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| Cincinnati Enquirer
Black, Asian and Hispanic children tested and treated for COVID-19 are doing far worse than other children during the pandemic, according to a comprehensive new analysis by an organization representing seven of the country’s largest pediatric medical centers. The disease also affects poor children and those who suffer the most from diabetes and cancer, according to the analysis.
In addition, the analysis points out that children are less likely to contract the virus than adults. About 1 in 25 children in the study (or 4% of over 135,000 participants) tested positive.
Results from the PEDSnet organization, which includes Cincinnati Children’s Hospital Medical Center and Nationwide Children’s Hospital in Columbus, were published Monday in JAMA Pediatrics. The report is based on data from the electronic medical records of children who were tested for infections with the SARS-CoV-2 virus from January 1 to September 8, 2020.
“These findings are important because they improve our understanding of the impact of COVID-19 in the pediatric population,” said Dr. Nathan Pajor, pulmonary medicine specialist at Cincinnati Children’s and one of the 18 co-authors of the study.
“We see that compared to adults, children are less likely to have serious illness or die from COVID-19,” he said in a press release. “However, we are also noticing disproportionate infection rates among blacks, Asians and Hispanics. Children as a clear target for further study.”
Other PEDSnet centers include the Children’s Hospital of Philadelphia; Colorado Children’s Hospital; Nemours children’s health system; Seattle Children’s Hospital; and St. Louis Children’s Hospital. Together, these centers provide care to approximately 2.5 million children per year.
Highlights of their analysis include:
- Like previous smaller studies, this data shows that children are less likely to test positive and less likely to suffer from serious illness when infected.
- Patients of African American, Hispanic and Asian descent were less likely than white children to be tested. However, they were two to four times more likely to test positive.
- Adolescents and young adults were more likely to test positive than younger children.
- Children covered by Medicaid and other public programs were more likely to test positive than children from private insured families.
- Underlying cancer, diabetes (types 1 and 2) and other immunosuppressive conditions were indicators of an increased risk of serious disease. But children with asthma did not have an increased risk of serious illness.
- Of the 5,374 children who tested positive, about 1 in 14 (or 7%) required hospitalization. Among those hospitalized, 28% required intensive care and 9% mechanical ventilation. Of the children hospitalized, eight died. (That’s a case fatality rate of 0.2%.)
“More study is needed to understand the causes of variations in positivity rates,” Pajor said. “To what extent are the social determinants of risk, such as exposure to air pollution, housing density or the probability of living with a person who must work in person, related? To what extent reflects the differences in the biology of diseases? “
The other Cincinnati Children’s co-author was Janet Zahner, Senior Data Warehouse Analyst.
The study has limits. It did not include some children infected or potentially killed by COVID19 due to the lack of availability of tests. It likely underestimates the true number of asymptomatic infected children across the country and does not take into account the risk these children may have presented to adults in their lifetime. The study also does not provide any insight into the long-term consequences of a new coronavirus infection.
Finally, the study also draws attention to the chaotic nature of the early days of the pandemic and how experts handled one of the most serious complications affecting children.
Early on, children who experienced severe inflammatory heart-damaging reactions were diagnosed with Kawasaki disease, a very rare disease with largely unknown causes. As clinicians noted differences between new and older cases, the diagnosis turned into Kawasaki-like disease. It has since evolved into “childhood multisystem inflammatory syndrome” (MIS-C).
The scan was funded by the Patient-Centered Outcomes Research Institute, a non-profit organization created through the Affordable Care Act (also known as Obamacare).
The PEDSnet data coordination center is based in Philadelphia, but the concept behind PEDSnet, launched in 2014, was a nationwide cooperative effort between its co-founders, says Dr. Tracy Glauser, associate director of the Cincinnati Children’s Research Foundation.
“Part of the challenge of pediatric research is that many of our conditions are rare, so no single institution has enough information to comprehensively tackle certain problems,” Glauser says. “The purpose of PEDSnet has been to find ways for institutions to share data to answer questions that we cannot answer on our own.
Cincinnati Children’s executives have invested years of work in launching several data sharing initiatives, including the Genomics Research and Innovation Network (GRIN) in 2015, becoming the data coordination center for the program. Bench to Bassinet (B2B) for cardiac research in 2016 and being appointed the Rare Disease Clinical Research Network (RDCRN) data coordinator in 2019.
Dr Peter Margolis, who is the Cincinnati Children’s Site Principal Investigator for PEDSnet, is Co-Director of the James M. Anderson Center for Health System Excellence and has extensive experience in building networks for improving the quality of health care. and research.
“PEDSnet provides a national digital architecture that can harness the power of the electronic health record to advance knowledge,” said Margolis. “Without PEDSnet, collecting the information we present today would have taken years.”
Participating medical centers overcame enormous technical challenges to build the tracking system at the start of the pandemic. Now, data can be quickly refreshed to allow for more in-depth analysis as the pandemic continues.
“An effective response to SARS-CoV-2 will require the rapid but robust development of new clinical and public health practices, based on a better understanding of viral and host biology,” the co-authors said in their review . “This knowledge will be essential not only in caring for critically ill patients, but also in building sustainable ways to minimize the disease burden caused by SARS-CoV-2.”
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