Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study

The Pediatric COVID-19 Registry in Kuwait: Methodology and Results of Pilot Phase

OBJECTIVE

Establishing a pediatric COVID-19 registry in Kuwait (PCR-Q8) was deemed imperative during the pandemic to study children infected with severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) focusing on mode of presentation, therapeutic interventions, disease severity, and early outcomes. This manuscript describes the rapid establishment of the PCR-Q8 registry showcasing an infrastructure of the development process and presents the results of the pilot phase.

SUBJECT AND METHODS

The registry was developed and implemented using the general key steps from a resource titled "Registries for Evaluating Patient Outcomes: A User's Guide" as a guide for best practice, experience from a previously established pediatric diabetes registry in Kuwait and several other COVID-19 registries developed globally. During the pilot phase, a convenience sample of 120 children was included, of whom 66 (55%) were male.

RESULTS

Experience and expertise from other COVID-19 registries; guidance provided by the World Health Organization; and effective collaboration and cooperation between the stakeholders, study group, and data enterers during these challenging times were critical for the development and implementation of the registry. Our results were similar to international reports which showed that most children presented with mild disease (69.2%), majority (70.2%) had normal chest X-ray, and the most common symptom at presentation was fever (77%).

CONCLUSION

We anticipate the development of PCR-Q8 to be a stepping-stone for more in-depth investigation of SARS-CoV-2 infection in children in Kuwait and for the establishment of other registries.

Multisystem inflammatory syndrome in children related to COVID-19: Data from a Mexican national referral children's hospital

OBJECTIVES

To describe characteristics of patients with the pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS)/multisystem inflammatory syndrome in children (MIS-C) and to identify factors associated with admission to the pediatric intensive care unit (PICU) in the Mexican children without coronavirus disease 2019 (COVID-19) vaccination.

METHODS

This was a cross-sectional study performed at Hospital Infantil de Mexico Federico Gomez, a referral children's hospital in Mexico. The study included all cases that met the criteria for PIMS-TS/MIS-C, unvaccinated, between March 2020 and January 2022. The primary outcome was the admission to PICU. Associations of PICU admission with demographic and clinical variables were estimated using logistic regression analyses.

RESULTS

We identified a total of 90 cases, with a median age of 7.5 years old, 47 (52.2%) girls. A previously healthy status was recorded in 76 (85%) children. All patients had positive PCR, serology test, or COVID-19 exposure. PICU admission was reported in 41 (45.6%) children. No deaths were reported. Patients received as treatment only corticosteroids in 53.3% of the cases. In univariable analyses, baseline factors associated with PICU admission were older age, hypotension or shock, positive PCR test, hypoalbuminemia, elevated procalcitonin, ferritin, and lymphopenia. Age, shock at admission, and hypoalbuminemia remained independently associated in the multivariable analysis adjusted by gender and previously healthy status.

CONCLUSION

We found a high proportion of previously healthy children in patients with PIMS-TS/MIS-C in our center. Critical care attention was received by nearly half of the children. The main treatment used was steroids. Age, shock at admission, and hypoalbuminemia were factors associated with PICU admission.

Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children

We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.

Ethical responsibilities of European children's teams facing the resurgent COVID-19 pandemic

The COrona VIrus Disease 2019 (COVID-19) pandemic is posing an unprecedented challenge to healthcare systems around the globe. Europe has been struggling for 1 year now, and despite some encouraging progress (above all, the beginning of vaccination), the second wave is ongoing. Even though children are less affected than adults, the COVID-19 pandemic-and in particular the measures to counter it-is having a considerable impact on the paediatric healthcare setting. It is, therefore, the duty of paediatric teams in Europe to prepare for the challenges ahead. We wish to contribute to this necessary preparedness in two ways: firstly, by assessing the direct and indirect impact of the pandemic on children and on the paediatric setting; secondly, and more importantly, by identifying the various responsibilities of paediatric healthcare professionals, in light of established ethical principles. Only abiding by these responsibilities will it be possible to ensure that ill children and their families are properly supported even in these difficult times and to grant that decisions about children's healthcare remain morally justified and lawful. What is Known: • The COVID-19 outbreak is posing an unprecedented challenge to healthcare systems around the globe • Despite the children are less affected than adults, the COVID-19 pandemic is having a huge impact also on paediatric setting What is New: • The COVID-19 pandemic lays out specific responsibilities of paediatric professionals towards our pa-tients, society and ourselves • The paediatric teams in Europe should assess the direct and indirect impact of the pandemic on the chil-dren and on the paediatric settings, ensuring consistency between centres and across regions in Europe.

COVID-19 in Children: Where do we Stand?

From the beginning of the coronavirus disease 2019 (COVID-19) pandemic it became evident that children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain mostly asymptomatic or mildly symptomatic. We reviewed the epidemiologic and clinical features of children with SARS-CoV-2 infection. The true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated, as asymptomatic children are less frequently tested. Serologic surveys indicate that half of children tested positive for SARS-CoV-2 report no symptoms. Anosmia/ageusia is not frequent in children but it is the strongest predictor of a positive SARS-CoV-2 test. In general, children with COVID-19 are at lower risk of hospitalization and life-threatening complications. Nevertheless, cases of severe disease or a post-infectious multisystem hyperinflammatory syndrome named multisystem inflammatory syndrome in children (MIS-C) have been described. Rarely children with severe COVID-19 develop neurologic complications. In addition, studies indicate that school closures have a limited impact on SARS-CoV-2 transmission, much less than other social distancing measures. The past months new SARS-CoV-2 variants emerged with higher transmissibility and an increased impact on morbidity and deaths. The role of children in the transmission dynamics of these variants must be elucidated. Lastly, preliminary results from COVID-19 vaccine trials indicate very good efficacy and tolerability in children. Very recently the United States Centers for Disease Control and Prevention and other public health authorities recommend vaccination of children 12 years or older to protect them but mostly to contribute to the achievement of herd immunity.

Pediatric COVID-19 infection in Sulaimaniyah Governorate, Iraq

BACKGROUND

COVID-19 is a severe acute respiratory syndrome caused by SARS-CoV-2.

OBJECTIVE

To study the demographic and clinical presentations of COVID-19 with their types including MIS-C and Kawasaki among children who were admitted to Doctor Jamal Ahmad Rashid Pediatric Teaching Hospital (DJARPTH) at Sulaimaniyah city, Iraq.

PATIENTS AND METHODS

A prospective cohort study was conducted from June to December 2020 in which 50 cases suspected of COVID-19 were enrolled in the study that was admitted at the first visit to the emergency department of DJARPTH and their age ranged between 3 months to 14 years. Then, the collected data were divided into 3 groups: COVID-19, Kawasaki disease (KD), and MIS-C.

RESULTS

The fever was the most common presented symptom in all cases with COVID-19 regardless of the severity. COVID-19 may be presented as KD as well as MIS-C. There is an increase in the number of Kawasaki cases since 2019 by 6.7 fold due to the increased number of COVID-19 cases in children. Death was more related to MIS-C and primary COVID-19 diseases. Most COVID-19 cases presented with pericardial effusion; although coronary involvement and LV dysfunction mostly seen with MIS-C cases.

CONCLUSION

COVID-19 is not uncommon in pediatric patients and it presents as either primary, MIS-C, and KD. Most of the deaths and ICU outcomes were related to MIS-C presentations.

The optimal vaccination strategy to control COVID-19: a modeling study in Wuhan City, China

Background

Reaching optimal vaccination rates is an essential public health strategy to control the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to simulate the optimal vaccination strategy to control the disease by developing an age-specific model based on the current transmission patterns of COVID-19 in Wuhan City, China.

Methods

We collected two indicators of COVID-19, including illness onset data and age of confirmed case in Wuhan City, from December 2, 2019, to March 16, 2020. The reported cases were divided into four age groups: group 1, ≤ 14 years old; group 2, 15 to 44 years old; group 3, 44 to 64 years old; and group 4, ≥ 65 years old. An age-specific susceptible-exposed-symptomatic-asymptomatic-recovered/removed model was developed to estimate the transmissibility and simulate the optimal vaccination strategy. The effective reproduction number (R_eff) was used to estimate the transmission interaction in different age groups.

