The study sheds new light on the impact of COVID-19 in the pediatric population

Reviewed by Emily Henderson, B.Sc.November 24, 2020

In the most comprehensive analysis to date of U.S. children tested and treated for COVID-19, an organization representing seven of the nation’s largest pediatric medical centers reports that certain groups of children are doing significantly worse than children in general during the pandemic. .

The findings from the PEDSnet organization, which includes Cincinnati Children’s, were published on November 23, 2020 in JAMA Pediatrics. The report is based on electronic health record data from more than 135,000 children who were tested for infections from the SARS-CoV-2 virus from January 1 to September 8, 2020.

These findings are important because they improve our understanding of the impact of COVID-19 in the pediatric population. We see that children are less likely to have a serious illness or die from COVID-19 than adults. However, we also note the disproportionately high infection rates among Black, Asian and Hispanic children as a clear target for further studies. “

Nathan Pajor, MD, Study Co-author, Pulmonary Medicine Specialist, Cincinnati Children’s Hospital Medical Center

PEDSnet centers include the Children’s Hospital of Philadelphia; Cincinnati Children’s Hospital Medical Center; Colorado Children’s Hospital; National Pediatric Hospital; Nemours Children’s Health System; Seattle Children’s Hospital; and St. Louis Children’s Hospital. Together, these centers provide care for approximately 2.5 million children a year.

Highlights of their analysis include:

• Like previous, smaller studies, these data show that children are less likely to test positive and less likely to suffer from serious illness when infected.
• Patients of African American, Hispanic, and Asian race / ethnicity were less likely to be tested than white children. However, they were 2-4 times more likely to test positive.
• Teenagers and young adults were more likely to test positive than younger children.
• Children covered by Medicaid and other public programs were more likely to test positive than children from privately insured families.
• The underlying cancer, diabetes (types 1 and 2), and other immune-suppressing conditions were indicators of an increased risk of serious disease. But children with asthma were not at increased risk for serious illness.
• Of the 5,374 children who tested positive, 7% required hospitalization. Of the inpatients, 28% required intensive care and 9% required mechanical ventilation. Of the hospitalized children, eight died. (Case mortality rate: 0.2%)

“More studies are needed to understand the underlying causes of changes in positivity rates,” says Pajor. “How much is it related to social determinants of risk, such as exposure to air pollution, population density, or the likelihood of living with a person who has to work in person? How does it reflect differences in disease biology?”

Harnessing the power of big data

The PEDSnet data coordination center is based in Philadelphia, but the concept behind PEDSnet – launched in 2014 – was a national cooperative effort among its co-founders, says Tracy Glauser, MD, Associate Director, Cincinnati Children’s Research Foundation.

“Part of the challenge of pediatric research has been that many of our conditions are rare so that no single institution alone has enough information to comprehensively address certain problems,” says Glauser. “PEDSnet’s goal has been to come up with ways for institutions to share data to answer questions we can’t address alone.”

Cincinnati Children’s leaders have invested years of work in launching numerous data sharing initiatives, including the Genomics Research and Innovation Network (GRIN) in 2015, becoming the data coordination center for the Bench to Bassinet (B2B) program for cardiac research in 2016 and be appointed data coordinator for the Rare Diseases Clinical Research Network (RDCRN) in 2019.

Peter Margolis, MD, PhD, chaired the PCORnet Council and serves as principal investigator of the Cincinnati Children’s site for PEDSnet. Margolis is co-director of the James M. Anderson Center for Health System Excellence and has extensive experience in networking for health care quality improvement and research.

“PEDSnet provides a national digital architecture that can harness the power of the electronic medical record to advance knowledge,” says Margolis. “Without PEDSnet, gathering the information we present today would have taken years.”

MIS-C needs a more in-depth study

While the latest study provides powerful data to answer any questions, it also draws attention to the chaotic nature of the pandemic’s early days and how experts dealt with one of the most serious complications affecting children.

At first, children who experienced severe heart-damaging inflammatory reactions were diagnosed with Kawasaki disease, a very rare condition with largely unknown causes. When doctors noticed differences between the new and older cases, the diagnosis turned into a Kawasaki-like disease. It has since evolved into “childhood multisystem inflammatory syndrome” (MIS-C).

The study’s co-authors say the medical community still has only a partial picture of the impact of MIS-C on children, in part because rapidly evolving name changes have complicated data collection. Furthermore, with the pandemic still less than a year old in the US, far more studies are needed to understand the long-term results of MIS-C.

Much more to learn

Some of the study’s limitations include the exclusion of children who have been infected or potentially killed by COVID19 due to a lack of testing availability. The study likely underestimates the actual number of asymptomatic infected children across the country and does not address the risk those children may have presented to adults in their lifetime.

Participating medical centers overcame enormous technical challenges to build this tracking system at the start of the pandemic. Now, the data can be updated quickly to allow for deeper analysis as the pandemic continues.

“An effective response to SARS-CoV-2 will require rapid but robust development of new clinical and public health practices based on a better understanding of viral and host biology,” say the co-authors. “This knowledge will be critical not only in caring for critically ill patients, but also in building sustainable ways to minimize the disease burden caused by SARS-CoV-2.”