Results
In the study period, 26,819 upper respiratory tract swabs were performed at RCH, of which 179 (0.68%) were SARS-CoV-2[+] (44% female, median age 3.5 yrs). They were matched to 391 SARS-CoV-2[-] children (42% female, median age 3.7 years). Of the children with PCR-confirmed SARS-CoV-2 infection, 16/179 (8.9%) had a previously documented cardiorespiratory co-morbidity. Samples from the SARS-CoV-2[+] and SARS-CoV-2[-] cohorts were obtained from outpatient services (87.6% vs 81.7%) and inpatient services (12.4% vs 18.3%). Overall, SARS-CoV-2[+] children were no more likely than SARS-CoV-2[-] children to report a history of any cardiac or respiratory disease (figure 1). Similar rates of asthma (5.0% vs 4.4%; p = 0.718), CHD (3.4% vs 1.8%; p = 0.246) and OSA (2.2% vs 2.3%; p = 0.817) were observed between groups. No patient with BPD, CF PCD, ILD, bronchiectasis or neuromuscular weakness presented with SARS-CoV-2 infection. Amongst the SARS-CoV-2[+] group with a current diagnosis of asthma, two children (n=2/179; 1.1%) were receiving inhaled corticosteroid therapy at the time of sampling, compared to three (n=3/391, 0.8%;) with asthma receiving therapy in the SARS-CoV-2[-] group. 115/179 (64.2%) reported symptoms compared to 226/391 (57.8%) in the SARS-CoV-2[-] group. Rates of symptomatic infection observed in the SARS-CoV-2[+] cohort were similar amongst children with and without cardiac and/or respiratory comorbidities (60% vs 55.2%, p = 0.879). All asymptomatic infection in the SARS-CoV-2[+] group occurred in children undergoing contact tracing or mandatory testing of international arrivals as part of the state wide public health response.
Approximately one in ten (n=21/179; 11.7%) SARS-CoV-2[+] children were subsequently hospitalised as a result of their infection, with six (28.6%) having a history of any cardiac and/or respiratory disease (4 had CHD requiring previous surgical intervention, 1 had atrial septal defect that did not require surgical intervention as well as asthma and 1 had only asthma). Two of these children were admitted for deteriorating respiratory symptoms and four were admitted for observation. No cases of surgically corrected CHD were reported among the SARS-CoV-2[-] group.
Most hospitalised children had mild respiratory symptoms and were admitted for observation, feeding support or for reasons unrelated to SARS-CoV-2 infection. Three had severe disease requiring respiratory intervention; one had severe COVID-19 (with comorbid complex congenital heart disease), one had paediatric multi-system inflammatory syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) and one a Kawasaki’s disease like presentation temporally associated with SARS-CoV-2.