Results

A total of 47 722 new cases were reported in Wuhan City from December 2, 2019, to March 16, 2020. Before the travel ban of Wuhan City, the highest transmissibility was observed among age group 2 (R_eff = 4.28), followed by group 2 to 3 (R_eff = 2.61), and group 2 to 4 (R_eff = 1.69). China should vaccinate at least 85% of the total population to interrupt transmission. The priority for controlling transmission should be to vaccinate 5% to 8% of individuals in age group 2 per day (ultimately vaccinated 90% of age group 2), followed by 10% of age group 3 per day (ultimately vaccinated 90% age group 3). However, the optimal vaccination strategy for reducing the disease severity identified individuals ≥ 65 years old as a priority group, followed by those 45–64 years old.

Conclusions

Approximately 85% of the total population (nearly 1.2 billion people) should be vaccinated to build an immune barrier in China to safely consider removing border restrictions. Based on these results, we concluded that 90% of adults aged 15–64 years should first be vaccinated to prevent transmission in China.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00922-4.

Intrinsic Kidney Pathology Following COVID-19 Infection in Children and Adolescents: A Systematic Review

Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently been reported in adults since the onset of the global COVID-19 pandemic in December 2019. Gradually, there have been an increased number of COVID-19-associated intrinsic kidney pathologies in children and adolescents reported as well. The pathophysiological mechanisms between COVID-19 and the onset of kidney pathology are not fully known in children; it remains a challenge to distinguish between intrinsic kidney pathologies that were caused directly by COVID-19 viral invasion, and cases which occurred as a result of multisystem inflammatory syndrome due to the infection. This challenge is made more difficult in children, due to the ethical limitations of performing kidney biopsies to reach a biopsy-proven diagnosis. Although previous systematic reviews have summarized the various pathological kidney manifestations that have occurred in adults following acute COVID-19 infection, such reviews have not yet been published for children and adolescents. We describe the results of a systematic review for intrinsic kidney pathology following COVID-19 infection in children and adolescents. Methods: A systematic literature search of published data up until 31 October was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Research articles reporting new-onset or relapsed intrinsic kidney pathology in children or adolescents (≤18 years) following acute COVID-19 infection were included for qualitative review. COVID-19 infection status was defined by a positive result from a RT-PCR, or nuclear antibody testing. Only full-text articles published in the English language were selected for review. Results: Twenty-nine cases from fifteen articles were included in the qualitative synthesis of this systematic review. Nephrotic syndrome, as an umbrella condition, appeared as the most frequently observed presentation (20 cases) with disease remission noted in all cases with steroid treatment. Other cases included numerous glomerulonephritides, such as acute necrotizing glomerulonephritis, MPO vasculitis and collapsing glomerulopathy, and thrombotic microangiopathies, such as aHUS. For patients with transplanted kidneys, T-cell-mediated rejection and mild tubular interstitial infiltration were noted following testing positive for COVID-19. There were no mortalities reported in any of the included cases, although two patients remained dialysis dependent at hospital discharge. Conclusion: This systematic review highlights the various intrinsic pathological kidney manifestations in children and adolescents as a result of acute COVID-19 infection. The clinical timeline and presentation of these cases support the mechanistic hypothesis between COVID-19 infection and the onset of intrinsic kidney pathologies within this context. The progressive introduction of vaccination programs for children and adolescents may hopefully reduce the severity of COVID-19-associated illnesses, and pathological kidney manifestations in this population.

Lung Ultrasound: A Diagnostic Leading Tool for SARS-CoV-2 Pneumonia: A Narrative Review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global pandemic. In this context, lung ultrasound (LUS) has played an important role due to its high diagnostic sensitivity, low costs, simplicity of execution and radiation safeness. Despite computed tomography (CT) being the imaging gold standard, lung ultrasound point of care exam is essential in every situation where CT is not readily available nor applicable. The aim of our review is to highlight the considerable versatility of LUS in diagnosis, framing the therapeutic route and follow-up for SARS-CoV-2 interstitial syndrome.

Innate and Adaptive Immunity Imbalance With Severe COVID-19 Pneumonia in Children and Adults

Introduction: Little is known about the laboratory and radiological characteristics and clinical significance of peripheral immune alterations in patients with coronavirus disease 2019 (COVID-19). This study aims to clarify these aspects in children and adults with COVID-19. Methods: In this consecutive pilot study, COVID-19 patients with the confirmed pneumonia and real-time RT-PCR were recruited prospectively in June 2020. The clinical, chest CT, and laboratory features, such as lymphocyte subpopulations, were analyzed for each individual. Results: Forty confirmed COVID-19 patients, 11 severe children, 12 severe adults, and 17 critical adult patients, besides 20 healthy pediatrics and 14 healthy adults as controls, were enrolled prospectively. Adult patients, especially critical ones, had a much higher prevalence of laboratory and chest CT abnormalities. Data regarding immune cell subsets in children patients, compared with matched controls, had higher CD3+ CD8+ T cells (p = 0.004) and lower CD4+/CD8+ ratio (p = 0.042), while adult patients, compared with matched controls, had lower CD14+ monocytes (p = 0.032). Adult patients were also categorized as experiencing critical or severe illness on admission and, compared with severe patients, had lower total lymphocytes (p < 0.047), CD3+ T-lymphocytes (p < 0.002), and CD3+ CD8+ T cells (p = 0.001) and, on the other hand, had higher CD3+ CD4+ T cells (p = 0.012) and CD4+/CD8+ ratio (p = 0.003). Non survived adults, compared with survived patients, had significantly lower CD3+ T-lymphocyte (p = 0.005). Conclusion: Unlike adult patients, who compared with matched controls and had more comorbidities, higher frequency of severe clinical symptoms, laboratory abnormalities, and immune cells alteration, clinical manifestations of COVID-19 in children (compared with matched controls) were relatively mild, and fewer clinical complications were seen either, perhaps because of a milder inflammatory response following their peripheral innate and adaptive immune cell alteration pattern.

Diagnostic Difficulties in a Case of Fetal Ventricular Tachycardia Associated with Neonatal COVID Infection: Case Report

The clinical course of COVID in the pediatric population is considered to be much milder when compared to adults; however, the occurrence of severe and fatal forms of the disease in children is non-negligible, especially in patients with comorbidities such as prematurity or cardiac disease. We report a case of a newborn with sotalol-controlled fetal ventricular tachycardia, who was postnatally diagnosed with COVID infection. The myocardial injury was sustained on the basis of pericardial effusion, left ventricular dysfunction, rapid progression to coronary artery dilation, and an arrhythmic storm. We believe that, in our case, there is a significant overlap between fetal ventricular tachycardia, associated with impaired left ventricular function, and COVID infection, diagnosed after birth; both factors contribute to the myocardial dysfunction with a fulminant clinical evolution. To our knowledge, this is the first case describing neonatal myocardial dysfunction associated with SARS-CoV infection complicating the clinical course of rare fetal tachyarrhythmia.

The impact of natural disasters on the spread of COVID-19: a geospatial, agent-based epidemiology model

Background

Natural disasters and infectious diseases result in widespread disruption to human health and livelihood. At the scale of a global pandemic, the co-occurrence of natural disasters is inevitable. However, the impact of natural disasters on the spread of COVID-19 has not been extensively evaluated through epidemiological modelling.

Methods

We create an agent-based epidemiology model based on COVID-19 clinical, epidemiological, and geographic data. We first model 35 scenarios with varying natural disaster timing and duration for a COVID-19 outbreak in a theoretical region. We then evaluate the potential effect of an eruption of Vesuvius volcano on the spread of COVID-19 in Campania, Italy.

Results

In a majority of cases, the occurrence of a natural disaster increases the number of disease related fatalities. For a natural disaster fifty days after infection onset, the median increase in fatalities is 2, 59, and 180% for a 2, 14, and 31-day long natural disaster respectively, when compared to the no natural disaster scenario. For the Campania case, the median increase in fatalities is 1.1 and 2.4 additional fatalities per 100,000 for eruptions on day 1 and 100 respectively, and 60.0 additional fatalities per 100,000 for an eruption close to the peak in infections (day 50).

Conclusion

Our results show that the occurrence of a natural disaster in most cases leads to an increase in infection related fatalities, with wide variance in possible outcomes depending on the timing of the natural disaster relative to the peak in infections and the duration of the natural disaster.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12976-021-00151-0.

