Severe COVID-19 cases are possible in children


COVID-19 is often mild in children, but severe and critical cases have been reported. Cases in children also strengthen the premise that disease is spread by human-to-human transmission.

Previous information on COVID-19 in children indicated that the disease course was mild. However, a new study of children in the Hubei region of China in Pediatrics (prepublication release, March 16, 2020) indicates that severe or critical cases of the disease can happen and that at least one pediatric case led to death.1

The researchers used a nationwide case series of 2143 pediatric patients with COVID-19 that was reported to the Chinese Center for Disease Control and Prevention from January 16, 2020, to February 8, 2020. Seven hundred thirty-one of the cases were laboratory confirmed and 1412 cases were suspected. The median age of all patients was 7 years and 1213 of the cases occurred in boys.

Over 90% of the patients were asymptomatic, mild, or moderate cases. However, there were 112 severe cases and 13 critical cases. Severe cases can have dyspnea and central cyanosis as well as oxygen saturation below 92%. Critical cases can have respiratory failure, shock, encephalopathy, or heart failure. In the early days of the epidemic, there was a rapid increase in cases and a gradual, steady decrease as time had gone on. There were more cases among children in Hubei province, the disease’s epicenter, than in any other region in China.

The researchers concluded that all children are susceptible to the disease, regardless of age. No difference was found between genders. Although the manifestation of the disease may be less severe in children, young children, especially infants, are vulnerable to the disease. Pediatric cases also provide strong evidence that COVID-19 has human-to-human transmission because children weren’t likely to visit the Seafood Wholesale Market, which is where the earliest adult cases of COVID-19 occurred.


1.    Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. In press. 2020; doi: 10.1542/peds.2020-0702

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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