COVID-19 in children and altered inflammatory responses

BACKGROUND The coronavirus disease (COVID-19) pandemic while affecting all age groups appears to be less severe in children. In this journal, we have international contributions relaying experiences from paediatricians across the world. Patients aged <18 years only account for 2% of severely affected patients. However, children can still be vectors if they are asymptomatic and shedding the virus. Dong et al. described a cohort of 2143 children with suspected infection. In 34%, infection was confirmed but there was little critical illness and one death. There appeared to be proportionally more severe illness in infants, a result that could have be confounded by concomitant bronchiolitis. Chen et al. and others have also shown that there is no evidence of vertical transmission in pregnant women, although this possibility may still exist. Possible reason for this disparity in severity between adults and children may relate to differences in receptors in the renin–angiotensin system (RAS) and altered inflammatory responses to pathogens.