SARS-CoV-2 signaling pathway map: A functional landscape of molecular mechanisms in COVID-19

Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been declared a pandemic by WHO. The clinical manifestation and disease progression in COVID-19 patients varies from minimal symptoms to severe respiratory issues with multiple organ failure. Understanding the mechanism of SARS-CoV-2 interaction with host cells will provide key insights into the effective molecular targets for the development of novel therapeutics. Recent studies have identified virus-mediated phosphorylation or activation of some major signaling pathways, such as ERK1/2, JNK, p38, PI3K/AKT and NF-κB signaling, that potentially elicit the cytokine storm that serves as a major cause of tissue injuries. Several studies highlight the aggressive inflammatory response particularly 'cytokine storm' in SARS-CoV-2 patients. A depiction of host molecular dynamics triggered by SARS-CoV-2 in the form of a network of signaling molecules will be helpful for COVID-19 research. Therefore, we developed the signaling pathway map of SARS-CoV-2 infection using data mined from the recently published literature. This integrated signaling pathway map of SARS-CoV-2 consists of 326 proteins and 73 reactions. These include information pertaining to 1,629 molecular association events, 30 enzyme catalysis events, 43 activation/inhibition events, and 8,531 gene regulation events. The pathway map is publicly available through WikiPathways: https://www.wikipathways.org/index.php/Pathway:WP5115 .

Cytokine profile in Egyptian children and adolescents with COVID-19 pneumonia: A multicenter study

BACKGROUND

To date, the cytokine profile in children and adolescent with novel coronavirus disease 2019 (COVID-19) has not been reported.

OBJECTIVES

We investigated serum levels of a panel of key cytokines in children and adolescent with COVID-19 pneumonia with a primary focus on "cytokine storm" cytokines such as interleukin (IL)-1β, IL-6, IL-17, IL-2, IL-4, IL-10, interferon (IFN-γ), tumor necrosis factor (TNF)-α, and two chemokines interferon-inducible protein-10 (IP-10) and IL-8. We also studied whether these cytokines could be potential markers for illness severity in COVID-19 pneumonia.

METHODS

Ninety-two symptomatic patients aged less than 18 years with confirmed COVID-19 pneumonia and 100 well-matched healthy controls were included in this multi-center study. For all patients, the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in respiratory fluid specimens was detected by real-time reverse-transcriptase polymerase chain reaction. We measured serum concentrations of studied cytokines by using flow cytometry.

RESULTS

Patients with COVID-19 had significantly higher median IL-1β, IL-6, IL-8, IL-10, IL-17, TNF-α, and IP-10 serum levels than did control children (all p < 0.01). Patients with severe COVID-19 pneumonia had significantly higher median IL-1β, IL-6, and IP-10 serum levels as compared with those with moderate COVID-19 pneumonia; all p < 0.01. ROC analysis revealed that three of the studied markers (IL-6, IL-1β, and IP-10) could predict severe COVID-19 pneumonia cases with the largest AUC for IL-6 of 0.893 (95% confidence interval: 0.84-0.98; p < 0.01).

CONCLUSION

Our study shows that pediatric patients with COVID-19 pneumonia have markedly elevated serum IL-1β, IL-6, IL-8, IL-10, IL-17, TNF-α, and IP-10 levels at the initial phase of the illness indicating a cytokine storm following SARS-CoV-2 infection. Moreover, serum IL-6, IL-1β, and IP-10 concentrations were independent predictors for severe COVID-19 pneumonia.

Viral load and rebound in children with coronavirus disease 2019 during the first outbreak in Daegu city

BACKGROUND

Viral load and shedding duration are highly associated with the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, limited studies have reported on viral load or shedding in children and adolescents infected with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

PURPOSE

This study aimed to investigate the natural course of viral load in asymptomatic or mild pediatric cases.

METHODS

Thirty-one children (<18 years) with confirmed SARS-CoV-2 infection were hospitalized and enrolled in this study. Viral loads were evaluated in nasopharyngeal swab samples using real-time reverse transcription polymerase chain reaction (E, RdRp, N genes). cycle threshold (Ct) values were measured when patients met the clinical criteria to be released from quarantine.

RESULTS

The mean age of the patients was 9.8 years, 18 (58%) had mild disease, and 13 (42%) were asymptomatic. Most children were infected by adult family members, most commonly by their mothers. The most common symptoms were fever and sputum (26%), followed by cough and runny nose. Nine patients (29%) had a high or intermediate viral load (Ct value≤30) when they had no clinical symptoms. Viral load showed no difference between symptomatic and asymptomatic patients. Viral rebounds were found in 15 cases (48%), which contributed to prolonged viral detection. The mean duration of viral detection was 25.6 days. Viral loads were significantly lower in patients with viral rebounds than in those with no rebound (E, P=0.003; RdRp, P=0.01; N, P=0.02).

CONCLUSION

Our study showed that many pediatric patients with coronavirus disease 2019 (COVID-19) experienced viral rebound and showed viral detection for more than 3 weeks. Further studies are needed to investigate the relationship between viral rebound and infectiousness in COVID-19.

SARS-CoV-2 in children with cancer in Brazil: Results of a multicenter national registry

BACKGROUND

Strategies to mitigate the impact of COVID-19 in special populations are complex and challenging. Few studies have addressed the impact of COVID-19 on pediatric patients with cancer in low- and middle-income countries.

METHODS

Multicenter observational cohort study with prospective records and retrospective analyses starting in April 2020 in 21 pediatric oncology centers distributed throughout Brazil.

PARTICIPANTS

Patients under 18 years of age who are infected by the SARS-CoV-2 virus (confirmed diagnosis through reverse transcriptase-polymerase chain reaction [RT-PCR]) while under treatment at pediatric oncology centers. The variables of interest included clinical symptoms, diagnostic and therapeutic measures. The repercussions of SARS-CoV-2 infection on cancer treatment and general prognosis were monitored.

RESULTS

One hundred seventy-nine patients were included (median age 6 [4-13] years, 58% male). Of these, 55.9% had acute leukemia and 34.1% had solid tumors. The presence of SARS-CoV-2 was diagnosed by RT-PCR. Various laboratory markers were analyzed, but showed no correlation with outcome. Children with low or high BMI for age had lower overall survival (71.4% and 82.6%, respectively) than those with age-appropriate BMI (92.7%) (p = .007). The severity of presentation at diagnosis was significantly associated with outcome (p < .001). Overall mortality in the presence of infection was 12.3% (n = 22).

CONCLUSION

In children with cancer and COVID-19, lower BMI was associated with worse prognosis. The mortality in this group of patients (12.3%) was significantly higher than that described in the pediatric population overall (∼1%).

Exploring urban dynamics of crowding with COVID-19 incidence A case study of Mumbai and Bengaluru city in India

Cities are the economic hubs of any country and their production efficiency increases with size and density. However, the rapid spread of COVID-19 in almost all the major cities has raised several questions on the efficacy of urban densification. The objective of this paper is to understand this dynamic interplay between crowding and virus incidence. The research seeks to explain the impact of crowding parameters (population, net and gross density, street crowding, indoor crowding) on the spread of the contagion, together with the confounding explanatory variables (government policies, socioeconomic and environmental characteristics). The study is based on two metropolitan cities of India, namely Mumbai and Bengaluru, which are the hotspots of the infection. At a time when there is a huge debate of compact cities versus sprawling cities, the results are favorable towards densification as the study reveals that other crowding variables have a much higher correlation with the infection transmission than density. In fact, density follows a sub-linear relationship with transmission rate and after a threshold density; the transmission rate is almost independent of the population density. The findings show that contrary to popular belief, dense cities are resilient to pandemics.

Allergy and COVID-19

The first cases of as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in Wuhan, China in December 2019. The World Health Organization declared the global pandemic in March 2020. Coronavirus disease 2019 (COVID-19) showed high rates of mortality in the adult population, whereas a mild course was observed in childhood. Allergic diseases, characterized by a type-2 polarization of the immune system, were considered one of the major risk factor of severe COVID-19. Large amounts of clinical data and expert opinions have been collected since the pandemic outbreak. This review summarizes the latest insights on COVID-19 and allergy.

