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How does the disease present in children?

Research to date seems to indicate that children are less likely to develop a severe case of COVID-19, although complicated cases or atypical manifestations of the disease do exist. An in-depth analysis of the pediatric community, with enough cases and done in a standardized way, is key to assessing the differences in the presentation of the disease compared with adults.

Understanding the reason for these differences can help develop treatments and prevention strategies for the entire population. We need to study a large number of patients in a coordinated way to answer the key questions.

How does the disease present and what are the long-term effects of COVID-19 in children?

Early epidemiological and clinical evidence for COVID-19 suggests significant differences in disease susceptibility and severity among the pediatric and adult population. In addition, affected children often present with milder forms of the disease or are even asymptomatic, although there are some serious cases. As far as other respiratory infections are concerned, children are a group at risk for serious respiratory infections, so the low incidence of COVID-19 in pediatric ages is surprising.

We are carrying out a large seroprevalence investigation with sufficient cases and studied in an standardized manner that will allow us to characterize in detail the presentation of the disease in previously healthy children but also in cases with chronic or severe pre-existing conditions. On the one hand, comparing different factors (biomarkers) between groups of severely and less severely affected patients we can find out how to predict which cases will develop the disease more aggressively, and thus anticipate the complications of the disease. On the other hand, we can study the best treatments for severe and atypical presentations, or for children with pre-existing conditions.

This study will also monitor patients over time to find out what the long-term effects of COVID-19 in children are, which is currently unknown.

What makes children and adults different when facing COVID-19?

Children have a different microbiota (set of microorganisms that inhabit our body) than adults, and it seems that this may be a protective factor with respect to the disease. They have also been shown to have different levels of ACE2, the receptor to which the coronavirus binds to enter our cells. Similarly, immunity may also be a factor that plays an important role in protecting children from coronavirus.

Analysis of the clinical presentation and course of the disease can help to find out if these factors actually act as protectors against coronavirus, and to see if they could be replicated in the adult population. We are conducting several studies with a large number of cases to investigate these factors in children and adults. The results obtained will be essential to understand how COVID-19 manifests in the pediatric population, and what the essential differences are between children and adults.

The information we obtain from the studies we have underway will be essential to continue advancing in the prevention, diagnosis and treatment of COVID-19. Understanding how COVID-19 affects children may be key to finding out how the transmission or severity of the infection in adults may be reduced.

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