The presenting features of children with COVID-19 appear to have changed during the pandemic, a small study of medical records hints. Early data suggest that COVID-19 has been less common in children than in adults, and several reports have described the emergence of a COVID-19-related multisystem inflammatory syndrome in children (MIS-C). Dr. Nazreen Jamal and colleagues of Irving Medical Center, Columbia University, in New York City, conducted a retrospective chart review of 106 patients aged 20 years and younger who presented to the pediatric emergency department from March 13 (the first known case) to May 19 and tested positive for SARS-CoV-2 by PCR or serology. Serology was only performed when there was clinical suspicion for SARS-CoV-2-related disease and negative PCR results. During the first and second five-week phases of the outbreak, hospitalization rates remained stable. The mean patient age was stable throughout this interval, but the proportion of patients less than 12 months of age decreased from the first phase (range, 22.2% to 71.4%) to the second phase (range, 4.5% to 16.7%). Mean nasopharyngeal viral loads decreased over time, whereas mean initial C-reactive protein concentrations increased in the second phase, the researchers report in Pediatrics. Positive serology results were seen only during the second phase, during which 25 children had positive serology test results and 29 had positive PCR results. In the first phase, hypoxemia and dyspnea predominated, whereas gastrointestinal and mucocutaneous symptoms emerged during the second phase. Neurological symptoms also increased over time, with altered mental status and cranial nerve VI palsy presenting exclusively in the second phase. "These data reveal a biphasic nature of disease presentation in a high-prevalence SARS-CoV-2 outbreak in susceptible children," the authors say. "The first phase is consistent with uncontrolled community spread followed by a drop in new infections after local nonpharmaceutical interventions (school closures and shelter-in-place orders) were instituted. The second phase reflected a resurgence of disease while nonpharmaceutical intervention measures were still in place and local new infection rates had markedly dropped." "Surveillance for these distinct acute versus delayed COVID-19-related disease phenotypes may help epidemiologists assess onset and intensity of ongoing community transmission and may have implications for emergency preparedness for recurrent waves of SARS-CoV-2 in terms of ensuring supply of relevant medications (e.g., remdesivir versus intravenous immunoglobulin) and supportive interventions (e.g., ventilators versus circulatory support)," they suggest. Dr. Jamal did not respond to a request for comments. —Will Boggs, MD Source