One-year Review of COVID-19 in the Arab World

The coronavirus disease 2019 (COVID-19) has affected almost every country worldwide, including all 22 Arab countries. To the best of our knowledge, this is the first study to follow the prevalence of COVID-19 in all Arab countries. In this review, we aimed to assess the 12-month prevalence of COVID-19 in Arab countries and to compare these findings with other significantly affected countries. World Health Organization, Worldometer, and Ministries of Health websites were used to search for COVID-19 data in all Arab countries. The period covered started from February 2020 to February 2021. In all Arab countries, the median age of the population was 26.25 years. As of March 01, 2021, the total number of confirmed COVID-19 cases in all Arab countries was 4,259,756. Bahrain, Qatar, Lebanon, Kuwait, and United Arab Emirates had the highest reported number of confirmed COVID-19 cases per million population. The total number of COVID-19 deaths was 72,950, with predominance in Lebanon, followed by Tunisia, Jordan, Palestine, and Iraq. In comparison with the topmost affected countries, and based on both the highest number of confirmed and deaths per million population, Arab countries ranked second last before India, with 9,646 and 165 cases, respectively. Among the Arab countries, Qatar, Bahrain, and Lebanon showed the highest number of recovered, confirmed, and death cases per million populations, respectively. The number of confirmed and death cases among all Arab countries triggered significant worries about morbidity and mortality of COVID-19, respectively. However, the younger population in Arab countries may have contributed to fewer COVID-19 deaths in comparison with the topmost affected countries.

Point-of-Care Diagnostic Tools for Surveillance of SARS-CoV-2 Infections

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a recently emerged and highly contagious virus that causes coronavirus disease 2019 (COVID-19). As of August 24, 2021, there were more than 212 million confirmed COVID-19 cases and nearly 4.4 million deaths reported globally. Early diagnosis and isolation of infected individuals remains one of the most effective public health interventions to control SARS-CoV-2 spread and for effective clinical management of COVID-19 cases. Currently, SARS-CoV-2 infection is diagnosed presumptively based on clinical symptoms and confirmed by detecting the viral RNA in respiratory samples using reverse transcription polymerase chain reaction (RT-PCR). Standard RT-PCR protocols are time consuming, expensive, and technically demanding, which makes them a poor choice for large scale and point-of-care screening in resource-poor settings. Recently developed isothermal nucleic acid amplification tests (iNAAT), antigen and/or serological tests are cost-effective to scale COVID-19 testing at the point-of-care (PoC) and for surveillance activities. This review discusses the development of rapid PoC molecular tools for the detection and surveillance of SARS-CoV-2 infections.

CT presentations of adult and pediatric SARS-CoV-2 patients: A review of early COVID-19 data

OBJECTIVE

Initial COVID-19 reports described a variety of clinical presentations, but lower respiratory abnormalities are most common and chest CT findings differ between adult and pediatric patients. We aim to summarize early CT findings to inform healthcare providers on the frequency of COVID-19 manifestations specific to adult or pediatric patients, and to determine if the sensitivity of CT justifies its use in these populations.

METHODS

PubMed was searched for the presence of the words "CT, imaging, COVID-19" in the title or abstract, and 17 large-scale PubMed and/or Scopus studies and case reports published between January 1, 2020 and April 15, 2020 were selected for data synthesis.

RESULTS

Initial CT scans identified ground-glass opacities and bilateral abnormalities as more frequent in adults (74%, n = 698, and 89%, n = 378, respectively) than children (60%, n = 25, and 37%, n = 46). At 14+ days, CT scans evidenced varied degrees of improvement in adults but no resolution until at least 26 days after the onset of flu-like symptoms. In pediatric patients, a third (n = 9) showed additional small nodular GGOs limited to a single lobe 3-5 days after an initial CT scan.

CONCLUSION

Early adult CT findings suggest the limited use of CT as a supplemental tool in diagnosing COVID-19 in symptomatic adult patients, with a particular focus on identifying right and left lower lobe abnormalities, GGOs, and interlobular septal thickening. Early pediatric CT findings suggest against the use of CT if RT-PCR is available given its significantly lower sensitivity in this population and radiation exposure.

COVID-19: The Cause of the Manifested Cardiovascular Complications During the Pandemic

In the course of human history, we encountered several devastating waves of pandemics, affecting millions of lives globally and now the rapid and progressive spread of the novel SARS-CoV-2, causing Coronavirus disease (COVID-19) has created a worldwide wave of crisis. Profoundly straining national health care systems, it also significantly impacted the global economic stability. With the introduction of COVID-19 measures, mainly driven by immunization drives, casualties due to the virus were reported to decrease considerably. But then comes into play the post-Covid morbidities, along with their short and long-term effects on the elderly and the co-morbid population. Moreover, the pediatric population and the otherwise healthy cohort of the young athletes were also reported being largely affected by the varying amount of post-recovery virus-induced Cardiac manifestations, in the subsequent waves of the pandemic. Therefore, here we thrived to find answers to the seemingly unending series of questions that popped up with the advent of the disease, nevertheless, there still lies a blind spot in understanding the impacts of the disease on the Cardiovascular Health of an individual, even after the clinical recovery. Thus, along with the current data related to the diverse cardiovascular complications due to SARS-COV-2 infection, we suggest long-term ‘Cardiac surveillance' for the COVID-19 recovered individuals.

What you need to know about children's COVID-19: a systematic review

The aim of the systematic review is to describe clinical features of coronavirus disease 2019 (COVID-19) in children with a focus on the possible reasons why children are less susceptible to COVID-19 and whether their immune response works better than adults. The three research questions below were determined. (1) Why do pediatric COVID-19 cases have milder clinical symptoms than adults? (2) What are clinical manifestations, diagnosis, and treatment of COVID-19 in children? (3) How long lasts viral shedding after recovery? We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects, as well as foreign literature with English translations. Extra information and data have been collected from Google Scholar and the American Society for Microbiology. Information on patients' age, comorbidities, methods of treatment, and effects on mortality and morbidity were extracted. It is concluded that children are less susceptible to COVID-19 than adults and that the symptoms in children are less severe than in adults. A low incidence of COVID-19 in children and milder disease than in adults might be attributed to many theories and reasons; however, the mechanisms involved are not fully understood.

Computed tomography findings in 3,557 COVID-19 infected children: a systematic review

Background

Although it was assumed in the early stages of the coronavirus disease 2019 (COVID-19) outbreak that the novel coronavirus infection was uncommon among children, the number of infected children has since been increasing significantly. Real-time polymerase chain reaction (RT-PCR) is the gold standard modality for the diagnosis of COVID-19 infection. In adults, chest CT is performed as an adjunct for identifying suspected COVID-19 cases along with patients' management and follow-up. However, CT findings in COVID-19 children studies have shown a diverse incidence of abnormal CT and finding patterns that made CT scan necessity to have remained controversial. The aim of the present review was to comprehensively determine the imaging findings of chest CT scans of confirmed COVID-19-infected pediatric patients through a systematic review of the available published studies.

Methods

A systematic literature search was performed in the PubMed, Embase, Scopus, and Web of Science core collection databases (four databases including SSCI, SCIE, AHCI, and ESCI) to find original articles containing chest CT findings in children with COVID-19 through May 7, 2021. This review included 81 articles published in English that in total included 3,557 pediatric patients.

Results

This review included 81 articles published in English that in total included 3,557 pediatric patients. Among the total confirmed coronavirus-infected cases (via RT-PCR test), two-thirds had abnormal chest CT findings; among these patients, 549 (37.8%) had bilateral lung involvement, and 475 (32.7%) had unilateral disease. Regarding the types of lung lesions, ground glass opacities were observed in 794 (54.7%) of patients, and consolidation was observed in 10.2%; moreover, halo sign, discrete pulmonary nodules, interstitial abnormalities or reticulations, and vascular thickening shadows were reported in 7.4%, 2.6%, 9.7% and 1.7% of the patients, respectively.

Discussion

This review revealed that chest CT scan manifestations in majority of COVID-19 positive children are mild, so regarding the risk of radiation exposure, it is reasonable to confine CT scan to individual cases that its benefits outweigh the risks.

Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study

BACKGROUND

COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region.

OBJECTIVE

This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19.

METHODS

This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients' demographics, premorbid clinical characteristics, and inpatient hospital courses were examined.

RESULTS

In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3% of children were younger than 1 year. Only 4 (3.6%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms, and none (0%) had severe illness requiring intensive care. Fever (23/111, 20.7%), cough (22/111, 19.8%), and rhinorrhea (17/111, 15.3%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7%), aspartate transaminase (18/111, 22.5%), alkaline phosphatase (29/111, 36.7%), and lactate dehydrogenase (31/111, 42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children.

CONCLUSIONS

This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks.

Severe Acute Respiratory Syndrome Coronavirus 2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study

BACKGROUND

Child with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection typically have mild symptoms that do not require medical attention, leaving a gap in our understanding of the spectrum of SARS-CoV-2-related illnesses that the viruses causes in children.

