key: cord-0899482-9vou06c7 authors: Hon, Kam Lun Ellis; Leung, Karen Ka Yan title: Pediatric COVID-19: what disease is this? date: 2020-06-17 journal: World J Pediatr DOI: 10.1007/s12519-020-00375-z sha: e0f4539aa99d9fccf9b7a271c5bef76328bb1d44 doc_id: 899482 cord_uid: 9vou06c7 nan with SARS 17 years ago, when most of the infected children also had mild clinical manifestations [10, 11] . The Chinese mainland also has reported mortality and morbidity of pediatric COVID-19 cases and has concluded that the disease was generally mild [10, 12] . Mortality is very low in children, and most of the known cases were teenagers [13] [14] [15] [16] . Similarly, low mortality and morbidity among children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or middle east respiratory syndrome coronavirus or SARS-CoV had been observed in the literature [12, 17] . Hence, it is reassuring that children are less likely to be adversely affected by COVID-19. In contrast, mortality appears to be higher in the local adult population at approximately 0.4% and even higher (3.7%) in the US [1, 5, 6] . Reports of children with confirmed COVID-19 in mainland China have described mild cold-like with/without gastrointestinal symptoms and suggest that severe complications (e.g., acute respiratory distress syndrome, septic shock) appear to be uncommon. However, as with other respiratory illnesses, certain populations of children with underlying health conditions may be at increased risk of severe infection. One report stated that the detection of human-CoV alone or in co-infection with rhinovirus-C was independently associated with pediatric intensive care unit admission in young children hospitalized for lower respiratory infection [18] . The virus does not pass from pregnant women to fetuses during pregnancy. It appears that transmission does not include vertical routes, such as amniotic fluid, cord blood, or breast milk [19] . Approved or clinically proven antiviral drugs recommended for COVID-19 in children do not exist. Clinical management includes prompt implementation of recommended infection prevention and control measures in healthcare settings and supportive management of complications [12] . Children should engage in the usual preventive actions to avoid infection, including cleaning hands often using soap and water or alcohol-based hand sanitizer, avoiding contact with others who are sick, and staying up to date on vaccinations, including influenza vaccine. It is still unclear why coronavirus disease is milder in the pediatric population, similar to other respiratory viral illnesses. Mortality and morbidity of coronavirus disease are postulated to be due to the exaggerated cytokine storm that results in selfdestruction of the lung parenchyma and other organ systems [20, 21] . Similar to other respiratory viral diseases, such as the seasonal influenza, two demographic groups seem to have a higher propensity to die from the disease, namely frail elderly people with chronic disease and seemingly healthy adults with exacerbated autoinflammatory responses with cytokine storm syndromes [10, 21, 22] . In contrast, two groups of patients seem to survive epidemics of coronavirus infections with very mild symptoms, namely the children and infants [17] . Our pediatric experience concurs with global data and allows us to reassure anxious parents of the benign nature of coronavirus among children and young people. Nevertheless, from a public health perspective, our current imperative is to contain these imported cases and to prevent onward transmissions, especially from children and young people to the elderly and vulnerable patients with co-morbidities. Coronavirus in mild or asymptomatic adolescent returners, like soldiers in the Trojan Horse, have to be contained. Universal masking, vigilant contact tracing, surveillance programs for testing suspected cases and social distancing are proven effective non-pharmaceutical interventions that are indispensable for containing the epidemic. The global battle against the coronavirus continues. The latest engima associated with pediatric COVID-19 is a novel multisystem inflammatory syndrome (MIS) of hyperinflammation resembling toxic shock syndrome, atypical Kawasaki disease (KD) or the Kawasaki disease shock syndrome (KDSS) [23] [24] [25] [26] [27] . Another novel acronym, PIM-TS is coined which stands for pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 [26] . Although controversial, common respiratory viruses including adenovirus, enterovirus, rhinovirus, coronavirus and respiratory syncytial viral have long been reported to be associated with KD. We postulate that SARS-CoV-2 may behave like any respiratory virus that can occasionally cause MIS, KDSS or the multi-organ dysfunction syndrome so familiar to the intensivists. Perhaps, we do not need another acronym. Author contributions Both authors contributed to the drafting and opinions in this viewpoint article, and approved the final version of the manuscript. Funding None. Ethical approval None for this viewpoint article. Latest situation of cases of COVID-19 Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention Official update of COVID-19 situation in Singapore The updates on COVID-19 in Korea as of Centers for Disease Control and Prevention. 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