(CN) — Before the fever, before the cough, the first sign of Covid-19 in a child might be a tummy ache.
In research published Monday evening by Frontiers in Pediatrics, scientists detail the cases of five children who tested positive for Covid-19 during treatment at the Tongji Hospital in Wuhan, China.
The novel coronavirus SARS-Cov-2 was first reported to be infecting people connected to an open-air seafood market this past December. To date, the virus has infected over 4.1 million people worldwide, taking the lives of over 285,000 according to the Johns Hopkins Coronavirus Resource Center. Around the world, medical professionals race to outpace the spread of the virus with better treatment.
The disease disproportionately claims the lives of the elderly and patients with pre-existing conditions. In contrast, most infected children exhibit mild symptoms and recover within two weeks. While few children were tested for the disease in the beginning, many children who are hospitalized now are tested, revealing new and important observations about the nature of Covid-19.
From Jan. 23 to Feb. 20, doctors at the Wuhan hospital treated five patients ages 2 months to 5.6 years old who tested positive for SARS-CoV-2, even though they were each hospitalized for other ailments. Only four of the five children had a fever and only one of them coughed at intake.
One of the patients, a 2-month-old baby girl, died on her ninth day in the hospital after undergoing an emergency operation to correct an intussusception — a telescoping of the intestines. Research have yet to confirm whether the cause of her death was Covid-19, her underlying medical condition, or both.
By far the most common symptom of Covid-19 in the children was gastrointestinal distress, including diarrhea and a refusal of food.
Although CT scans reveal pneumonia in the lungs of children, pediatrician at Tongji Hospital, Dr. Wenbin Li said that even then, “children infected with SARS-CoV-2 exhibit relatively mild symptoms and the incidence of infection is lower than in adults.”
Monday’s study adds to a growing body of research suggesting the Covid-19 virus can infect the human gastrointestinal system as well as the lungs, particularly since both systems contain cells with the ACE2 receptor to which the virus binds.
“SARS-CoV-2 might infect patients not only through the respiratory tract in the form of air droplets, but also through the digestive tract by contact or fecal–oral transmission,” Li said in an email. “Children are active and do not pay much attention to hand hygiene. Consequently, the likelihood of infection through the digestive tract by contact or fecal–oral transmission is likely to be significantly greater for children than for adults.”
While researchers continue to test multiple theories as to why children are spared the worst of Covid-19, the exact mechanisms remain unknown. Some point to children’s developing immune systems, others postulate recentness of vaccines may help, or that cell receptors manifest differently in children versus adults.
The children’s legal guardians consented to them being reported in the study. The National Natural Science Foundation of China funded this study, which doctors around the world can learn from.
“We are continuing continually learning about this virus,” said Dr. Tina Cheng, a professor of pediatrics at Johns Hopkins who is following this area of research closely, said by phone. “Children are not just little adults, we often say, they often present with illnesses in different ways than adults do.”
To help protect kids from Covid-19 and other diseases, Cheng said parents should keep up to date on vaccines and, “do things like hand washing, wearing masks out in public, doing the social distance thing to make sure that they don’t get affected as well as their children don’t get affected. The usual things that that they’ve been hearing.”