METHODS

We conducted a prospective cohort study of children and adolescents (aged <21 years) with a SARS-CoV-2-infected close contact. We collected nasopharyngeal or nasal swabs at enrollment and tested for SARS-CoV-2 using a real-time polymerase chain reaction assay.

RESULTS

Of 382 children, 293 (77%) were SARS-CoV-2-infected. SARS-CoV-2-infected children were more likely to be Hispanic (P < .0001), less likely to have asthma (P = .005), and more likely to have an infected sibling contact (P = .001) than uninfected children. Children aged 6-13 years were frequently asymptomatic (39%) and had respiratory symptoms less often than younger children (29% vs 48%; P = .01) or adolescents (29% vs 60%; P < .001). Compared with children aged 6-13 years, adolescents more frequently reported influenza-like (61% vs 39%; P < .001) , and gastrointestinal (27% vs 9%; P = .002), and sensory symptoms (42% vs 9%; P < .0001) and had more prolonged illnesses (median [interquartile range] duration: 7 [4-12] vs 4 [3-8] days; P = 0.01). Despite the age-related variability in symptoms, wWe found no difference in nasopharyngeal viral load by age or between symptomatic and asymptomatic children.

CONCLUSIONS

Hispanic ethnicity and an infected sibling close contact are associated with increased SARS-CoV-2 infection risk among children, while asthma is associated with decreased risk. Age-related differences in clinical manifestations of SARS-CoV-2 infection must be considered when evaluating children for coronavirus disease 2019 and in developing screening strategies for schools and childcare settings.

Diagnostic Imaging in Newborns, Children and Adolescents Infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Is There a Realistic Alternative to Lung High-Resolution Computed Tomography (HRCT) and Chest X-Rays? A Systematic Review of the Literature

Chest computed tomography has been frequently used to evaluate patients with potential coronavirus disease 2019 (COVID-19) infection. However, this may be particularly risky for pediatric patients owing to high doses of ionizing radiation. We sought to evaluate COVID-19 imaging options in pediatric patients based on the published literature. We performed an exhaustive literature review focusing on COVID-19 imaging in pediatric patients. We used the search terms "COVID-19," "SARS-CoV2," "coronavirus," "2019-nCoV," "Wuhan virus," "lung ultrasound (LUS)," "sonography," "lung HRCT," "children," "childhood" and "newborn" to query the online databases PubMed, Medical Subject Headings (MeSH), Embase, LitCovid, the World Health Organization COVID-19 database and Medline Bireme. Articles meeting the inclusion criteria were included in the analysis and review. We identified only seven studies using lung ultrasound (LUS) to diagnose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in newborns and children. The studies evaluated small numbers of patients, and only 6% had severe or critical illness associated with COVID-19. LUS showed the presence of B-lines in 50% of patients, sub-pleural consolidation in 43.18%, pleural irregularities in 34.09%, coalescent B-lines and white lung in 25%, pleural effusion in 6.82% and thickening of the pleural line in 4.55%. We found 117 studies describing the use of chest X-ray or chest computed tomography in pediatric patients with COVID-19. The proportion of those who were severely or critically ill was similar to that in the LUS study population. Our review indicates that use of LUS should be encouraged in pediatric patients, who are at highest risk of complications from medical ionizing radiation. Increased use of LUS may be of particularly high impact in under-resourced areas, where access to chest computed tomography may be limited.

Anxiety Levels of Primary Caregivers of Children With Tracheostomy During the COVID-19 Pandemic

We aim to evaluate the anxiety levels of caregivers of children with tracheostomy during the COVID-19 (coronavirus disease 2019) pandemic. Caregivers of 31 children with tracheostomy and 105 healthy children (control group) were included. The State-Trait Anxiety Inventory was administered via teleconference in order to investigate how participants describe how they feel at a particular moment (State) and how they generally feel (Trait). The trait anxiety levels of caregivers of children with tracheostomy were significantly higher (P = .02). Their state anxiety levels were similar. The state and trait anxiety levels of caregivers of children with tracheostomy correlated (r = 0.70, P < .001). At the end of the teleconference, caregivers of children with tracheostomy experienced greater anxiety relief than controls (P < .001). Trait anxiety scores were higher among caregivers of children with tracheostomy, but their state anxiety levels were comparable to those of controls. Caregivers with high trait anxiety also exhibited high state anxiety. Informing caregivers of children with tracheostomy about COVID-19 via teleconference can reduce their anxiety during such stressful times.

Neurologic Manifestations of COVID 19 in Children: Prospective Study in a Single Center

Background:

The data related to the neurologic manifestations of coronavirus disease 2019 (COVID-19) in children are limited. The frequency of the neurologic manifestations and the risk factors in the development of these symptoms are not clear.

Objectives:

We aimed to determine the exact frequency of the neurological symptoms in pediatric patients with confirmed COVID-19 and to identify the risk factors for the development of neurological manifestations.

Materials and Methods:

We included pediatric Covid-19 patients admitted to the Children's Hospital of Ankara City Hospital between March 22 and June 1, 2020. Neurological findings were questioned by interviewing the patients and their families and detailed neurologic examinations were performed within protection measures.

Results:

A total of 312 pediatric patients with the diagnosis of COVID-19 were enrolled in the study. Sixty-six participants (21.15%) showed neurologic symptoms during COVID-19. Headache was the most common neurologic symptom and present in 14% (n: 44) of the cases. The other neurologic symptoms were myalgia (n: 30, 9.6%), anosmia/hyposmia (n: 6, 1.9%), ageusia (n: 2, 0.6%), and vertigo (n: 1, 0.3%). Neutrophil-to-lymphocyte ratio (NLR) (P = 0.002) and platelet-to-lymphocyte ratio (PLR) (P = 0.001) were significantly elevated in patients with neurological symptoms when compared to the patients without the symptoms.

Conclusions:

Physicians should be alert to the neurologic involvement of COVID-19 disease in children. NLR and PLR ratios could have a predictive value for the development of neurological manifestations.

Management and Outcome of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Centre Experience from a Developing Country

INTRODUCTION

Sufficient data pertaining to the impact of the Coronavirus disease 2019 (COVID-19) on pediatric cancer patients is still lacking. The aim of this prospective study was to describe clinical management and outcomes of COVID-19 in pediatric oncology patients.

PATIENTS AND METHODS

Conducted between May 1, 2020 and November 30, 2020, this study included 76 pediatric oncology patients with confirmed COVID-19. Remdesivir (RDV) was the antiviral therapy used.

RESULTS

The median age of patients was 9 years. Sixty patients were on first line treatment. Hematological malignancies constituted 86.8% of patients. Severe to critical infections were 35.4% of patients. The commonest symptom was fever (93.4%). Chemotherapy was delayed in 59.2% of patients and doses were modified in 30.2%. The 60-day overall survival (OS) stood at 86.8%, with mortalities occurring only among critical patients. Of sixteen acute leukemia patients in the first induction therapy, 13 survived and 10 achieved complete remission. A negative RT-PCR within 2 weeks and improvement of radiological findings were statistically related to disease severity (P = .008 and .002, respectively). Better OS was associated with regression of radiological findings after 30 days from infection (P = .002). Forty-five patients received RDV, 42.1% had severe and critical forms of infection compared to 25.7% in the No-RDV group and yet OS was comparable in both groups.

CONCLUSION

Most pediatric cancer patients with COVID-19 should have good clinical outcomes except for patients with critical infections. Cancer patients can tolerate chemotherapy including induction phase, alongside COVID-19 treatment. In severe and critical COVID-19, RDV might have a potential benefit.

A Review on the Role of Stem Cells against SARS-CoV-2 in Children and Pregnant Women

Since the COVID-19 outbreak was acknowledged by the WHO on 30 January 2020, much research has been conducted to unveil various features of the responsible SARS-CoV-2 virus. Different rates of contagion in adults, children, and pregnant women may guide us to understand the underlying infection conditions of COVID-19. In this study, we first provide a review of recent reports of COVID-19 clinical outcomes in children and pregnant women. We then suggest a mechanism that explains the curious case of COVID-19 in children/pregnant women. The unique stem cell molecular signature, as well as the very low expression of angiotensin-converting enzyme 2 and the lower ACE/ACE2 ratio in stem cells of children/pregnant women compared to adults might be the cause of milder symptoms of COVID-19 in them. This study provides the main molecular keys on how stem cells can function properly and exert their immunomodulatory and regenerative effects in COVID-19-infected children/pregnant women, while failing to replicate their role in adults. This can lay the groundwork for both predicting the pattern of spread and severity of the symptoms in a population and designing novel stem cell-based treatment and prevention strategies for COVID-19.

