To the editor:
Approximately 2% of COVID-19 patients are younger than 20 years
old1. Intrafamilial transmission is the main method of
paediatric infection. The SARS-CoV-2 infection incidence in assessed
paediatric patients increased from 1.6% to 12.3% with increased
screening in Wuhan2,3. Among them,
53%-65% of paediatric patients had pneumonia that required
hospitalization4, 3. The time to
become SARS-CoV-2 PCR negative (TTN) in paediatric patients without
pneumonia was shorter than that of paediatric patients with
pneumonia4. Considering that the virulence of virus
strains may vary between families while it is most likely constant among
family members, analysis of paediatric patient characteristics,
including TTN, in families will extend the understanding of familial
virus infection. We analysed the clinical characteristics of paediatric
patients (aged ≤18 years) and their familial adults (details are
provided in the Supplementary Appendix).
After screening 93 patients, 4 paediatric and 9 adult patients in 4
families treated at the Nanjing Second Hospital from February 2020 to
March 2020 were included (Fig. S1). Most patients were female. The
median ages of the paediatric and adult groups were 10 and 47 years,
respectively. Two families had a Wuhan exposure history. The most
frequent antiviral drugs in paediatric patients were interferon α (4/4)
and lopinavir/ritonavir (3/4). Three paediatric patients and 2 adults
received concurrent antibiotics. Except for one paediatric patient who
received azithromycin because of positive mycoplasma IgM, the other 4
patients (2 patients in each group) were treated with empirical
antibiotics because of aggravated pneumonia. Most patients received
glucocorticoids because of aggravated pneumonia (details in TABLE 1).
The TTN in the paediatric group was longer than that in the adult group,
using the paired t test (median 16.5 days vs. 10.4 days,
P<0.05), while there was no difference between the two groups
for the time to CT finding improvement (P>0.05) (Fig. S2).
This study showed that children with pneumonia need more time to recover
than their familial adults even though children may be less susceptible
to SARS-CoV-2. A large number of children should have been infected and
have pneumonia in the global pandemic situation. As the time to CT
finding improvement was not different between paediatric patients and
their familial adults, children should not receive more frequent CT
scans than adults. Considering our results and the fact that prolonged
viral shedding occurs in the respiratory secretions and faeces of
children5, additional attention should be paid to
paediatric COVID-19 patients with pneumonia.