key: cord-0952193-c0qj3yd9
authors: Zachariah, Philip; Halabi, Katia C; Johnson, Candace L; Whitter, Susan; Sepulveda, Jorge; Green, Daniel A
title: Symptomatic Infants have Higher Nasopharyngeal SARS-CoV-2 Viral Loads but Less Severe Disease than Older Children
date: 2020-05-20
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa608
sha: 56eefc00f0d9e2f86a4679b31eee12a619050bb6
doc_id: 952193
cord_uid: c0qj3yd9

nan

M a n u s c r i p t 2 Dear editor:

Published data suggest lower rates of severe coronavirus disease 2019 in pediatric age groups [1, 2] . However, the relative contribution of infants and children to community transmission is not known. Data from China suggest that children were infected early in the outbreak [3] . A report published in this journal described the presence of a high nasopharyngeal (NP) viral load of severe acute respiratory coronavirus 2 (SARS-CoV-2) in a well infant [4] . Whether this observation is generalizable to symptomatic infants, and how it compares to NP viral loads in older children and adolescents is not known. Studies in adults have demonstrated a positive correlation between viral load and COVID-19 severity [5] . While some data have suggested a higher disease severity in infants [2, 6] , how NP viral load correlates with severity across the pediatric age spectrum has not been firmly established.

Here we report NP viral load among infants, children and adolescents who were hospitalized and discharged from our children's hospital from March 14 th to April 24 th , 2020. All patients were tested either in the emergency department or during inpatient hospitalization based on symptoms suggestive of COVID-19. For each patient, we extracted age, time from reported symptom onset to the date of test, and severity of disease during hospitalization. Severity of COVID-19 disease was determined by: i) the need for respiratory support with non-invasive positive pressure ventilation and/or mechanical ventilation or, ii) ICU admission. Our report suggests symptomatic infants have higher NP viral loads at presentation but develop less severe disease as compared to older children and adolescents. Whether this is attributable to slightly earlier presentation to clinical care vs.

host biology requires investigation. These data have implications for mitigating spread, especially in congregate settings (e.g. child care centers) or hospital units (e.g. neonatal intensive care units) that serve this group.

Financial Disclosures: There are no financial disclosures to report on any of the authors

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