Comprehensive pediatric study examines viral load, immune response, and hyperinflammation caused by COVID-19 disease in children. The results of this study shed light on the fact that children are silent propagators of the SARS-CoV-2 coronavirus.
In the most comprehensive study to date in pediatric patients with COVID-19 disease, researchers at the Massachusetts General Hospital (MGH) and the Mass General Hospital for Children (MGHfC) provide critical data showing that these The latter play a larger role in the community spread of COVID-19 than previously thought.
Indeed, in a study of 192 patients aged 0 to 22, 49 children tested positive for SARS-CoV-2 and 18 others had late-onset illness linked to COVID-19. Infected children have been shown to have significantly higher rates of the virus in the respiratory tract than adults hospitalized in intensive care units for treatment of COVID-19 disease.
« I was surprised at the high levels of the virus we found in children of all ages, especially during the first two days of infection Said Lael Yonker, director of the MGH Kystic Fibrosis Center and lead author of the study. ” I didn’t expect the viral load to be this high. You think of a hospital and all the precautions taken to treat critically ill adults, but the viral loads of these hospitalized patients are significantly lower than that of a ‘healthy child’, who walks quietly with a viral load of Elevated SARS-CoV-2 ».
Indeed, it should be known that the transmissibility or the risk of contagion is greater with a high viral load. And even when children have typical symptoms of COVID-19, such as fever, dry cough, or fatigue, these often overlap with common childhood illnesses, like the flu and colds. ” This makes an accurate diagnosis of COVID-19 complicated Yonker explained.
Additionally, alongside viral load, researchers looked at viral receptor expression and antibody response in healthy children, children with acute SARS-CoV-2 infection and more. small number of children with multisystem inflammatory syndrome (MIS-C).
The results of nose and throat swabs, and blood samples from the MGHfC’s pediatric COVID-19 bio-directory, have implications for the reopening of schools, daycares and other places with high child density, as well as ” close interaction with teachers and staff. ” Children are not immune to this infection and their symptoms do not correlate with exposure and infection. Says Alessio Fasano, director of the MGH Research Center in Immunology and Mucosal Biology and lead author of the study.
« During this COVID-19 pandemic, we mainly detected symptomatic subjects, therefore we came to the wrong conclusion that the vast majority of those infected are adults. However, our results show that children are not protected against this virus. We must not overlook children as potential spreaders of this virus », Explained Fasano.
Researchers note that although children with COVID-19 are not as likely to become as seriously ill as adults, as asymptomatic carriers or carriers of few symptoms attending school, they can spread the infection and introduce the virus to them.
And this is bound to be of particular concern for families from certain socio-economic groups, which have been hit hardest by the pandemic, and multigenerational families with vulnerable seniors in the same household. In the MGHfC study, 51% of children with acute SARS-CoV-2 infection were from low-income communities, compared with 2% from high-income communities.
In another landmark study finding, researchers challenge the current hypothesis that because children have lower immune receptor counts for SARS-CoV2, it makes them less likely to be infected or seriously ill. This is because data from the group show that although younger children have lower amounts of virus receptors than older children and adults, this does not correlate with a decrease in viral load. According to the authors, this finding suggests that children can carry a high viral load, which means they are more contagious, regardless of their susceptibility to developing an infection.
Researchers also studied the immune response in MIS-C, a systemic multi-organ infection that can develop in children with COVID-19 several weeks after infection: Complications of the accelerated immune response seen in MIS -C can include crucial heart problems, along with shock and acute heart failure. ” It is a serious complication due to the immune response to COVID-19 infection, and the number of such patients is increasing. And, as in adults with these very serious systemic complications, the heart appears to be the preferred organ targeted by the post-COVID-19 immune response. Explained Fasano, who is also a professor of pediatrics at Harvard Medical School (HMS).
On the same topic : COVID-19 could affect many more children than expected
Understanding MIS-C and the post-infectious immune responses of COVID-19 patients who are still infants is essential to developing the next steps in treatment and prevention strategies for the disease, researchers say. ” Early information on immune dysfunction in MIS-C should prompt caution when developing vaccine strategies », Notes Yonker.
As MGHfC pediatricians, Yonker and Fasano constantly answer questions from parents about the safe return of their children to school and daycare: They agree that the most critical question is what action schools will take. implemented ” to ensure the safety of children, teachers and staff ».
Recommendations from their study, which includes 30 co-authors from MGHfC, MGH, HMS, Massachusetts Institute of Technology, Brigham and Women’s Hospital, and Harvard TH Chan School of Public Health, state the following: don’t rely on body temperature or symptom surveillance to identify SARS-CoV-2 infection in the school setting.
Researchers therefore focus on infection control measures, including social distancing, universal use of the mask (if applicable), effective hand washing protocols and an combination of distance and in-person learning. They also consider that systematic and ongoing screening of all students for SARS-CoV-2 infection with reporting of results in a timely manner is an imperative part of a safe back-to-school policy.
« This study provides essential facts for decision makers to make the best possible decisions for schools, daycares and other institutions that serve children. », Dit Fasano. « Children are a possible source of the spread of this virus, and this should be taken into account in the planning stages for the reopening of schools », he added.
Fasano also fears that a rushed return to school without proper planning could lead to an increase in cases of infections of the COVID-19 disease: ” If schools were to reopen completely without the necessary precautions, children are likely to play a bigger role in this pandemic », the authors conclude.
Source : Journal of Pediatrics
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