Navier-Stokes resolved turbulent flow. Within this framework, the effects of different flow rates, particle diameters and lung sizes are investigated to enable new insights into local particle deposition behavior and therefore virus loads among selected age groups. We identify a signicant increase of aerosol deposition in the upper airways and thus a strong reduction of virus load in the lower airways for younger individuals. Based on our findings, we propose a possible relation between the younger age related fluid mechanical protection of the lower lung regions due to the airway size and a reduced risk of developing a severe respiratory illness originating from COVID-19 airborne transmission.

Racial and Ethnic Disparities in COVID-19 Outcomes: Social Determination of Health

As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University's Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.