Archives de Pédiatrie 27 (2020) 117–118

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Editorial

COVID-19 virus and children: What do we know?

With a mortality rate of 2–3% and a transmissibility rate (R0) of have been reports about etiological treatment with the antiviral
2–3, the COVID-19 virus outbreak is spreading rapidly worldwide activity of chloroquine (a well-known antimalarial treatment) [11]
and is the new foe. and remdesivir (which had been tried against the Ebola virus) [12].
The first cases in Wuhan, China, did not involve children, which Similarly, no severe or lethal case linked to coronavirus
suggested that the disease was not symptomatic in children infection has been reported to date among pregnant women
[1]. Now that the outbreak is global with more than 90,870 [13–15]. However, a higher risk of preterm birth is reported (five
confirmed cases and 3112 deaths (as of March 3, 2020) [2], we can preterm neonates at 30–33 gestational weeks, seven at around 34–
evaluate more accurately the epidemiology of this disease. There 36 gestational weeks, and 12 at full term/24 neonates), and
are more than 900 confirmed pediatric cases, but currently no child maternal infection could be involved in neonatal distress; one
under 10 years of age has died; only one individual between 10 and neonate died but his samples were negatives for COVID-19 virus
19 years of age died [3–6] and only one child under 1 year old was [13–16]. The vertical transmission before and during delivery is
reported to have a severe form of the disease [7]. Most of the unknown. Some data suggest that no viral RNA is found in amniotic
children were infected after exposure to an adult from the fluid, cord blood, or breastmilk [13], but neonatal infected cases
household [4]. These data suggest that children seem to have been have been reported and they evolved favorably [17–21]. In cases of
spared the major impact of COVID-19 virus. confirmed or suspected infection in pregnant women, it is
By comparison with adults, the number of confirmed pediatric necessary to maintain a high level of surveillance during the
cases is very low, and the severity and mortality rates are even 14–21 days following birth. Breastfeeding should be encouraged as
lower [5–8]. In China, the journal Zhonghua Liu Xing Bing Xue Za Zhi it is the best source of nutrition and also provides antibodies; the
described the age distribution of 44,672 symptomatic confirmed spread of the virus in milk is not well known. Infected mothers
cases: among 43,707 patients older than 20 years, there were should wash their hands often with soap and water or hydro-
1022 deaths (2.3%), whereas among 416 patients aged 0–9 years alcoholic solutions and, if possible, wear a face mask. If a mother is
there was no case of death (0%), and among 549 patients aged 10– too tired to breastfeed, it can be suggested to express the milk with
19 years there was one death (0.2%) [5]. manual or electric pumps so that a healthy member of the family or
The proportion of asymptomatic patients described worldwide a caregiver may give the expressed milk to the infant. Hygiene is
is very small (889 confirmed asymptomatic cases/45,561 con- required when handling the pump and bottles in order to prevent
firmed cases in China; 2.0% [5]), but this could be underestimated transmission of viruses or bacteria [21].
because of the diagnostic methods that involved exclusively RNA No data are available in the literature concerning the severity of
detection by RT-PCR of secretions (nasopharyngeal and throat the infection in immunocompromised pediatric patients. And
swabs and in stool samples [4,9]). RNA in nasopharyngeal and although caution should be taken in this population, the lack of
throat swab samples has been shown to become undetectable data suggests that an increased risk of severe infection has not
within 6–22 days (mean: 12 days) of illness onset in children been demonstrated in these patients [22].
[4]. The excretion of the virus could be shorter in asymptomatic In conclusion, the COVID-19 virus seems to cause benign
patients and there is no systematic sampling series in asymptom- infections in children. The reasons for this tolerance are unknown.
atic persons. The age distribution of asymptomatic patients is not Currently, it is not clear whether specific pediatric populations
detailed in the literature. Do children represent less severe cases, (children with chronic disease or immunosuppressive treatment)
are they less infected, or are they being underdiagnosed as less will also have such a favorable outcome. Moreover, children as
symptomatic [10]? asymptomatic or mildly symptomatic carriers of the virus may
Symptoms in children include flu-like syndrome, fluctuating transmit the virus to other groups (elderly relatives, caregivers,
fever, pneumonia, and upper respiratory signs (cough, sore throat, etc.) even if no transmission of the COVID-19 virus from children to
stuffy nose, sneezing, and rhinorrhea) [3,4,8]. Symptomatic care is adults has been described to date. Children and their relatives
sufficient in the majority of cases but sometimes antibiotic should act to prevent the spread of respiratory infections (covering
treatment of bacterial superinfection may be necessary. There coughs, cleaning hands often with soap and water or hydro-

https://doi.org/10.1016/j.arcped.2020.03.001
0929-693X/ C 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
118 Editorial / Archives de Pédiatrie 27 (2020) 117–118

alcoholic solutions), and in the event of suspected or confirmed [15] Liu W, Wang Q, Zhang Q, et al. Coronavirus disease 2019 (COVID-19) during
pregnancy: a case series. Preprints 2020, 2020020373.
cases they should wear a mask. Furthermore, orofecal transmission [16] Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers
is suspected as COVID-19 virus DNA has been detected in stool with 2019-nCoV pneumonia. Transl Pediatr 2020;9:51–60.
samples. [17] Lu Q, Shi Y. Coronavirus disease (COVID-19) and neonate: what neonatologist
need to know. J Med Virol 2020. http://dx.doi.org/10.1002/jmv.25740 [Epub
This article was written early march. Since new data have been ahead of print].
published, allowing a better view of pediatric population without [18] Niu Y, Yue H. Wuhan Tongji Hospital diagnoses first case of neonatal infection
changing the sense of this article, however you can refer to Dong Y. with new coronavirus; 2020, http://society.people.com.cn/n1/2020/0205/
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Disclosure of interest http://dx.doi.org/10.3760/cma.j.issn.0578-1310.2020.0009 [Epub ahead of
print].
The authors declare that they have no competing interest.
[20] Zhang Z, Wang C, Gao CC. Neonatal coronavirus expert confirmed at 30 hours
of birth: vertical transmission from mother to infant; http://www.cnr.cn/
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