The ABCs of COVID-19 in Children

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Joanna Deng
Jasrita Singh
Austin Mardon



Coronavirus Disease 2019 (COVID-19) has become notorious for its transmissibility and virulence among adults and the elderly. However, it is becoming increasingly clear that children are not spared from the grips of this infectious disease. As the six-month anniversary of the pandemic approaches, a notable rise is evident in pediatric COVID-19 cases, particularly severe cases. Yet, coronavirus-related research has been concentrated towards older demographics, the result of which is an insufficient understanding of the disease in children. This makes it more difficult to manage severe pediatric cases in clinical settings. This narrative review presents a summary of COVID-19 literature from a pediatric lens, as it is understood today. It consolidates the range of clinical features observed in child-related cases, evaluates the features unique to pediatric patients and explores the unprecedented spike of multisystem inflammatory conditions coinciding with the pandemic. Regarding the current understanding of COVID-19 in children, three areas requiring further research were identified. First, clinical trials determining the safety and efficacy of remdesivir, and other drug candidates, must be elucidated in pediatric patients. A shift towards larger-scale, multicenter case studies are also needed when examining the poorly understood, child-specific COVID-19 features that have been observed. Further investigation into these features, which include delayed symptoms, prolonged viral presence, and prevalence of asymptomatic cases, may help in achieving a better understanding of the disease pathogenesis in children. Finally, the effectiveness of interventions like aspirin for long-term complications of inflammatory conditions associated with COVID-19, must be established. It is imperative to elucidate the pathogenesis of COVID-19 and gain a better understanding of treatment guidelines for children to manage the mounting rates of infection and cases of increased severity observed in this young demographic.