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Hundreds of severe pediatric COVID-19 infections in Wuhan prior to the lockdown
Zhanwei Du
Ciara Nugent
Benjamin J Cowling
Lauren Ancel Meyers
Novel Coronavirus
Acceso Abierto
Atribución-NoComercial-SinDerivadas
10.1101/2020.03.16.20037176
Before January 22, 2020, only one pediatric case of COVID-19 was reported in mainland China. However, a retrospective surveillance study identified six children who had been hospitalized for COVID-19 in one of three central Wuhan hospitals between January 7th and January 15th. Given that Wuhan has over 395 other hospitals, there may have been far more severe pediatric cases than reported. There were six and 43 children out of 336 who tested positive for COVID-19 and influenza, respectively among all pediatric admissions during the 9-day period. By using this ratio in a detailed analysis of influenza surveillance data and COVID-19 epidemic dynamics (see Appendix), we estimate that there were 313 [95% CI: 171-520] children hospitalized for COVID-19 in Wuhan during January 7-15, 2020 (Figure). Under an epidemic doubling time of 7.31 days4, we estimate that there were 1105 [95% CI: 592, 1829] cumulative pediatric COVID-19 hospitalizations prior to the January 23rd lockdown, which far surpasses the 425 confirmed cases reported across all age groups, none of which were children under age 15. Children are strikingly absent from COVID-19 reports and limited data suggest that pediatric infections are overwhelmingly mild5. Thus, our estimates for hundreds of severe pediatric cases likely translates to thousands or even tens of thousands of mildly infected children, suggesting that the force of infection from children may be grossly underestimated and the infection fatality rate overestimated from confirmed case counts alone. This highlights the urgent need for more robust surveillance to gauge the true extent and severity of COVID-19 in all ages. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement We acknowledge grant support from NIH (U01 GM087719). ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All available in open access
Cold Spring Harbor Laboratory Press
2020
Preimpreso
https://www.medrxiv.org/content/10.1101/2020.03.16.20037176v2
Inglés
VIRUS RESPIRATORIOS
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