Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York | Infectious Diseases | JAMA Pediatrics | JAMA Network
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    1 Comment for this article
    Sickle cell trait as possible COVID-19 risk factor
    Jody Lanard, MD | Retired pediatrician. Advisor to WHO on outbreak communication, 2003-2016.
    In your June 3 article "Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York" you write:

    "One previously healthy child who required mechanical ventilation was found on whole-exome sequencing to be heterozygous for a variant of uncertain significance; further workup is ongoing."

    I would be very interested in what this variant is. I am also interested in whether you or others have looked into what percentage of hospitalized and ICU COVID-19 patients are positive for sickle cell trait -- in other words, is
    the trait a risk factor for more severe COVID-19 disease?

    Given the over-representation of severe cases in African-origin persons, and the obvious attribution to social determinants of health, I worry that we are missing something that is more immediately actionable in terms of protecting vulnerable people.

    Jody Lanard MD, Brooklyn
    Original Investigation
    June 3, 2020

    Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York

    Author Affiliations
    • 1Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
    • 2Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York
    • 3Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
    JAMA Pediatr. 2020;174(10):e202430. doi:10.1001/jamapediatrics.2020.2430
    Key Points

    Question  What are the clinical manifestations of children and adolescents hospitalized with coronavirus disease 2019 (COVID-19)?

    Findings  In this case series of 50 children and adolescents hospitalized with COVID-19 infection, respiratory symptoms, while common, were not always present. Children hospitalized with COVID-19 commonly had comorbidities, infants had less severe disease, those with obesity were likely to receive mechanical ventilation, and elevated markers of inflammation at admission and during hospitalization were associated with severe disease.

    Meaning  Expanded testing, maintaining a high suspicion for severe acute respiratory syndrome coronavirus 2 infection given the variable presentation of COVID-19, risk stratification, and recognition of findings suggestive of immune dysregulation are crucial to effective COVID-19 management in children.


    Importance  Descriptions of the coronavirus disease 2019 (COVID-19) experience in pediatrics will help inform clinical practices and infection prevention and control for pediatric facilities.

    Objective  To describe the epidemiology, clinical, and laboratory features of patients with COVID-19 hospitalized at a children’s hospital and to compare these parameters between patients hospitalized with and without severe disease.

    Design, Setting, and Participants  This retrospective review of electronic medical records from a tertiary care academically affiliated children’s hospital in New York City, New York, included hospitalized children and adolescents (≤21 years) who were tested based on suspicion for COVID-19 between March 1 to April 15, 2020, and had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

    Exposures  Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription–polymerase chain reaction assay.

    Main Outcomes and Measures  Severe disease as defined by the requirement for mechanical ventilation.

    Results  Among 50 patients, 27 (54%) were boys and 25 (50%) were Hispanic. The median days from onset of symptoms to admission was 2 days (interquartile range, 1-5 days). Most patients (40 [80%]) had fever or respiratory symptoms (32 [64%]), but 3 patients (6%) with only gastrointestinal tract presentations were identified. Obesity (11 [22%]) was the most prevalent comorbidity. Respiratory support was required for 16 patients (32%), including 9 patients (18%) who required mechanical ventilation. One patient (2%) died. None of 14 infants and 1 of 8 immunocompromised patients had severe disease. Obesity was significantly associated with mechanical ventilation in children 2 years or older (6 of 9 [67%] vs 5 of 25 [20%]; P = .03). Lymphopenia was commonly observed at admission (36 [72%]) but did not differ significantly between those with and without severe disease. Those with severe disease had significantly higher C-reactive protein (median, 8.978 mg/dL [to convert to milligrams per liter, multiply by 10] vs 0.64 mg/dL) and procalcitonin levels (median, 0.31 ng/mL vs 0.17 ng/mL) at admission (P < .001), as well as elevated peak interleukin 6, ferritin, and D-dimer levels during hospitalization. Hydroxychloroquine was administered to 15 patients (30%) but could not be completed for 3. Prolonged test positivity (maximum of 27 days) was observed in 4 patients (8%).

    Conclusions and Relevance  In this case series study of children and adolescents hospitalized with COVID-19, the disease had diverse manifestations. Infants and immunocompromised patients were not at increased risk of severe disease. Obesity was significantly associated with disease severity. Elevated inflammatory markers were seen in those with severe disease.