Clinical Characteristics

This prospective observational cohort study describes the clinical characteristics of 651 children and adolescents from England, Wales, and Scotland, of which 52 met WHO criteria for MIS-C. In addition to the WHO diagnostic criteria, children with MIS-C were more like to present with fatigue (51% (24/47) vs 28% (86/302);
P=0.004), headache (34% (16/47) vs 10% (26/263); P<0.001), myalgia (34% (15/44) vs 8% (21/270); P<0.001), sore throat (30% (14/47) vs (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) vs 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) vs 11% (38/348); P<0.001) than children who did not have MIS-C.

In a cross-sectional study of 192 children in Boston w/ symptoms concerning for SARS-CoV-2 infection, 26% (n = 49) were diagnosed with COVID-19. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms. Age did not impact viral load (although younger children had lower ACE2 expression, p=0.004), and IgM and IgG to the receptor binding domain of the SARS-CoV-2 spike protein were increased in severe MIS-C (p<0.001)

In a cross-sectional study of 216 children, ocular manifestations of COVID-19 infection were typically mild.  The common ocular manifestations were conjunctival discharge (27 [55.1%]), eye rubbing (19 [38.8%]), and conjunctival congestion (5 [10.2%]). Children with systemic symptoms (29.3% vs 14.0%; difference, 15.3%; 95% CI, 9.8%-20.7%; P = .008) or with cough (31.6% vs 17.5%; difference, 14.1%; 95% CI, 8.0%-20.3%; P = .02) were more likely to develop ocular symptoms.

Case report of COVID-19 reinfection

Testing

Within an analysis of 33,041 asymptomatic children, 250 of them were positive for SARS-CoV-2. Across the combined statistical area, the prevalence varied from 0-2.2%, with a pooled prevalence of 0.65% (95%CI, 0.47% to 0.84%, with significant heterogeneity)

Treatment

In a randomized, open-label, phase 3 trial in individuals aged 12 years and older w/ moderate COVID-19, the day 11 clinical status was significantly better for those randomized to a 5-day course of remdesivir compared to those with standard care. No significant difference in clinical status when given a 10 day course of remdesivir, compared to those with standard care.