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How does the disease present in children and how has the confinement affected them?

Research to date has shown that children are generally 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 COVID-19 compared with adults. Understanding the reason for these differences can help develop treatments and prevention strategies for the entire population.

Aside from the manifestation of the disease itself, a very relevant consequence of the COVID-19 crisis was home confinement. This preventive measure, which was initially taken to protect the physical health of children and other vulnerable groups, has also had effects on their mental health. During the months of confinement, various stressors coincided that could promote the onset of a mental health problem. In addition, some of these factors have persisted or reappeared in the months following the most restrictive confinement. What the impact of these stressors on the mental health of children and adolescents has been is a key question we need to answer.

How does COVID-19 present and what are the medium and long-term effects on children?

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 a 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.

To understand the possible consequences that confinement has had on the mental health of the pediatric community, we have carried out a macroproject entitled  EmCoVID19 in healthy people as well as subprojects derived from it in which the  clinical population is studied and which are still in the process of sample collection. The EmCoVID19 project has collected data from more than 1,500 healthy children and young people aged 4 to 18 through online research questionnaires during confinement with a follow-up of up to 7 months. This is one of the pioneering studies in assessing whether the number of children and young people who, due to their emotional and behavioral disorders, would be at risk of developing a mental problem has increased, and, among other objectives, seeks to detect those groups most at risk of developing mental illness.

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.

What have we discovered so far with our research? (updated January 22, 2021)

Researchers in the EmCoVID19 study have collected data from 1,529 children and adolescents to assess their risk of developing a mental illness during the COVID-19 lockdown.

Through online questionnaires addressed at the caregivers of young people aged 4 to 18, the researchers looked at whether the emotional and behavioral problems of this group of children and adolescents had increased compared with the previous year. In addition, they also assessed which groups are the most vulnerable and which factors are able to better predict the presence of more emotional and behavioral disorders.

The results show that, in the population of children and adolescents studied, emotional and behavioral problems that could increase the risk of a mental health problem more than doubled during confinement (from 13% to 34.7 %), with children under 8 and a half having a higher risk of suffering such problems. Depression and anxiety were the most prevalent symptoms (64.5%), followed by hyperactivity and behavior change (30.8%). It is worth noting the need for longitudinal data to be able to state that they are probably people at risk of developing a mental health problem, and also that, owing to the tools used, it is only an approximation, not a diagnosis.

The study also found that the factors that best predict the presence of an increased risk of emotional and behavioral disorders are different in children and adolescents. On the one hand, stress and depression in caregivers are the best predictors in children, while in adolescents the best predictor is their style of coping. This suggests that improving the caregiver’s mental state and helping teens cope with stress by focusing on the problem are important goals for preventing mental illness in children and adolescents, respectively. These strategies should be a priority to ensure the mental health of children under conditions of great stress, such as confinement due to COVID-19.