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Clinical and Epidemiologic Analysis of COVID-19 Children Cases in Colombia PEDIACOVID

Our take —

This study compared the age distribution among individuals <18 years old across different categories pertaining to SARS-Cov-2 infection using a large, nationwide registry of COVID-19 in Colombia. Children with mild or asymptomatic SARS-CoV-2 infection were older in age compared to those with severe symptomatic disease. Also, children who recovered from SARS-CoV-2 infection and did not require hospitalization were older in age compared to those who were deceased or hospitalized. Reported cases were likely biased towards more severe disease due to limited testing. Inadequate identification of asymptomatic SARS-CoV-2 infection at younger ages could have biased the results, resulting in an underestimation of SARS-CoV-2 infection in the Colombian NIH database; thus, the findings may not represent the true distribution of SARS-CoV-2 infection across the general population of Colombia.

Study design

Cross-Sectional

Study population and setting

The PEDIACOVID study was a cross sectional study that described the clinical characteristics of COVID-19 infection among those <18 years-old in Colombia. The study used a National Institute of Health (INS) database to identify cases with laboratory-confirmed COVID-19 infection from March 6, when the 1st case was identified, through June 16, 2020. Out of 54,971 confirmed COVID-19 participants, 5062 (9.2%) were <18 years old. Confirmed cases were categorized as asymptomatic or symptomatic. The latter was further categorized into four ordinal categories; mild, moderate, severe or deceased. Confirmed asymptomatic cases in the database were defined as positive PCR tests within 14 days of unprotected exposure to confirmed cases or positive serological antibodies at 11 days or more from exposure to a confirmed case. Confirmed symptomatic cases were defined as positive PCR tests within 14 days of having symptoms or positive serological tests at 11 days or more from having symptoms. Mild symptomatic cases were defined as having mild upper respiratory tract symptoms. Moderate symptomatic cases had dyspnea or tachypnea, but did not require any oxygen supplementation; severe symptomatic cases had pulmonary radiographic findings, elevated serum ferritin, LDH, D-dimer, lymphopenia or thrombocytopenia. All COVID-19 cases with comorbid conditions were categorized as severe. The study compared the age distribution across categories of disease severity and participants’ place of care (home versus general hospital ward versus intensive care unit (ICU)). Comparisons were made using an ANOVA test and a post-hoc Tukey’s test to adjust for multiple comparisons.

Summary of Main Findings

Of the 5,062 cases <18 years of age (49% male), 4,022 (80%) were classified as mildly symptomatic, 854 (17%) asymptomatic, and only 8 cases were deceased (0.16%). The majority of the cases were treated at home (2,886 [57%]), while 146 (2.8%) were treated in general hospital wards and only 26 (0.5%) in an ICU. The study found a statistically significantly higher mean age in the asymptomatic and mildly symptomatic cases (9.4 years) compared to those who were moderately, severely symptomatic and deceased (6.3, 4.9 and 2.9 years respectively).

There was a statistically significant difference in mean age between those who were treated at home compared to those who were treated in hospitals or ICU (9.3 vs. 6.1 and 4.9, respectively). Participants who recovered were significantly older than those who died (9.3 vs. 2.9 years of age). These results were similar when the data were stratified by the three most-affected regions in Colombia.

Study Strengths

This study used a large national database of confirmed COVID-19 to examine infection and disease severity among individuals less than 18 years old in Colombia. The study adds critical information in regards to the age distribution of severe COVID-19 infection among children.

Limitations

The study categorized any children with comorbid conditions as severe COVID-19 cases regardless of their actual clinical severity of SARS-CoV-2 infection, which may have resulted in a spurious association between age as a risk factor and severe SARS-CoV-2 infection if these comorbidities were more common in younger ages (the authors did not mention the distribution of these comorbidities across different ages in children).

The study used a large national database in which participants had to have medical attention to be tested for SARS-CoV-2 virus, either due to exposure to other COVID-19 subjects or due to having symptoms. Therefore, the sample was not randomly selected from the population. It is plausible that children across different ages with asymptomatic disease were not tested, and thus, were not included in this database. If the distribution of these asymptomatic, untested subjects differed across age groups, the age comparison between asymptomatic and severely symptomatic disease would not be valid. It is unlikely, however, that this would bias the comparison between the deceased and the recovered subjects, unless the database did not capture COVID-19 related deaths in older ages of childhood. Given the descriptive nature of the study, no formal hypothesis testing or adjustment was conducted.

Value added

The study provides information about the age distribution across different categories pertaining to the severity of COVID-19 infection among children (<18 years) using a large, nationwide COVID-19 registry in Colombia. The study results could be potentially extrapolated to other developing countries in South America.

This review was posted on: 11 January 2021