key: cord-0930864-b9unqnkb authors: Zhou, Meng-Yao; Xie, Xiao-Li; Peng, Yong-Gang; Wu, Meng-Jun; Deng, Xiao-Zhi; Wu, Ying; Xiong, Li-Jing; Shang, Li-Hong title: From SARS to COVID-19: What we have learned about children infected with COVID-19 date: 2020-05-07 journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases DOI: 10.1016/j.ijid.2020.04.090 sha: d47fd27d9d86a340ef1c1ee2f5987809aea8e172 doc_id: 930864 cord_uid: b9unqnkb Abstract Coronaviruses, both SARS-CoV and SARS-CoV-2 were firstly appeared in China. They have certain similarities in biological, epidemiological and pathological. To data, the researches have shown that their gene exhibit 79% of identical sequence and the receptor-binding domain structure is also very similar. There have been extensive research performed on SARS, however, the understanding of pathophysiology impact of Corona Virus Disease 2019(COVID-19) is still limited. In the review, we draw upon the lessons learnt from SARS in the epidemiology, clinical characteristics and pathogenesis for further understand the features of COVID-19. By comparing these two diseases, we found, COVID-19 has quicker and wider transmission, obvious family agglomeration, higher morbidity and mortality. Newborns, asymptomatic children and normal chest imaging cases were emerged in COVID-19. Children started with gastrointestinal symptoms may progress to severe condition and newborn whose mother was infected with COVID-19 could have severe complications. The laboratory test data showed, the percentage of neutrophils and the level of LDH is higher, otherwise the number of CD4+ and CD8+T cells is decreased in children's COVID-19 cases. Based on these early observations, as pediatrician, we put forward some thoughts on children's COVID-19 and give some recommendations to contain the disease. Children as a special group show different clinical features when compared to adults. Therefore, it has posted a significant challenge for medical community to diagnose and treat children with COVID-19. As a group of pediatrician we reviewed available information and propose the In conclusion, we found COVID-19 has quicker and wider transmission, obvious family agglomeration, higher morbidity and mortality. Digestive tract transmission cannot be ignored and maternal-infant vertical transmission is doubtful. It suggested traditional public measures took on SARS may not enough to contain the epidemic of COVID-19, international collaboration and information resource sharing can help to minimize the size of outbreak and reduce the global deaths. After There was only one death child with SARS in Guangzhou, China, in 2003. The case is a 10 years old male child who had severe hepatitis before 2months ago. He was closely contacted with a doctor who had consulted with a SARS patient. The child had fever and cough in the early time, with the progressively worse condition, he was Therefore, although majority children had mild clinical symptoms and good prognosis, we should not overlook the possibility these children can develop to deleterious serious condition, especially those who has atypical manifestations, basic diseases, long-term use of immune-suppressants and immunocompromised children. There were no newborn's SARS cases reported in China. 3 newborns with COVID-19 were reported. One had fever at the age of 5 days, another one was diagnosed after a home caregiver (first ill) and the mother were diagnosed, the third one was born to pregnant women with suspect CIOVD-19, and the nucleic acid test showed positive after 30h when he was born(Lu Q and Shi 2020). It should pay a great attention that although the low possibility through vertical transmission, the infants whose mother infected with COVID-19 may have adverse reactions, such as fetal distress, preterm delivery, respiratory distress and even death (Chen H et al., 2020) . Multidisciplinary team should make collective effort in perform labor room to improve the newborn survival rate. In general, both of these two diseases had the following characteristics: normal or decreased peripheral blood white blood cells, decreased lymphocytes, mild abnormal In general, the pulmonary image of children infected with SARS and COVID-19 are Long-term follow-up results showed adult with SARS had different degrees of avascular necrosis of the femoral head, lung function impairment and pulmonary fibrosis. The reason of these outcomes may be related to the usage of large does hormones (Xie, 2006) . Many Children infected with SARS were treated with hormones too, but recent report had suggested that available clinical evidence does not support the use of corticosteroid to treat patient infecting with COVID-19 (Russell, 2020) .Therefore, the widely usage of hormones in children infected with COVID-19 remains to be skeptical. Strictly control the criteria to use hormones in clinical work, severe and critical patients can be used for a short time (Yi, 2020). The envelope spiker protein of coronavirus associate with cellular receptors to mediate infection of their target cells and ACE2 is a functional protein of SARS (Li et al., 2003) . SARS-CoV-2 and SARS-CoV have similar receptor-binding domain which suggest that SARS-CoV-2 might also use ACE2 as a cell receptor (Lu R et al., 2020; Zhu et al., 2020). Duan, 2006; .The results suggest that cellular immunity is severely damaged after coronavirus infection. However, the detail mechanisms still need to be investigated. IFNα/β system is a powerful innate immune system with strong antiviral activity. Study had shown that, SARS-CoV not only can block the attack of IFN system, but also actively inhibit the activation of IFN regulator 3 (IRF-3) to prevent the activation of IFN system, and prevent the production of antiviral IFN by the body (Kuri & Weber, 2010). Whether these mechanisms were similar to COVID-19 require additional research. Membrane protein of SARS-CoV can directly bind to Ilapak kinase (IKK), inhibit the activity of nuclear factor kappaB (NF-kappaB) and reduce the expression of cyclooxygenase2 (COX-2) gene and other transcription factors to regulate the body's immune and inflammatory responses (Fang et al., 2007) . The mechanism on COVID-19 still need to be elucidated. There is significant deficit knowledge and unanswered questions on SARS-CoV-2, For example, ACE2 is widely distributed in lung, kidney, intestinal and other tissues, why the lung tissue damaged more frequently? Why children with COVID-19 show mild clinical symptoms? Why children patients with COVID-19 show less change of subtype T-cell level when compared to adults (Duan, 2006) ? Whether there were other pathways entering into the cell？ Although there are many similarities between SARS and COVID-19 from epidemiology to clinical characters they also show differences ( Table 1 ). The potential reasons of higher transmissibility are as following: (1) Currently, limited data are available on children with COVID-19，defining clinical characteristics and severity of the disease is an urgent need especially in those countries lack of pediatric patients data. At present, China has made initial progress in containing the spread of COVID-19, but many countries are still suffering from the disease. In this paper, we summarized the difference and similarities between children's SARS and children's CVOID-19 from epidemiology to clinical characteristics, at the same time, we provide some suggestions on containing children's COVID-19. On the one hand, we hope to draw upon the experience of containing SARS to mitigate the epidemic. On the other hand, we hope our suggestions could help other countries to identify possible preventive and therapeutic strategies. The authors declare that they have no conflict of interest. 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