Understanding COVID-19 in children may provide clues to protect at-risk populations

Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China at the end of 2019, the vast majority of severe COVID-19 cases globally have occurred in older adults compared with children. Epidemiological data from the USA show that <2% of laboratory-confirmed cases have occurred in children, with the majority presenting as mild or asymptomatic.1 At the time of writing (2 May 2020), eight child deaths have been reported worldwide, with one case possibly related to intussusception.2 It remains unknown whether children with COVID-19 have less severe illness than adults due to a combination of a lower incidence of infection, lower disease severity or both. Current screening for COVID-19 is predominantly on symptomatic patients, and so the true prevalence of SARS-CoV-2 infections among children and the wider community is unknown. Importantly, in one case of COVID-19 in a 6-month-old boy in Singapore, persistent and high SARS-CoV-2 viral load was observed despite the child being asymptomatic.3 Viral shedding has been detected in rectal swabs of children even beyond the recovery period, suggesting that transmission through the faecal-oral route is possible,4 a point likely to be of greater importance in …