Impact of COVID-19 on Children and Young Adults With Type 2 Diabetes: A Narrative Review With Emphasis on the Potential of Intermittent Fasting as a Preventive Strategy

Background: The world is still struggling to control the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The level of uncertainty regarding the virus is still significantly high. The virus behaves differently in children and young adults. Most children and adolescents are either asymptomatic or have mild symptoms. They generally have a very good prognosis. However, it is not well-known whether children and young adults with type 2 diabetes are at risk of getting a severe infection of COVID-19. Many Muslim children with type 2 diabetes have been performing dawn to dusk fasting during the month of Ramadan, before and during the COVID-19 pandemic, and the impact of this on their health has not been well investigated. Previous studies in adults have suggested that intermittent fasting may be beneficial in different ways including reversal of type 2 diabetes and prevention of COVID-19 infection. Objective: The primary aim of this narrative review is to summarise the impacts of the COVID-19 pandemic on children and young adults with type 2 diabetes, and to identify the knowledge gaps in the literature. It also explores the potential of intermittent fasting in reversing the pathogenesis of diabetes and highlighting how this approach could prevent these patients from developing chronic complications. Methods: This narrative review has been produced by examining several databases, including Google Scholar, Research Gate, PubMed, Cochrane Library, MEDLINE (EBSCO), and Web of Science. The most common search terms used were "COVID-19 AND Children", "SARS-CoV-2 AND/OR Children", "COVID-19 AND Diabetes" "COVID-19 Epidemiology", "COVID-19 AND Ramadan fasting", "COVID-19 and Intermittent fasting." All the resources used are either peer-reviewed articles/reports and/or official websites of various media, governmental and educational organisations. Results: Having reviewed the currently limited evidence, it has been found that the incidence of COVID-19 among children with type 2 diabetes seems to be not much different from children without diabetes. However, these patients are still vulnerable to any infection. Several studies have reported that prevention programmes such as intermittent fasting are effective to protect these groups of patients from developing any complications. Moreover, observing Ramadan fasting as a type of intermittent fasting could be beneficial for some children with established diabetes, prediabetes and people at risk. Conclusion: Children and young adults with type 2 diabetes are not at risk of severe COVID-19 infection as the case in adults with diabetes. More research is needed to identify the impact of COVID-19 and to investigate the efficacy and safety of intermittent fasting, including Ramadan fasting, among these age groups. Implementing these cost-effective programmes may have a great impact in minimising the incidence of diabetes. Moreover, this could be effective particularly at prediabetes stage by preventing these people from going onto develop type 2 diabetes and taking medications for the rest of their life and protecting people from complications linked to disease and infection.

COVID-19 in children: an approach for multisystem inflammatory syndrome

Background and objectives

Children suffering from coronavirus disease (COVID-19) usually present with mild symptoms and show lower mortality rates than adults. However, there have been several recent reports of more severe hyperinflammatory presentation in pediatric COVID-19 patients. This review article aims to summarize the current literature available on the main clinical features and management approaches of multisystem inflammatory syndrome in children (MIS-C).

Methods

The authors searched different indexing databases for observational and interventional studies using search terms including “Coronavirus, COVID-19, pediatric, MIS-C, Kawasaki, and inflammation.” The retrieved publications were further assessed for relevance to the topic. Only relevant articles were included in writing this review article.

Main body

Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome temporally related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in pediatrics. It is characterized by persistent fever, rash, elevated inflammatory markers, and multiorgan failure with increasing rates of cardiovascular and gastrointestinal involvement. The exact pathophysiologic mechanisms of MIS-C are still unknown, but it is postulated to be due to an exaggerated immune response to SARS-CoV-2 infection. Multisystem inflammatory syndrome in children is diagnosed by exclusion of other underlying causes of organ failure. There is a lack of clinical evidence on the management of MIS-C. The current guidelines depend mainly on expert opinion based on the management of other hyper-inflammatory syndromes in children. Patients suffering from MIS-C are treated with intravenous immunoglobulin (IVIg), corticosteroids, infliximab, tocilizumab, and anakinra.

Conclusions

Despite the growing reports on COVID-19 in children, there is still a lot to elucidate on the pathophysiology, diagnosis, and subsequent management of MIS-C. Further trials are needed to investigate new approaches to manage MIS-C. Specific evidence-based guideline for management of MIS-C should be tailored to the current available information on MIS-C.

Factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients: a retrospective cohort study

OBJECTIVE

This study aimed to describe the epidemiological and clinical features and potential factors related to the time to return negative reverse transcriptase (RT)-PCR in discharged paediatric patients with COVID-19.

DESIGN

Retrospective cohort study.

SETTING

Unscheduled admissions to 12 tertiary hospitals in China.

PARTICIPANTS

Two hundred and thirty-three clinical charts of paediatric patients with confirmed diagnosis of COVID-19 admitted from 1 January 2020 to 17 April 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures: factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients.

SECONDARY OUTCOME MEASURES

epidemiological and clinical features and laboratory results in paediatric patients.

RESULTS

The median age of patients in our cohort was 7.50 (IQR: 2.92-12.17) years, and 133 (57.1%) patients were male. 42 (18.0%) patients were evaluated as asymptomatic, while 162 (69.5%) and 25 (10.7%) patients were classified as mild or moderate, respectively. In Cox regression analysis, longer time to negative RT-PCR was associated with the presence of confirmed infection in family members (HR (95% CI): 0.56 (0.41 to 0.79)). Paediatric patients with emesis symptom had a longer time to return negative (HR (95% CI): 0.33 (0.14 to 0.78)). During hospitalisation, the use of traditional Chinese medicine (TCM) and antiviral drugs at the same time is less conducive to return negative than antiviral drugs alone (HR (95% CI): 0.85 (0.64 to 1.13)).

CONCLUSIONS

The mode of transmission might be a critical factor determining the disease severity of COVID-19. Patients with emesis symptom, complications or confirmed infection in family members may have longer healing time than others. However, there were no significant favourable effects from TCM when the patients have received antiviral treatment.

Clusters of SARS-CoV-2 Lineage B.1.1.7 Infection after Vaccination with Adenovirus-Vectored and Inactivated Vaccines

A SARS-CoV-2 B.1.1.7 variant of concern (VOC) has been associated with increased transmissibility, hospitalization, and mortality. This study aimed to explore the factors associated with B.1.1.7 VOC infection in the context of vaccination. On March 2021, we detected SARS-CoV-2 RNA in nasopharyngeal samples from 14 of 22 individuals vaccinated with a single-dose of ChAdOx1 (outbreak A, n = 26), and 22 of 42 of individuals with two doses of the CoronaVac vaccine (outbreak B, n = 52) for breakthrough infection rates for ChAdOx1 of 63.6% and 52.4% for CoronaVac. The outbreaks were caused by two independent clusters of the B.1.1.7 VOC. The serum of PCR-positive symptomatic SARS-CoV-2-infected individuals had ~1.8-3.4-fold more neutralizing capacity against B.1.1.7 compared to the serum of asymptomatic individuals. These data based on exploratory analysis suggest that the B.1.1.7 variant can infect individuals partially immunized with a single dose of an adenovirus-vectored vaccine or fully immunized with two doses of an inactivated vaccine, although the vaccines were able to reduce the risk of severe disease and death caused by this VOC, even in the elderly.

Research Status of SARS-CoV-2 on Cardiovascular System Injury in Children

In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to break out in the Hubei Province of China. At present, the epidemic situation in the world continues and the number of confirmed cases is increasing every day. A recent review showed that children under the age of ten years make up about 1% of the infected population, which cannot be ignored. Studies have shown that after SARS-CoV-2 infection children can show clinical symptoms of cardiovascular system damage in addition to typical respiratory symptoms. This article mainly discusses the possible damage of SARS-CoV-2 to children's cardiovascular system and related mechanisms.

The effect of COVID-19 on the characteristics of adult emergency department visits: A retrospective cohort tertiary hospital experience in Riyadh

Background

On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients’ demographic information, acuity level, length of stay, and admission rate.

Methods

Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19.

Results

The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime.

Conclusion

We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.

