key: cord-0845782-555e3ndo
authors: Hildenwall, Helena; Luthander, Joachim; Rhedin, Samuel; Hertting, Olof; Olsson‐Åkefeldt, Selma; Melén, Erik; Alfvén, Tobias; Herlenius, Eric; Ryd Rinder, Malin
title: Paediatric COVID‐19 admissions in a region with open schools during the two first months of the pandemic
date: 2020-06-21
journal: Acta Paediatr
DOI: 10.1111/apa.15432
sha: 49befc1b43b5f4719968c1bb3a8771724552a38a
doc_id: 845782
cord_uid: 555e3ndo

According to the United Nations Educational, Science and Cultural Organization, 194 countries had implemented country‐wide school closures by April 1(st) 2020 in an effort to combat the COVID‐19 pandemic. It’s estimated that those closures affected 91.3% of students across the globe. However, Sweden adopted a different approach to the strict lockdowns imposed elsewhere and day care centres and schools for children up to 15 years of age remained open. The strategy decision to shift schools to distance learning only for children aged 16 years and older was influenced by multiple factors, including the potential impact on school closures on the availability of the healthcare work force, the increasing evidence of mainly mild infections among children and the potential negative consequences of school closures for younger children.

globe. However, Sweden adopted a different approach to the strict lockdowns imposed elsewhere and day care centres and schools for children up to 15 years of age remained open.

The strategy decision to shift schools to distance learning only for children aged 16 years and older was influenced by multiple factors, including the potential impact on school closures on the availability of the healthcare work force, the increasing evidence of mainly mild infections among children and the potential negative consequences of school closures for younger children.

While it appears that most children get mild symptoms if they become infected with the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) (1), there have been concerns that they may present with high viral loads and contribute to asymptomatic transmission (2) . In addition, the number of admissions could exceed the available paediatric hospital care resources (3) . Because many Swedish schools have remained open during the pandemic, there is a unique opportunity to assess the impact of this strategy on the incidence and severity of paediatric admissions.

We carried out a two-month review of paediatric admissions aged 0-17 years who tested positive for SARS-CoV-2 in the Stockholm region, where approximately 514,000 (24%) of all Swedish children live. This covered 13 March, when local transmission was announced, until 14 May. We included children of all age groups to allow for comparison of admissions between children who remained in school and teenagers who were affected by school closures. During the study period, a nasopharyngeal sample was collected from close to all paediatric hospital admissions, regardless of why they had been hospitalised, and these were analysed using real-time reverse transcriptase-polymerase chain reaction assays for the SARS-CoV-2 virus. The patient files were reviewed to identify children who were positive for the virus and to collect data on their background characteristic, the symptoms they presented with, any concurrent illnesses and their outcomes. Ethical approval to conduct the study was obtained from the Central Ethical Research Board in Sweden (EPM #2020-02487) and a waiver of informed consent was provided because of the minimal risk of the study.

A total of 63 admitted children aged 0-17 years tested positive for SARS-CoV-2 during the study period. Thirty had a primary COVID -19 diagnosis, corresponding to 0.7% of all admissions due to COVID -19 in the region. Fourteen children were admitted with another concurrent illness and Accepted Article was a non-infectious cause. The cumulative incidence for hospitalization with a non-incidental diagnosis of COVID -19 among children was nine per 100,000 children. This compares to 230/100,000 hospitalized and 99/100,000 deaths due to Covid-19 amongst the adult population in Stockholm (n≈1.84 million) during the same time period. Table 1 provides an overview of the characteristics of the 63 children. This shows that 39/63 (62%) presented with fever and 32/63 (51%) had respiratory symptoms. We found that four children (6%) required oxygen treatment and one patient with immunosuppression was admitted for intensive care but was never intubated. Infants represented more than half of all symptomatic admissions (16/30, 53%) whereas the proportion of all SARS-CoV-2 positive admitted children Paediatric admissions accounted for a minor part of the total admissions due to COVID-19 as a primary diagnosis during the first two months of the pandemic in Stockholm (30/4347, 0.7%). In line with previous research, most children with a primary diagnosis of COVID-19 were less than one year of age and fever and respiratory symptoms were common, but not universal, symptoms (4).

Overall, our results point toward a low incidence of severe illness due to COVID-19 among 

This article is protected by copyright. All rights reserved Continued assessment of hyperinflammation and other late-onset complications in children is warranted, given that symptoms may present weeks after the acute infection. Results should be considered in relation to the limited evidence regarding the overall benefit of school closures and the potential risks that school closures pose for children who are already vulnerable (5) .

This study did not receive any specific funding.

The authors have no conflicts of interest to declare. 

Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults

An analysis of SARS-CoV-2 viral load by patient age

COVID-19 in Children in the United States: Intensive Care Admissions, Estimated Total Infected, and Projected Numbers of Severe Pediatric Cases in 2020

Clinical Features, and Disease Severity in Patients With Coronavirus Disease

COVID-19, school closures, and child poverty: a social crisis in the making

We thank Dr Berit Hammas, Department of Clinical Microbiology, Karolinska University Hospital for excellent collaboration in data collection of SARS-CoV-2 positive paediatric patients.

This article is protected by copyright. All rights reserved

Accepted Article