COVID-19 in children. II: Pathogenesis, disease spectrum and management

Abstract

The global disruption of the COVID-19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID-19 in children, summarising the most up-to-date data including recent developments regarding variants of concern. The acute infection with SARS-CoV-2 is generally mild in children, whilst the post-infectious manifestations, including paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and 'long COVID' in children, are more complex. Given that most research on COVID-19 has focused on adult cohorts and that clinical manifestations, treatment availability and impacts differ markedly in children, research that specifically examines COVID-19 in children needs to be prioritised.

Keywords: COVID-19; PIMS-TS; SARS-CoV-2; management; virology.

Fig 1

Overall severity of COVID‐19 disease in children., , , The left‐hand panel depicts outcomes from acute COVID‐19 infection; the right‐hand panel represents outcomes from PIMS‐TS in children. Estimates of the proportion hospitalised and those requiring intensive care shown here are higher than are being observed in Australia in 2021 (Hospitalised ~1% for medical reasons and ICU admitted ~0.1% of symptomatic cases; unpublished data, PN Britton).

Fig 2

Pharmaceutical agents available for use in severe COVID‐19 disease and important considerations for use in children, based on the principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). These considerations are reflective of advice current on 5 October 2021, which is updated regularly. The reader is directed to the most up‐to‐date recommendations at (), Recommended; (), conditional recommendation; (), conditional recommendation against; (), not recommended.