Review: Development of SARS-CoV-2 immuno-enhanced COVID-19 vaccines with nano-platform

Vaccination is the most effective way to prevent coronavirus disease 2019 (COVID-19). Vaccine development approaches consist of viral vector vaccines, DNA vaccine, RNA vaccine, live attenuated virus, and recombinant proteins, which elicit a specific immune response. The use of nanoparticles displaying antigen is one of the alternative approaches to conventional vaccines. This is due to the fact that nano-based vaccines are stable, able to target, form images, and offer an opportunity to enhance the immune responses. The diameters of ultrafine nanoparticles are in the range of 1-100 nm. The application of nanotechnology on vaccine design provides precise fabrication of nanomaterials with desirable properties and ability to eliminate undesirable features. To be successful, nanomaterials must be uptaken into the cell, especially into the target and able to modulate cellular functions at the subcellular levels. The advantages of nano-based vaccines are the ability to protect a cargo such as RNA, DNA, protein, or synthesis substance and have enhanced stability in a broad range of pH, ambient temperatures, and humidity for long-term storage. Moreover, nano-based vaccines can be engineered to overcome biological barriers such as nonspecific distribution in order to elicit functions in antigen presenting cells. In this review, we will summarize on the developing COVID-19 vaccine strategies and how the nanotechnology can enhance antigen presentation and strong immunogenicity using advanced technology in nanocarrier to deliver antigens. The discussion about their safe, effective, and affordable vaccines to immunize against COVID-19 will be highlighted.

Positive effects of Lianhuaqingwen granules in COVID-19 patients: A retrospective study of 248 cases

ETHNOPHARMACOLOGICAL RELEVANCE

Lianhuaqingwen (LHQW) is a Chinese medicine, developed from appropriate addition and reduction of combined traditional Chinese medicine (TCM) Yinqiao San and Maxing Shigan decoction. LHQW has been used in routine influenza treatment for decades and plays a role in a broad-spectrum therapy on various influenza viruses.

AIMS OF THE STUDY

The therapeutic effects of LHQW in coronavirus disease 2019 (COVID-19) have not been fully elucidated. A retrospective study was conducted in patients with COVID-19 to evaluate the influence of LHQW on laboratory results related to the disease, and to provide evidence for the clinical practice of TCM.

MATERIALS AND METHODS

We retrospectively collected 248 patients who met the moderate type COVID-19 diagnostic criteria, and received treatment in Tongji Hospital. Patients were divided into control (158 cases, standard treatment) and LHQW treatment (90 cases, standard treatment combined with LHQW) groups according to the different treatments administered. All laboratory data were obtained after 5-7 days' treatment.

RESULTS

In this study, the average patient age was 58.95 years and 131 patients were male. The two groups were comparable in demographic characteristics, symptoms, and treatment. Compared with in the control group, D-dimer and erythrocyte sedimentation rate were significantly lower in the LHQW treatment group (2.47 ± 4.67 vs. 1.68 ± 3.61; 44.47 ± 30.24 vs. 35.39 ± 27.43; both P < 0.05). Lymphocyte counts, albumin and hemoglobin levels were higher in the LHQW treatment group than those in the control group (1.00 ± 0.46 vs. 1.13 ± 0.5; 34.39 ± 5.2 vs. 35.71 ± 4.76; 127.03 ± 16.58 vs. 131.11 ± 14.66; both P < 0.05).

CONCLUSION

The study showed that LHQW significantly improved laboratory results of patients with COVID-19 and could be effectively applied alongside standard treatment of patients with moderate type COVID-19, providing preliminary clinical research evidence for the use of TCM in treatment of this disease.

Diagnosis and Acute Management of COVID-19 and Multisystem Inflammatory Syndrome in Children

ABSTRACT

Most children with coronavirus disease 2019 (COVID-19) infection are asymptomatic or have mild disease. About 5% of infected children will develop severe or critical disease. Rapid identification and treatment are essential for children who are critically ill with signs and symptoms of respiratory failure, septic shock, and multisystem inflammatory syndrome in children. This article is intended for pediatricians, pediatric emergency physicians, and individuals involved in the emergency care of children. It reviews the current epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children, summarizes key aspects of clinical assessment including identification of high-risk patients and manifestations of severe disease, and provides an overview of COVID-19 management in the emergency department based on clinical severity.

Electronic data collection, management and analysis tools used for outbreak response in low- and middle-income countries: a systematic review and stakeholder survey

BACKGROUND

Use of electronic data collection, management and analysis tools to support outbreak response is limited, especially in low income countries. This can hamper timely decision-making during outbreak response. Identifying available tools and assessing their functions in the context of outbreak response would support appropriate selection and use, and likely more timely data-driven decision-making during outbreaks.

METHODS

We conducted a systematic review and a stakeholder survey of the Global Outbreak Alert and Response Network and other partners to identify and describe the use of, and technical characteristics of, electronic data tools used for outbreak response in low- and middle-income countries. Databases included were MEDLINE, EMBASE, Global Health, Web of Science and CINAHL with publications related to tools for outbreak response included from January 2010-May 2020. Software tool websites of identified tools were also reviewed. Inclusion and exclusion criteria were applied and counts, and proportions of data obtained from the review or stakeholder survey were calculated.

RESULTS

We identified 75 electronic tools including for data collection (33/75), management (13/75) and analysis (49/75) based on data from the review and survey. Twenty-eight tools integrated all three functionalities upon collection of additional information from the tool developer websites. The majority were open source, capable of offline data collection and data visualisation. EpiInfo, KoBoCollect and Open Data Kit had the broadest use, including for health promotion, infection prevention and control, and surveillance data capture. Survey participants highlighted harmonisation of data tools as a key challenge in outbreaks and the need for preparedness through training front-line responders on data tools. In partnership with the Global Health Network, we created an online interactive decision-making tool using data derived from the survey and review.

CONCLUSIONS

Many electronic tools are available for data -collection, -management and -analysis in outbreak response, but appropriate tool selection depends on knowledge of tools' functionalities and capabilities. The online decision-making tool created to assist selection of the most appropriate tool(s) for outbreak response helps by matching requirements with functionality. Applying the tool together with harmonisation of data formats, and training of front-line responders outside of epidemic periods can support more timely data-driven decision making in outbreaks.

Computed tomography features of COVID-19 in children: A systematic review and meta-analysis

BACKGROUND

There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes.

OBJECTIVES

To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice.

DATA SOURCES

We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu.

METHODS

Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software.

RESULTS

Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%-70.6%), with a rate of 61.0% (95% CI: 50.8%-71.2%) in China and 67.8% (95% CI: 57.1%-78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%-48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%-67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%-72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae.

CONCLUSIONS

The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.

Serum biochemical parameters as a surrogate marker for chest computed tomography in children with COVID-19

Aim:

This study aimed to investigate whether serum biochemical parameters can be used as a surrogate for chest computed tomography (CT) in the diagnosis of COVID-19 in pediatric patients.

Materials & methods:

We evaluated potential associations between various serum biochemical markers and the COVID-reporting and data system (RADS) pneumonia grading system in 53 individuals with confirmed COVID-19.

Results:

A total of 28 chest CT scans (52.8%) were abnormal. Patients with confirmed COVID-19 on CT showed a statistically significant increase in lactate dehydrogenase (186.4 ± 56.5 vs 228.4 ± 60.6; p = 0.01), which was significantly correlated with the COVID-RADS pneumonia grading system.

Conclusion:

Lactate dehydrogenase can be used as a surrogate marker for chest CT in children with COVID-19. This can reduce exposure to ionizing radiation during initial diagnostic procedures in children with suspected COVID-19 pneumonia.

Clinical overview for pediatric population with SARS-CoV-2 and care: review

OBJECTIVE

To identify in the scientific literature the clinical overview of the pediatric population that tested positive for SARS-CoV-2 and care recommendations and recommendations among children who tested positive for SARS-CoV-2 in the scientific literature.

METHOD

Rapid review based on the guidelines of the Joana Briggs Institute: elaboration of the research question, structured search of the literature in April 2020, in nine databases, selection and critical analysis of the eighteen primary studies (using two instruments to assess methodological quality), elaboration of the synthesis, incorporation of suggestions and dissemination.

RESULT

The most frequent clinical overview was respiratory, gastrointestinal symptoms and fever. The images showed irregular frosted glass opacification. It is recommended to screen the pediatric population and family members who show signs and symptoms and to adopt isolation for more than fourteen days.

