COVID-19 More evidence points for children doing “silent spreaders”

Children with COVID-19 may shed the virus for up to 3 weeks, even when asymptomatic, according to a South Korean study.

SARS-CoV-2 RNA was detected in nasopharyngeal swabs and oropharyngeal swabs for an average of 17.6 days in 91 children with confirmed CO quad-19 infections since the first positive test, Jong- of the Catholic University of Korea. In Seoul, reported by Dr. Hyun Kim, MD.

About half of the symptomatic children had the virus shed for 3 weeks. 49% of children with upper respiratory tract infections and 55% of children with lower respiratory tract infections JAMA Pediatrics..

Of 20 asymptomatic children in the cohort, SARS-CoV-2 RNA was detected for an average of 14.1 days after the first positive test, and 4 (20%) were still shedding the virus in 3 weeks. ..

In particular, the study included PCR tests, and detection of SARS-CoV-2 using this method may not be comparable to infectivity, the authors said.

“The main hurdle involved in diagnosing and treating COVID-19 children in this study is that a significant number of children are asymptomatic and COVID-19 is diagnosed even in the presence of symptoms It has been overlooked and overlooked,” Kim and co-author wrote.

Although most COVID-19 cases tend to be less severe in children than in adults, the role of children in transmission is still unclear. As many school districts resumed face-to-face education next month, renewed attention was given to the way children spread the virus. In adults, estimated 20% to 45% of infections are asymptomatic..

COVID-19 infants Carry large amounts of SARS-CoV-2 in the upper respiratory tract It indicates that they may be more important drivers of viral spread than adults.

However, it is unclear whether high viral load correlates with child severity or withdrawal over a longer period, says Roberta L. DeBiasi, MD, MS and Meghan Delaney, DO, MPH at Children’s National Hospital in Washington, DC. Commented. of Accompanying editorial..

Anyway, the small number of cases originally reported in children was suspected not because they were uninfected, but because they were asymptomatic or mild and had not been tested. , Thomas A. Russo, MD commented. University of Buffalo who was not involved in this study.

“When kids get back to school, they get more cases when they get infected and take them home,” Russo said. MedPage today. “Just because the kids come back from school and feel great, doesn’t mean they don’t spread the virus.”

Kim et al. estimated that 93% of infections in children would have been missed if only symptomatic cases were examined. Asymptomatic children experienced a median of 3 days of symptoms before being diagnosed, which is significantly different (1-28 days), with only 7% of children being positive at the onset of symptoms. That was the case, Kim and co-authors reported.

“A surveillance strategy that tests only symptomatic children will fail to identify those who are quietly shedding the virus while roaming the community or school,” Deviaci and Delaney wrote.

Earlier this week, CDC Changed COVID-19 Testing Guidelines It is currently stated that intimate, asymptomatic close contact of infected individuals “does not necessarily require testing” unless recommended by the provider or local health authorities.

In contrast, Korean public health support allows for extensive testing, contact tracking, and quarantine. Children who come in contact with a confirmed or suspected COVID are quarantined in a medical facility.

The current study included a cohort of children who tested positive during observation and were tested at median 3 day intervals. Cohorts-median age of 11, 58% of boys-most commonly infected with home contact (63%), then travel (17%), cluster-related infections (12%), external separate. Infections that were imported through contact with continued social circles (4%), or unknown routes (4%). Three children had asthma and three had epilepsy, but no other comorbidities or immunodeficiencies have been reported.

The most common symptoms experienced by children were fever (69%), respiratory symptoms (60%), gastrointestinal symptoms (18%), and loss of smell and taste (16%). Only 12 children were treated, most commonly using lopinavir ritonavir (caretra) or hydroxychloroquine, and none needed mechanical ventilation.

The median duration of symptoms was 13 days, but this also fluctuated significantly, with some children showing symptoms for 5 weeks. Children with presymptomatic symptoms at diagnosis had a median duration of symptoms of 3.5 days, whereas children with new symptoms at diagnosis had a median duration of 6.5 days. Symptoms lasted 13 days, with a median of presymptomatic children.

There was no significant difference in duration of symptoms between children with upper respiratory tract infections and children with mild or moderate lower respiratory tract infections.

The latter finding “indicates that even children with mild to moderately affected children may have long-lasting symptoms,” De Biasi and Delaney wrote.

This study had all the limitations of the tests available. DeBiasi and Delaney found that some patients tested negative on one platform and positive on the next, and whether testing elsewhere in the respiratory tract or on another staff would return a positive test. It could affect somehow.

SARS-CoV-2 has also been detected in other body fluids, including stool, for extended periods of time, but has not been measured in this study.