Preliminary epidemiological analysis on children and adolescents with novel coronavirus disease 2019 outside Hubei Province, China: an observational study utilizing crowdsourced data

Brandon Michael Henry; Maria Helena S Oliveira

In both MERS and SARS outbreaks, children were less likely to develop severe respiratory distress seen in adults, experiencing a pneumonia or common cold symptoms. [7] [8] [9] Exposure of young children in China to other coronaviruses, such as OC43, 229E, NL63, and HKU1, 17 may impart some immunity not reinforced in older individuals, explaining partial protection against COVID-19 in this population. 18, 19 Comorbidities have been reported to be associated with severity of COVID-19 infection. 20, 21 As children generally have less comorbidities, this may also in part explain the lack of serious infections in children and contribute to decreased detection. Moreover, behavioral differences and limited travel as compared to adults may have also explained the limited number of cases early in the outbreak. 5 In our data set, children under 10 years old made up a near equal proportion of included cases. This is different than data presented in a recent Chinese CDC report which showed a slightly greater number of cases in those over age 10 (416 aged 0-9 vs. 549 aged 10-19). 6 Whether this is due to the availability of cases in the line lists or a higher detection of cases in young children outside China is unclear, however, this should be monitored going forward. In general, infants and young children are often at increased risk of poor outcomes from respiratory infections, 22 which has not yet been witnessed with COVID-19 from reported aggregate data. 6 Interestingly, a significant male skew in cases was observed in pediatric patients throughout the analysis. This sex skew was not observed among children in SARS or MERS. In adults, cases of COVID-19 are reported to be skewed towards men also. 5, 6 However, explanations applied to adults, such as the high prevalence rates of smoking 23 and comorbidities (i.e. cardiovascular . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.