CONCLUSION

The clinical overview in pediatric population is varied, not exclusively with respiratory symptoms, and a significant number of asymptomatic patients. The importance of new investigations is highlighted, such as randomized clinical trial or cohort studies, identifying their participation in the transmission of COVID-19.

COVID-19 Infection in Children, Infants and Pregnant Subjects: An Overview of Recent Insights and Therapies

BACKGROUND

The SARS-CoV-2 pandemic has involved a severe increase of cases worldwide in a wide range of populations. The aim of the present investigation was to evaluate recent insights about COVID-19 infection in children, infants and pregnant subjects.

METHODS

a literature overview was performed including clinical trials, in vitro studies, reviews and published guidelines regarding the present paper topic. A descriptive synthesis was performed to evaluate recent insights and the effectiveness of therapies for SARS-CoV-2 infection in children, infants and pregnant subjects.

RESULTS

Insufficient data are available regarding the relationship between COVID-19 and the clinical risk of spontaneous abortion and premature foetus death. A decrease in the incidence of COVID-19 could be correlated to a minor expression of ACE2 in childrens' lungs. At present, a modulation of the dose-effect posology for children and infants is necessary.

CONCLUSIONS

Pregnant vertical transmission has been hypothesised for SARS-CoV-2 infection. Vaccines are necessary to achieve mass immunity for children and also pregnant subjects.

Cutaneous manifestations in children with SARS-CoV-2 infection and/or COVID-19: what do we know after 10 months under this pandemic?

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global crisis. However, cutaneous manifestations in children with SARS-CoV-2 infection have received little attention.

OBJECTIVE

Our study was aimed to present clinical and cutaneous manifestations of children with SARS-CoV-2 and to provide the basis for early diagnosis.

METHODS

We analyzed the clinical data of COVID-19 infected (CI) children worldwide from December 2019 to October 6, 2020, by using search terms "COVID-19," "SARS-CoV-2," "Coronavirus" in combination with "cutaneous," "lesion," "rash," "skin," "dermatology," "epidermis," "dermis," "multisystem inflammatory syndrome." We collected and analyzed the general information, clinical symptoms, cutaneous manifestations, laboratory examination results, history of close contact with CI patients or suspected CI patients, and outcome in CI children.

RESULTS

Among 90 CI children, there were 46 boys (59%) and 32 girls (41%). Erythema was the most frequent lesion, followed by conjunctivitis, and edematous lesions. Face was the most commonly affected location including lips, conjunctivae, tongue, eyes, and eyelids. Sixty-three (73.3%) patients had multisystem inflammatory syndrome (MIS-C). As for clinical symptoms, 70 (81.4%) CI children suffered fever, and 34 (39.5%) patients had lung involvement. Meanwhile, 65.1% of patients had cardiac involvement, 4.7% of patients were asymptomatic, and 71.6% of patients received intravenous immunoglobulin, as well as 31.1% of CI children received systemic corticosteroids. Three children were dead. The most frequent route of infection was familial clustering. As silent virus carriers of CI children, it is important to find out the clinical and cutaneous manifestations in CI children to prevent and control COVID-19 transmission.

Treatment and outcomes of pediatric patients with cancer and COVID-19 at MAHAK pediatric cancer treatment and research center, Tehran, Iran

The COVID-19 pandemic has been particularly devastating for Iran. Children with cancer are generally immunosuppressed and especially vulnerable to SARS-CoV-2 infections. We report the treatment and outcomes of pediatric oncology patients with COVID-19 at the MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC) in Tehran. We enrolled pediatric oncology patients who experienced SARS-CoV-2 infections from March 18, 2020, to January 28, 2021. The COVID-19 diagnostic criteria at MPCTRC were based on imaging and clinical presentation because of specific challenges diagnosing SARS-CoV-2 infections with molecular testing, which was locally developed and conducted at centers other than MPCTRC. We enrolled nine outpatients and eight inpatients (mean age = 9 years), seven of whom had a diagnosis of leukemias, and five who had brain tumors. COVID-19 symptoms were mild in fourteen patients, and three patients were asymptomatic. Of twelve patients who received molecular testing for SARS-CoV-2 infection, eight were negative and four were positive. Of nine patients tested for IgG and IgM antibodies, one was positive. Three patients died of COVID-19, all of whom were hospitalized. Mild COVID-19 symptoms did not appear to affect the outcomes of the pediatric patients with cancer who received treatment at MPCTRC during the study period.

Development of an Early Warning Model for Predicting the Death Risk of Coronavirus Disease 2019 Based on Data Immediately Available on Admission

Introduction: COVID-19 has overloaded worldwide medical facilities, leaving some potentially high-risk patients trapped in outpatient clinics without sufficient treatment. However, there is still a lack of a simple and effective tool to identify these patients early.

Methods: A retrospective cohort study was conducted to develop an early warning model for predicting the death risk of COVID-19. Seventy-five percent of the cases were used to construct the prediction model, and the remaining 25% were used to verify the prediction model based on data immediately available on admission.

Results: From March 1, 2020, to April 16, 2020, a total of 4,711 COVID-19 patients were included in our study. The average age was 63.37 ± 16.70 years, of which 1,148 (24.37%) died. Finally, age, SpO2, body temperature (T), and mean arterial pressure (MAP) were selected for constructing the model by univariate analysis, multivariate analysis, and a review of the literature. We used five common methods for constructing the model and finally found that the full model had the best specificity and higher accuracy. The area under the ROC curve (AUC), specificity, sensitivity, and accuracy of full model in train cohort were, respectively, 0.798 (0.779, 0.816), 0.804, 0.656, and 0.768, and in the validation cohort were, respectively, 0.783 (0.751, 0.815), 0.800, 0.616, and 0.755. Visualization tools of the prediction model included a nomogram and an online dynamic nomogram (https://wanghai.shinyapps.io/dynnomapp/).

Conclusion: We developed a prediction model that might aid in the early identification of COVID-19 patients with a high probability of mortality on admission. However, further research is required to determine whether this tool can be applied for outpatient or home-based COVID-19 patients.

Interferon therapy in patients with SARS, MERS, and COVID-19: A systematic review and meta-analysis of clinical studies

Concern regarding coronavirus (CoV) outbreaks has stayed relevant to global health in the last decades. Emerging COVID-19 infection, caused by the novel SARS-CoV2, is now a pandemic, bringing a substantial burden to human health. Interferon (IFN), combined with other antivirals and various treatments, has been used to treat and prevent MERS-CoV, SARS-CoV, and SARS-CoV2 infections. We aimed to assess the clinical efficacy of IFN-based treatments and combinational therapy with antivirals, corticosteroids, traditional medicine, and other treatments. Major healthcare databases and grey literature were investigated. A three-stage screening was utilized, and included studies were checked against the protocol eligibility criteria. Risk of bias assessment and data extraction were performed, followed by narrative data synthesis. Fifty-five distinct studies of SARS-CoV2, MERS-CoV, and SARS-CoV were spotted. Our narrative synthesis showed a possible benefit in the use of IFN. A good quality cohort showed lower CRP levels in Arbidol (ARB) + IFN group vs. IFN only group. Another study reported a significantly shorter chest X-ray (CXR) resolution in IFN-Alfacon-1 + corticosteroid group compared with the corticosteroid only group in SARS-CoV patients. In a COVID-19 trial, total adverse drug events (ADEs) were much lower in the Favipiravir (FPV) + IFN-α group compared with the LPV/RTV arm (P = 0.001). Also, nausea in patients receiving FPV + IFN-α regimen was significantly lower (P = 0.03). Quantitative analysis of mortality did not show a conclusive effect for IFN/RBV treatment in six moderately heterogeneous MERS-CoV studies (log OR = -0.05, 95% CI: (-0.71,0.62), I2 = 44.71%). A meta-analysis of three COVID-19 studies did not show a conclusive nor meaningful relation between receiving IFN and COVID-19 severity (log OR = -0.44, 95% CI: (-1.13,0.25), I2 = 31.42%). A lack of high-quality cohorts and controlled trials was observed. Evidence suggests the potential efficacy of several combination IFN therapies such as lower ADEs, quicker resolution of CXR, or a decrease in inflammatory cytokines; Still, these options must possibly be further explored before being recommended in public guidelines. For all major CoVs, our results may indicate a lack of a definitive effect of IFN treatment on mortality. We recommend such therapeutics be administered with extreme caution until further investigation uncovers high-quality evidence in favor of IFN or combination therapy with IFN.