THE MAJORITY OF children and adolescents experience mild symptoms when diagnosed with Covid-19 and only a small number die from the disease, according to a new study published in the Lancet Journal. 

The multinational study of 582 children and adolescents under the age of 18 noted there were only four deaths, less than 1% of the sample taken. 

While 8% of those experienced severe symptoms from the disease and were admitted to ICU, researchers pointed out the study was hospital-based and therefore that figure may not accurately represent the impact of the disease on those under-18 in the wider community. 

The study, which included children and adolescents aged from three days up to 18 years old found that fewer than one in ten patients required treatment in intensive care – 8% or 48 patients.

Researchers note that their study only involved patients who had sought medical help and been tested for Covid-19, and so milder cases would not have been included.

However, they say their findings should be taken into consideration when planning for demand on intensive care services as the pandemic progresses. 

The Health Information and Quality Authority (Hiqa) has previously published summaries investigating the international evidence on immunity and the spread of the virus by children.

“An Australian study that examined potential spread from 18 confirmed (nine students and nine staff) cases to over 800 close contacts in 15 different schools found that no teacher or staff member contracted Covid-19 from any of the initial school cases,” Hiqa deputy chief executive and director of health technology assessment Dr Mairin Ryan said.

Dr Marc Tebruegge from the UCL Great Ormond Street Institute of Child Health in London, and lead author of the latest study said: “Our study provides the most comprehensive overview of Covid-19 in children and adolescents to date.

“We were reassured to observe that the case fatality rate in our cohort was very low and it is likely to be substantially lower still, given that many children with mild disease would not have been brought to medical attention and therefore not included in this study.

“Overall, the vast majority of children and young people experience only mild disease. Nevertheless, a notable number of children do develop severe disease and require intensive care support, and this should be accounted for when planning and prioritising healthcare resources as the pandemic progresses.”

The study was carried out over a 3.5 week period from 1 to 24 April 2020, during the initial peak of the European Covid-19 pandemic. It involved 82 specialist healthcare institutions across 25 European countries.

Symptoms

Researchers found that the most common symptom reported was fever – 65% or 379 patients reported fever.

Around half of the patients had signs of upper respiratory tract infection – 54% or 313 patients.

A quarter had evidence of pneumonia – 25%, or 143. Gastrointestinal symptoms were also reported in around a quarter of the children – 22% or 128 and some 40 of those did not have any respiratory symptoms.

Some 92 children, most of whom were tested due to close contact with a known Covid-19 case, had no symptoms at all – 16% of all patients in the study. 

Dr Florian Götzinger, from Wilhelminenspital in Vienna, Austria, said: “Although Covid-19 affects children less severely than adults overall, our study shows that there are severe cases in all age groups. Those who have pre-existing health issues and children under one month of age were more likely to be admitted to intensive care.”

Four patients died during the study period, two of whom had pre-existing medical conditions. All of the patients who died were older than 10 years of age. However, the overwhelming majority of patients were alive when the study closed.

Meanwhile, a second study also published in the Lancet Journal today has pointed to brain complications in some patients of Covid-19. 

A study of 153 patients treated in UK hospitals during the acute phase of the Covid-19 pandemic describes a range of neurological and psychiatric complications that may be linked to the disease.

Researchers say their report offers the first detailed snapshot of the breadth of neurological complications in Covid-19 patients and should help to direct future research to establish the mechanisms of such complications so that potential treatments can be developed.

The most common brain complication observed was stroke, which was reported in 77 of 125 patients.

Of these, 57 patients had a stroke caused by a blood clot in the brain, known as an ischaemic stroke, nine patients had a stroke caused by a brain haemorrhage, and one patient had a stroke caused by inflammation in the blood vessels of the brain.

Age data was available for 74 of the patients who experienced a stroke and the majority – 82% – were over 60 years of age.

Some 39 patients showed signs of confusion or changes in behaviour reflecting an altered mental state.

Of these, nine patients had unspecified brain dysfunction, known as encephalopathy, and seven patients had inflammation of the brain, medically termed encephalitis. Long-term follow-up studies to assess duration and severity of these complications are needed.

Dr Benedict Michael, one of the lead authors of the study, from the University of Liverpool, said: “Our study is an important early step towards defining neurological complications in Covid-19 patients, which will help with health policy planning as well as informing the immediate next steps in Covid-19 neuroscience research.”