While we have previously considered children to be somehow spared the worst of the pandemic (more on that here) new research comes to show that it was, perhaps, only us hoping for the best.

Children, teens, and young adults are at greater risk for severe complications from COVID-19 than believed, a new paper reports, and as with other age groups, those with underlying health conditions are the most vulnerable to the disease. The authors say theirs is the first study to describe the “characteristics of seriously ill pediatric COVID-19 patients in North America”.

The kids aren’t alright

“The idea that COVID-19 is sparing of young people is just false,” said study coauthor Lawrence C. Kleinman, professor and vice-chair for academic development at Rutgers Robert Wood Johnson Medical School.

“While children are more likely to get very sick if they have other chronic conditions, including obesity, it is important to note that children without chronic illness are also at risk. Parents need to continue to take the virus seriously.”

The authors followed 48 American and Canadian children and young adults (from newborns to 21 years old) who were admitted to pediatric intensive care units (PICU) for COVID-19 in March and April. Over 80% of them (43 individuals) had chronic underlying conditions ranging from obesity, diabetes, or seizures to chronic lung disease and immune suppression. Of this group, 38% (18 individuals) required invasive ventilation. All in all, 35 of the patients in this study (73%) presented to the hospital with respiratory symptoms.

During their time in the hospital, 11 patients (23% of total) experienced failure of 2 or more organ systems. Two of them died while receiving care and, by the end of the study period, 15 (31%) were still hospitalized, with 3 still requiring ventilatory support and 1 receiving extracorporeal membrane oxygenation.

“This study provides a baseline understanding of the early disease burden of COVID-19 in pediatric patients,” said Hariprem Rajasekhar, a pediatric intensivist involved in conducting the study at Robert Wood Johnson Medical School’s Department of Pediatrics.

“The findings confirm that this emerging disease was already widespread in March and that it is not universally benign among children.”

All in all, the team says they were “cautiously encouraged” by the patients’ outcomes as they recorded a 4.2% mortality rate among the PICU group — which is 4.2% higher than I’d like it to be but still way better than the 62% mortality rate the team cites for adults admitted to ICUs. They also highlight the lower incidence of respiratory failure seen in this study compared to those seen in adult ICU patients.

That being said, however, they also point to growing concerns about a new COVID-related syndrome seen in children in the New York metropolitan area, citing the incidence of heart failure and a Kawasaki disease-like condition termed pediatric multi-system inflammatory syndrome as examples.

“Although our data collection for this study has ended, we continue to develop collaborations with colleagues in our region and across the country to try to understand these more severe complications,” he concludes.

The paper “Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units” has been published in the journal JAMA Pediatrics.