Children With COVID-19 Show Different Symptom Pattern, May Shed Virus in Feces

By Gene Emery

March 17, 2020

(Reuters Health) - Another analysis of COVID-19 infections in Chinese children have uncovered evidence that the novel coronavirus can often appear as a less-serious infection and the virus itself can continue to appear in fecal samples long after nose and throat swabs no longer show evidence of an infection.

The findings, based on data from 10 children, suggest how difficult it can be to detect the virus based only on symptoms.

The only reason the 10 were tested was because they were family members of COVID-19 patients or had close contact with people diagnosed with the disease, not because medical care had been sought for them. One, in fact, had no symptoms at all.

"Mild and atypical presentations of the infection in children may make it difficult to detect," said the research team led by Dr. Yi Xu of Guangzhou Women and Children's Medical Center in Guangzhou, China. The study was published online Friday in Nature Medicine.

In all, 745 children were screened and only 1.3% were found to be infected. They ranged in age from 2 months to 15 years and had mild symptoms.

The low ratio follows the pattern described Thursday in The New England Journal of Medicine, where a separate team of Chinese doctors reporting out of Wuhan found only 1.6% of respiratory infections in hospitalized children were COVID-19.

In this latest study, 7 of the 10 children had fever, although it was never over 39 degrees C (102.2 F).

None had the pneumonia that has made the disease so deadly in adults, although CT scans showed that 5 of the 10 had isolated or multiple patchy ground-glass opacities, usually in the outer lung fields.

The headache, muscle aches, nausea, lethargy, labored breathing, vomiting and disorientation that can be seen in the adult version of the illness were all absent in this small group.

Five of the 10 had cough, 4 had a sore throat, 3 had diarrhea and 2 had nasal congestion and rhinorrhea, which can make COVID-19 look like other illnesses.

All the infected children were hospitalized. All were treated with an antiviral alpha-interferon oral spray.

While only 1.3% of the screened children proved to be infected, the rate was 3.5% among 3,174 screened adults who also had close contact with someone who had tested positive.

The researchers cautioned that although the virus was persistently found in the rectal swabs of 8 children even after it has vanished from nose and throat swabs, it's not clear if the virus particles in the feces are infectious.

"Rectal swab-testing may be more useful than nasopharyngeal swab-testing in judging the effectiveness of treatment and determining the timing of termination of quarantine," the researchers said. "However, we do not have evidence of replication-competent virus in fecal swabs, which is required to confirm the potential for fecal-oral transmission."

Data on children with COVID-19 has been hard to come by. An early report on the disease out of China had said that no children had been infected. The newer research is showing why those cases may have been missed.

SOURCE: Nature Medicine, online March 13, 2020.