COVID-19 in children: what did we learn from the first wave?

Published:September 18, 2020DOI:


      A pandemic caused by the novel coronavirus, severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2), has caused high rates of mortality, predominantly in adults. Children are significantly less affected by SARS-CoV-2 with far lower rates of recorded infections in children compared to adults, milder symptoms in the majority of children and very low mortality rates. A suspected late manifestation of the disease, paediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS), has been seen in small numbers of children and has a more severe disease course than acute SARS-CoV-2. The pandemic has meant that children around the world have been kept off school, isolated from their extended family and friends and asked to stay inside. The UK has been declared as being in an economic recession and unemployment rates are increasing. These indirect effects of SARS-CoV-2 are likely to have a significant impact on many children for years to come. Consolidating the knowledge that has accumulated during the first wave of this pandemic is essential for recognising the clinical signs, symptoms and effective treatment strategies for children; identifying children who may be at increased risk of severe SARS-CoV-2 infection; planning the safe delivery of healthcare and non-health related services that are important for childrens' wellbeing; and engaging in, and developing, research to address the things that are not yet known. This article summarises the evidence that has emerged from the early phase of the pandemic and offers an overview for those looking after children or planning services.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Paediatrics and Child Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • ECDP
        2020 (Available from:)
        • van Doremalen N.
        • Bushmaker T.
        • Morris D.H.
        • et al.
        Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.
        N Engl J Med. 2020; 382: 1564-1567
        • Hoffmann M.
        • Kleine-Weber H.
        • Schroeder S.
        • et al.
        SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor.
        Cell. 2020; 181: 271-280 e8
        • England P.H.
        The weekly surveillance report in England.
        Public Health England, 2020
        • Team C.C.-R.
        Coronavirus disease 2019 in children - United States, February 12-April 2, 2020.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 422-426
        • Gudbjartsson D.F.
        • Helgason A.
        • Jonsson H.
        • et al.
        Spread of SARS-CoV-2 in the Icelandic population.
        N Engl J Med. 2020; 382: 2302-2315
        • Rosenberg E.S.
        • Dufort E.M.
        • Blog D.S.
        • et al.
        COVID-19 testing, epidemic features, hospital outcomes, and household prevalence, New York State-March 2020.
        Clin Infect Dis. 2020;
        • Lavezzo E.
        • Franchin E.
        • Ciavarella C.
        • et al.
        Suppression of COVID-19 outbreak in the municipality of Vo, Italy.
        medRxiv. 2020;
        • Docherty A.B.
        • Harrison E.M.
        • Green C.A.
        • et al.
        Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study.
        BMJ. 2020; 369: m1985
        • Swann O.V.
        • Holden K.A.
        • Turtle L.
        • et al.
        Clinical characteristics of children and young people hospitalised with COVID-19 in the United Kingdom: prospective multicentre observational cohort study.
        medRxiv. 2020;
        • Li Y.
        • Wang H.
        • Wang F.
        • et al.
        Comparison of hospitalized patients with pneumonia caused by COVID-19 and influenza A in children under 5 years.
        Int J Infect Dis. 2020; 98: 80-83
        • To K.K.
        • Tsang O.T.
        • Leung W.S.
        • et al.
        Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study.
        Lancet Infect Dis. 2020; 20: 565-574
        • Nickbakhsh S.
        • Mair C.
        • Matthews L.
        • et al.
        Virus-virus interactions impact the population dynamics of influenza and the common cold.
        Proc Natl Acad Sci U S A. 2019;
        • Jia H.P.
        • Look D.C.
        • Shi L.
        • et al.
        ACE2 receptor expression and severe acute respiratory syndrome coronavirus infection depend on differentiation of human airway epithelia.
        J Virol. 2005; 79: 14614-14621
        • Bunyavanich S.
        • Do A.
        • Vicencio A.
        Nasal gene expression of angiotensin-converting enzyme 2 in children and adults.
        JAMA. 2020; 323: 2427-2429
        • Simon A.K.
        • Hollander G.A.
        • McMichael A.
        Evolution of the immune system in humans from infancy to old age.
        Proc Biol Sci. 2015; 28220143085
        • Mateus J.
        • Grifoni A.
        • Tarke A.
        • et al.
        Selective and cross-reactive SARS-CoV-2 T cell epitopes in unexposed humans.
        Science. 2020;
        • Watson J.
        • Whiting P.F.
        • Brush J.E.
        Interpreting a Covid-19 test result.
        BMJ. 2020; 369: m1808
      1. Jefferson Tom, Spencer Elizabeth, Brassey Jon, Heneghan Carl. Viral cultures for COVID-19 infectivity assessment. Systematic review. medRxiv 2020.08.04.20167932.

