COVID-19 Research News Update for March 18

Post Date: March 18, 2020 | Publish Date:

The Research Horizons science blog is sharing links to research-oriented news about the COVID-19 pandemic, especially information about how children are affected.

If you see an article that should be shared with the research community, please send a note to scienceblogeditor@cchmc.org

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Stealth Transmission Reported

In a study posted March 8, 2020, to medRxiv, epidemiologists found higher rates of transmission by people who either were not very sick or who had not yet developed symptoms of infection—a contrast to past experiences with SARS and MERS and one reason why many cases during the early spread of the novel coronavirus can go undetected.

“The proportion of pre-symptomatic transmission was 48% (95%CI 32-67%) for Singapore and 62% (95%CI 50-76%) for Tianjin, China,” the co-authors state.

Children may be a significant source of hard-to-detect transmission, according to this pre-print report posted March 16, 2020, by the journal Pediatrics. NOTE: Pre-print information has not been peer-reviewed.

This report is based on a case series of 2143 pediatric patients with COVID-19 reported to the Chinese Center for Disease Control and Prevention.

“Children at all ages appeared susceptible to COVID-19, and there was no significant gender difference. Although clinical manifestations of children’s COVID-19 cases were generally less severe than those of adults’ patients, young children, particularly infants, were vulnerable to infection,” the co-authors state.

The good news: while children are getting infected, the vast majority are doing well.

“Why most of the children’s COVID-19 cases were less severe than adults’ cases is puzzling,” the report states. “This may be related to both exposure and host factors.”

An accompanying editorial expands upon the findings:

“There are several salient points from this paper. First, while children are less likely to become
severely ill than older adults, there are subpopulations of children with an increased risk for more
significant illness,” the editorial states.

“Third, children may play a major role in community-based viral transmission. Available data suggest that children may have more upper respiratory tract (including nasopharyngeal carriage), rather than lower respiratory tract involvement.

There is also evidence of fecal shedding in the stool for several weeks after diagnosis, leading to concern about fecal-oral transmission of the virus, particularly for infants and children who are not toilet-trained, and for viral replication in the gastrointestinal tract.

Prolonged shedding in nasal secretions and stool has substantial implications for community spread in daycare centers, schools, and in the home.”

This data, indicating that children are indeed becoming infected, serves as another rationale for social distancing.