key: cord-1012578-fx2tuak5
authors: Li, Yuanzhe; Guo, FeiFei; Cao, Yang; Li, LiFeng; Guo, YanJun
title: Insight into COVID‐2019 for pediatricians
date: 2020-03-18
journal: Pediatr Pulmonol
DOI: 10.1002/ppul.24734
sha: dccd4b93ca9b7f91c8c385f81ffb8e8487519879
doc_id: 1012578
cord_uid: fx2tuak5

Since December 2019, patients with unexplained pneumonia have been found in Wuhan City, Hubei Province, China. The pathogen in these cases is a new type of coronavirus. The World Health Organization confirmed this diagnosis and named the pathogen SARSCoV‐2. The disease caused by SARSCoV‐2 is called Corona Virus Disease (COVID‐2019). The virus is highly infectious and pathogenic, causing human‐to‐human transmission. At present, SARSCoV‐2 is still rampant in the world. Zhengzhou City in Henan Province serves as an example, 102 people have been confirmed to be infected with SARSCoV‐2 (at 24:00 on February 5th, 2020), including three children, the youngest is 4 years old. From the perspective of clinical pediatricians as the first line fighting the epidemic, this paper will discuss the clinical characteristics, prevention and control measures, outcomes, diagnosis, and treatment of pediatric cases.

The family genealy of the two kids see (Figure 3 ).

In response to the epidemic, China has launched the first-level response to major public health emergencies. As of 24:00 on February 5th, the National Health Commission has received a total of 28 018 confirmed cases reported. The number of confirmed cases is far more than the total number of confirmed cases of a severe acute respiratory syndrome (SARS) worldwide, which indicates that the infectivity of SARSCoV-2 is higher than that of SARS coronavirus. There have been 3859 severe cases, 563 fatal cases, and more than 110 confirmed cases in children.

The disease is still in progress. 3 SARSCoV-2 is the seventh coronavirus that can infect humans and belongs to the β-coronavirus group. Current research shows that SARSCoV-2 may come from wild animals, but its specific source needs further study. SARSCoV-2 is a new β-coronavirus, and its gene sequence is most similar to that of viruses isolated from bats, According to the current epidemiological data, the infection rate of SARSCoV-2 to children is low. Studies have demonstrated that SARSCoV-2 has a similar binding receptor and binding properties to SARS-CoV, namely the S protein of coronavirus, which is mainly responsible for binding to the receptor protein of the infected host, enabling the virus to invade and infect host cells. Studies have shown that angiotensin-converting-enzyme-2 (ACE2) is the receptor protein of S protein, which provides evidence for human infection of SARSCoV-2. 9, 10 The study 11 analyzed the mononuclear RNA sequencing data of more than 430 000 human lung cells (non-SARSCoV-2 infection), and found that more than 80% of the ACE2 in the lung was distributed on the surface of type II alveolar epithelial cells (AT2). ACE2 is necessary for SARSCoV-2 to enter into cells and may be one of the receptors of SARSCoV-2. The reason for the low susceptibility of children to SARSCoV-2 may be related to the imperfect development and function of ACE2 protein, or the intracellular response induced by ACE2 in alveolar epithelial cells of children is lower than that of adults. In addition, it may also be related to the imperfect innate immune development of children, and the subsequent low level of adaptive immune response. 5 The symptoms of COVID-2019 in children are mild which may be related to a reduce inflammatory response because the immune system in children is less well developed. Epidemiological studies show that 43 of 99 adults infected with SARSCoV-2 have different degrees of abnormal liver function. Further studies showed that the abnormal liver function of the patients infected with SARSCoV-2 may be caused by bile duct cell dysfunction and other reasons, but not related to the direct damage of hepatocytes. 12, 13 In addition, children are susceptible to a variety of viruses, such as influenza viruses, parainfluenza viruses, adenoviruses, respiratory syncytial viruses, and rhinoviruses. Antibodies produced after infection may cross-react with the coronaviruses to provide some protection. Further studies are needed to confirm whether these manifestations lead to differences in the clinical manifestations of children and adults were infected, whether there are still unexplored mechanisms.

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Henan Province Health Committee of the people's Republic of China

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