        • PHE
        COVID-19: laboratory investigations and sample requirements for diagnosis.
        • Wolfel R.
        • Corman V.M.
        • Guggemos W.
        • et al.
        Virological assessment of hospitalized patients with COVID-2019.
        Nature. 2020; 581: 465-469
        • RCPCH
        COVID-19 - Service evaluation and audit on the care needs of children admitted to hospital (England).
        2020 [20/05/2020] (Available from:)
        • Qiu H.
        • Wu J.
        • Hong L.
        • Luo Y.
        • Song Q.
        • Chen D.
        Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study.
        Lancet Infect Dis. 2020;
        • Parri N.
        • Lenge M.
        • Buonsenso D.
        • Coronavirus Infection in Pediatric Emergency Departments Research G.
        Children with Covid-19 in pediatric emergency departments in Italy.
        N Engl J Med. 2020; 383: 187-190
        • Sinha I.P.
        • Kaleem M.
        The role of pulmonary CT scans for children during the COVID-19 pandemic.
        BMC Med. 2020; 18: 171
        • Gotzinger F.
        • Santiago-Garcia B.
        • Noguera-Julian A.
        • et al.
        COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study.
        Lancet Child Adolesc Health. 2020; 4: 653-661
        • Vivanti A.J.
        • Vauloup-Fellous C.
        • Prevot S.
        • et al.
        Transplacental transmission of SARS-CoV-2 infection.
        Nat Commun. 2020; 11: 3572
        • Chambers C.D.
        • Krogstad P.
        • Bertrand K.
        • et al.
        Evaluation of SARS-CoV-2 in breastmilk from 18 infected women.
        medRxiv. 2020;
        • WHO
        Pregnancy, childbirth, breastfeeding and COVID-19.
        2020 (Available from:)
        • Shekerdemian L.S.
        • Mahmood N.R.
        • Wolfe K.K.
        • et al.
        Characteristics and outcomes of children with Coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units.
        JAMA Pediatr. 2020;
        • Boulad F.
        • Kamboj M.
        • Bouvier N.
        • Mauguen A.
        • Kung A.L.
        COVID-19 in children with cancer in New York City.
        JAMA Oncol. 2020;
        • PICANet
        PICANet COVID-19 Report.
        • Group R.C.
        • Horby P.
        • Lim W.S.
        • et al.
        Dexamethasone in hospitalized patients with Covid-19 - Preliminary Report.
        N Engl J Med. 2020;
        • Beigel J.H.
        • Tomashek K.M.
        • Dodd L.E.
        • et al.
        Remdesivir for the treatment of Covid-19 - preliminary report.
        N Engl J Med. 2020;
        • George P.M.
        • Wells A.U.
        • Jenkins R.G.
        Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy.
        Lancet Respir Med. 2020; 8: 807-815
        • Speth M.M.
        • Singer-Cornelius T.
        • Oberle M.
        • Gengler I.
        • Brockmeier S.J.
        • Sedaghat A.R.
        Mood, anxiety and olfactory dysfunction in COVID-19: evidence of central nervous system involvement?.
        Laryngoscope. 2020;
        • Bikdeli B.
        • Madhavan M.V.
        • Jimenez D.
        • et al.
        COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review.
        J Am Coll Cardiol. 2020; 75: 2950-2973
        • Whittaker E.
        • Bamford A.
        • Kenny J.
        • et al.
        Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.
        JAMA. 2020; 324: 259-269
        • Harwood R.
        • Allin B.
        • Jones C.E.
        • et al.
        A national consensus management pathway for Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS): the results of a national Delphi process.
        medRxiv. 2020;
        • Pain C.E.
        • Felsenstein S.
        • Cleary G.
        • et al.
        Novel paediatric presentation of COVID-19 with ARDS and cytokine storm syndrome without respiratory symptoms.
        Lancet Rheumatol. 2020; 2: e376-e379
        • Riollano-Cruz M.
        • Akkoyun E.
        • Briceno-Brito E.
        • et al.
        Multisystem inflammatory syndrome in children (MIS-C) related to COVID-19: a New York City experience.
        J Med Virol. 2020;
        • Davies P.
        • Evans C.
        • Kanthimathinathan H.K.
        • et al.
        Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study.
        Lancet Child Adolesc Health. 2020; 4: 669-677
        • Feldstein L.R.
        • Rose E.B.
        • Horwitz S.M.
        • et al.
        Multisystem inflammatory syndrome in U.S. children and adolescents.
        N Engl J Med. 2020; 383: 334-346
        • WHO
        Situation Report 202.
        • Nagarajan C.
        Impact of COVID-19 on VAWG in Nigeria.
        Department for Internatonal Development, 2020 17/07/2020
        • Bank W.
        Food security and COVID-19.
        • Simba J.
        • Sinha I.
        • Mburugu P.
        • et al.
        Is the effect of COVID-19 on children underestimated in low- and middle- income countries?.
        Acta Paediatr. 2020;
      2. Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic. Interim guiadance. World Health Organization, May 2020 (Available at:)
        • Lin J.
        • Duan J.
        • Tan T.
        • Fu Z.
        • Dai J.
        The isolation period should be longer: lesson from a child infected with SARS-CoV-2 in Chongqing, China.
        Pediatric Pulmonol. 2020; 55: e6-e9
        • NCMD
        Child suicide rates during the COVID-19 pandemic in England: real-time surveillance.
        • Hornby P.
        • Mafham M.
        • Linsell L.
        • et al.
        Effect of hydroxychloroquine in hospitalised patients with COVID-19: preliminary results from a multi-centre, randomised controlled trial.
        medRxiv. 2020;

      Further reading

        • Godfred-Cato S.
        • Bryant B.
        • Leung J.
        • et al.
        COVID-19–Associated multisystem inflammatory syndrome in children — United States, March–July 2020.
        MMWR Morb Mort Weekly Rep. 2020; 69
        • Götzinger F.
        • Santiago-García B.
        • Noguera-Julián A.
        • et al.
        COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study.
        The Lancet Child Adolesc Health. 2020;
        • Group R.C.
        • Horby P.
        • Lim W.S.
        • et al.
        Dexamethasone in hospitalized patients with covid-19 - preliminary report.
        N Engl J Med. 2020;

      Linked Article