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COVID-19 of short duration with low symptom burden in children

An analysis of adult proxy reported symptoms found that COVID-19 in children has a short duration and a low burden of symptoms.

Mortality associated with COVID-19 infection has been associated with increasing age and the presence of several co-morbidities. This suggests that death from COVID-19 in children and adolescents are likely to be much lower and this has been confirmed in studies. However, one analysis found that nearly a quarter (23%) of infected children were asymptomatic and concluded that paediatric transmissibility should not be ignored. Another clinical syndrome that has emerged in children during the pandemic is a new, rare condition termed multisystem inflammatory syndrome (MIS-C), which has features similar to Kawasaki disease and appears 2 – 4 weeks after the onset of COVID-19. While in adults, long COVID has become a recognised post-infection syndrome, it remains unclear whether children can also experience protracted symptoms after an acute infection.

The COVID Symptom Study has been compiling self-reported symptom data from adults via a smartphone app since March 2020. Starting in September 2020, the app was extended to allow for the analysis of data in children and while this data was not self-reported by the children themselves, it was proxy-reported by an adult. The COVID Symptom Study team therefore set out to investigate illness duration and symptom burden in children aged 5 – 17 years and who had tested positive for COVID-19. The data was split into two groups: children aged 5 – 11 years and those 12 – 17 years. The children were considered to be COVID-19 positive where proxy-reported relevant symptoms were present. The primary outcome of interest was illness duration and symptom burden in children who had tested positive for COVID-19. For comparative purposes, the team also included children who tested negative for the virus.

A total of 75,529 children had a valid COVID-19 positive test result and 1,734 children (588 in the younger age group) had calculable illness duration. The median illness duration for COVID-19 in children was 6 days and was slightly shorter in younger compared to older children (5 days vs 7 days, younger vs older children, p <0.001). In contrast, this was longer than in children reporting symptoms but who had tested negative for COVID-19 (6 days vs 3 days, COVID-19 positive vs negative). Overall, among children testing positive for COVID-19, 74.5% had fever, cough, anosmia or a combination of these symptoms. The most common symptoms reported were headache (62.2%) and fatigue (55%) and during the first week of illness the median symptom burden was only 3 symptoms for the whole cohort. A total of 77 (4.4%) of children reported that their duration of illness was at least 28 days and this was more common among older than younger children (5.1% vs 3.1%, p = 0.046). Only 25 (1.8%) of children reported experiencing symptoms for at least 56 days.
The authors commented on how in children, infection had a short illness duration and with a low symptom burden. They concluded that it was reassuring to find that symptom burden in children did not increase over time.

Molteni E et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health 2021.

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