Children with COVID-19 behaving milder may challenge the public policies: a systematic review and meta-analysis

BMC Pediatr. 2020 Sep 1;20(1):410. doi: 10.1186/s12887-020-02316-1.

Abstract

Background: The emerging virus is rampaging globally. A growing number of pediatric infected cases have been reported. Great efforts are needed to cut down the transmission.

Methods: A single-arm meta-analysis was conducted. We searched PubMed, Google Scholar, Web of Science, and several Chinese databases for studies presenting characteristics of children confirmed with Coronavirus Disease 2019 (COVID-19) from December 12, 2019 to May 10, 2020. Quality Appraisal of Case Series Studies Checklist was used to assess quality and publication bias was analyzed by Egger's test. Random-effect model was used to calculate the pooled incidence rate (IR) or mean difference (MD) with 95% confidence intervals (CI), or a fixed model instead when I2 < 50%. We conducted subgroup analysis according to geographic region. Additionally, we searched United Nations Educational Scientific and Cultural Organization to see how different countries act to the education disruption in COVID-19.

Results: 29 studies with 4300 pediatric patients were included. The mean age was 7.04 (95% CI: 5.06-9.08) years old. 18.9% of children were asymptomatic (95% CI: 0.121-0.266), 37.4% (95% CI: 0.280-0.474) had no radiographic abnormalities. Besides, a proportion of 0.1% patients were admitted to intensive care units (0, 95% CI: 0.000-0.013) and four deaths were reported (0, 95% CI: 0.000-0.000). Up to 159 countries have implemented nationwide school closures, affecting over 70% of the world's students.

Conclusion: Children were also susceptible to SARS-CoV-2, while critical cases or deaths were rare. Characterized by mild presentation, the dilemma that children may become a potential spreader in the pandemic, while strict managements like prolonged school closures, may undermine their well-beings. Thus, the public policies are facing challenge.

Keywords: COVI-19; Children; Meta-analysis; SARS-CoV-2; School closure.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adolescent
  • Betacoronavirus*
  • COVID-19
  • COVID-19 Testing
  • Child
  • Child, Preschool
  • Clinical Laboratory Techniques*
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / prevention & control*
  • Global Health
  • Health Policy*
  • Humans
  • Models, Statistical
  • Pandemics / prevention & control*
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / prevention & control*
  • SARS-CoV-2
  • Schools
  • Severity of Illness Index*