March 24, 2020
3 min read

COVID-19 spreads, mostly sparing children

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In less than 2 months, the COVID-19 outbreak that originated in Wuhan, China, grew to include dozens of countries on every continent except Antarctica. The United States reported hundreds of cases of the respiratory illness by March, and larger outbreaks were underway in South Korea, Italy and Iran.

“No country should assume it will not get cases. That could be a fatal mistake,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said during a briefing. “Quite literally, this virus does not respect borders. It does not distinguish between races or ethnicities. It has no regard for a country’s GDP or level of development.”

There is no evidence that children are more susceptible than adults to the coronavirus that causes COVID-19, the CDC noted.

“In fact, most confirmed cases of COVID-19 reported from China have occurred in adults,” it said.

According to the CDC, this aligns with what occurred during the past two outbreaks involving novel coronaviruses — SARS and MERS — in which infections among children were relatively uncommon.

Among the initial 425 cases of laboratory-confirmed COVID-19 in Wuhan, few of the patients were children — and none were younger than age 15 years, according to a report in The New England Journal of Medicine. Two other small studies from China reported no evidence of vertical transmission of the coronavirus and no severe outcomes in infected infants who were hospitalized. (Editor’s note: For more on these studies, click here.)

According to the CDC, limited reports from China indicated that children generally present with mild symptoms, including fever, runny nose and cough.

The first U.S. infections and deaths occurred in adults. The first deaths were reported in Washington state at a facility near Seattle — all among hospitalized adults in their 50s with underlying medical conditions.

Early in the outbreak, the CDC tested all U.S. samples from suspected patients. A wider rollout of CDC testing kits was delayed by a problem related to the manufacturing of one of the reagents, which kept labs from being able to verify the test performance, the agency said.

President Donald J. Trump appointed Vice President Mike Pence to lead the U.S. response, to some consternation. Pence was governor of Indiana during a large outbreak of HIV among people who inject drugs and was criticized for not acting fast enough to stop it.

Pence appointed Deborah Birx, MD, U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health, to be the White House’s COVID-19 response coordinator. Birx’s long career includes work in HIV and AIDS immunology research, vaccine research and global health initiatives.


“We consider her extremely well- qualified. She’s a well-respected physician and scientist,” Infectious Diseases Society of America President Thomas File Jr., MD, MSc, FIDSA, told Infectious Diseases in Children, adding that IDSA was “pleased” with the appointment.

Trump’s appointment of Pence came the same day the CDC confirmed the first U.S. case of community-spread COVID-19 in California in a person with no relevant travel history or exposure to another patient with the disease.

“I speculated from the beginning that there was community spread of this coronavirus,” Amesh A. Adalja, MD, senior scholar at Johns Hopkins Center for Health Security, told Infectious Diseases in Children. “The California case just illustrates that community spread is possible and will become more common and that diagnostic testing protocols must be modified.”

In early March, Congress passed, and Trump signed an $8.3 billion emergency funding bill for the response. – by Gerard Gallagher, Caitlyn Stulpin, Eamon Dreisbach and Ken Downey Jr.