The COVID-19 pandemic has wreaked havoc across the globe since its outset and has been accountable for considerable morbidity and mortality.

The typical clinical characteristics of COVID-19 infection have been reported as fever, cough, shortness of breath, muscle ache, confusion, and headache.¹ Children infected with COVID-19 have largely been found to be asymptomatic or have only mild disease.²

A retrospective descriptive clinical study was conducted in the early days of the pandemic in China. Sixty seven cases, 53 adults and 14 children, of confirmed COVID-19 from 23 Jan 2020 to 15 Feb 2020 were recruited in this study. Most cases in children in this study were mild (21.4%). All cases in children were of family clusters. Fever (35.7%) and dry cough (21.4%) were the clinical presentations in children. Notably, dry cough and phlegm were not the most common symptoms in children when compared with adults. In adults, the most common symptom at onset of the disease was fever (60.4%), followed by dry cough (54.7%), phlegm (37.7%), pharyngalgia (35.8%) and fatigue (32.1%).¹

In the early stages of the illness, lymphocytes did not show a significant reduction but neutrophils did in children compared with adults. Additionally, children had a lower level of CRP compared to adults. Of the 14 children in this study, 8 (57.1%) were asymptomatic and 6 (42.9%) were symptomatic. Furthermore, the age of asymptomatic patients was younger than symptomatic patients. It is noteworthy that even in the asymptomatic patients, 5 (62.5%) cases had lung injuries,with 3 (60%) having bilateral involvement, which was not different from the symptomatic patients. 

The investigators of this study concluded that clinical symptoms in children are mild, but there is marked lung injury even in pediatric patients. However, there is less clinical disease in children, probably due to a less marked inflammatory response.

Another study was conducted to characterize the symptoms of pediatric patients with COVID-19 in the community and look into the association between symptoms and viral RNA levels in children and adults.² Among 555 COVID patients, 38.2% of the children were asymptomatic compared to 7.2% adults. Among symptomatic participants, fewer symptoms were evident among children compared with adults (mean [SD], 1.6 [2.0] vs 4.5 [3.1]). Symptomatic subjects appeared to have lower Ct values (corresponding to higher viral RNA levels) compared to asymptomatic individuals. The difference in mean Ct values was statistically significant neither between symptomatic children and adults nor between asymptomatic children and adults.

This community-based study conducted in Washington noted that a range of signs and symptoms were reported by COVID-positive children or their caregivers, including runny nose in around half of the children, followed by fever, headache, and cough. Adults most commonly reported headache, cough, and fatigue.

To sum up –

• Children affected by COVID-19 appear to have mild or asymptomatic illness.
• Fever and cough are the common symptoms among children while fever, cough and fatigue seem to be the most common symptoms among adults.
• Symptomatic subjects tend to have lower Ct values compared to asymptomatic individuals.

References

1. Du W, Yu J, Wang H, et al. Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China. Infection 2020;48:445-52.
2. Chung E, Chow EJ, Wilcox NC, et al.Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting. JAMA Pediatr. 2021 Jun 11.