Symptomatology and outcome of acute COVID-19 illness in children at Faridabad, India

Introduction: The surveillance case definitions for coronavirus disease 2019 (COVID-19) in children adapted from adult guidelines emphasized the presence of fever and/or respiratory symptoms as the criteria for suspicion and testing. The clinical course of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in Indian children is still not well described. Materials and Methods: This observational study was done at a dedicated COVID-19 tertiary care hospital of Haryana, India, between April 1, 2020 and December 31, 2020, with due approval of Institutional Ethics Committee. A total of 86 SARS-CoV-2 positive inpatient children in the age group of 1 month − 12 years were enrolled to outline the clinical course and outcome of acute illness longitudinally over initial 2 weeks of infection. Clinical management and hospital discharge policy was guided by public health authorities and prevailing scientific evidence which were updated and notified time to time as the pandemic evolved. Descriptive statistics were applied to analyze the study variables. Results: Majority children (48/86; 56%) remained asymptomatic throughout 2-week surveillance period, 35 (41%) suffered mild, 2 (2%) moderate, and 1 (1%) severe disease. All children had intact survival. Comorbid condition(s) were present in five (6%) children. Among infants and the subset of children with premorbid condition(s), the proportion of children suffering symptomatic illness (88% and 80%, respectively) and moderate-severe illness (25% and 40%, respectively) was quite high. Respiratory symptoms (68%) and fever (50%) were the most common symptoms. Gastrointestinal symptoms were present in 26% symptomatic children. Fever was the only symptom in 11% children; and 16% children had only gastrointestinal symptoms without any fever or respiratory symptom(s). Conclusion: Acute SARS-CoV-2 infection in children is commonly asymptomatic, or a mild illness with not only respiratory but also non-respiratory manifestations. Thus, a high index of suspicion for SARS-CoV-2 infection is required by the treating physicians in this subgroup of population as they might play an important role in virus transmission and amplification. In case the testing is deferred among asymptomatic contacts or children with mild symptoms, they may be presumed SARS-CoV-2 infected, isolated, and managed accordingly.