Nurşen BELET, Nihan ŞIK, Hatice KARAOĞLU ASRAK, İrem Ceren ERBAŞ, Ayşe ÇAKIL GÜZİN, Durgül YILMAZ, Murat DUMAN, Şilem Özdem ALATAŞ, Ayça Arzu SAYINER, Özgür APPAK

Evaluation of COVID-19 Disease and the Effect of Trends in Intervention Measures: The Pediatric Perspective from a Tertiary Care Hospital in Turkey

Background: COVID-19 is an emerging disease of global public health concern. Aims: To evaluate the epidemiological, clinical, laboratory, and radiologic findings and the clinical outcomes of children who were diagnosed with SARS-CoV-2 by polymerase chain reaction (PCR), and to evaluate the effect of the trends in intervention measures. Study Design: Between April 2, 2020 and January 16, 2021, children aged 0-18 years who had presented at the pediatric emergency department and were diagnosed with confirmed SARS-CoV-2 by PCR were enrolled. Methods: Details on demographics, epidemiologic characteristics, clinical findings, laboratory data, and radiologic investigations, hospital admissions, and prognosis were recorded. According to clinical severity, patients were divided into 5 groups as asymptomatic, mild, moderate, severe, or critical. We classified the outbreak into 3 periods. The first was between April 2, 2020, the date when the first pediatric case of our hospital was detected, and June 1, 2020, when restrictive measures were relaxed. The second period was between June 1, 2020 and November 15, 2020, when restrictive measures were reimplemented. The third period was between November 15, 2020 and January 16, 2021. Results: A total of 600 patients [median age: 10.3 years (IQR: 4.4-15.1); 304 females] were enrolled. Among them, 25.0% were asymptomatic, while the 3 most common symptoms among symptomatic cases were fever, cough, and fatigue. There was contact with a COVID-19 PCRpositive individual in 73.5% of the cases, with 76.6% of those being a household contact. There were 23 (3.9%) moderate, severe, or critical cases in terms of clinical severity. The presence of chronic disease, a pathological physical chest examination, and procalcitonin levels of >0.05 ng/mL were identified as predictors of being moderate, severe, or critical. Twenty-four (4.0%) patients were admitted to the hospital; 14 (2.3%) to the ward and 10 (1.6%) to the pediatric intensive care unit. In the second intervention period, we observed a rapidly increasing number of new cases daily, especially in August. From September, an increase was observed, being particularly marked from October to November 18. Since then, there was a decrease in the daily number of cases. Conclusion: The majority of the cases were asymptomatic or had a mild clinical presentation. The presence of chronic disease, a pathological physical chest examination, and procalcitonin levels of >0.05 ng/mL were identified as predictors of being moderate, severe, or critical in terms of clinical severity. Strict intervention measures seem to be effective in containing the spread of COVID-19.

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1. Paules CI, Marston HD, Fauci AS. Coronavirus infections-more than just the common cold. JAMA. 2020;323(8):707-708. [CrossRef]
2. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265-269. [CrossRef]
3. Demirbilek Y, Pehlivantürk G, Özgüler ZÖ, Alp Meşe E. COVID-19 outbreak control, example of ministry of health of Turkey. Turk J Med Sci. 2020;50;SI- 1(SI-1):489-494. [CrossRef]
4. Posfay-Barbe KM, Wagner N, Gauthey M, et al. COVID-19 children and the dynamics of infection in families. Pediatrics. 2020;146(2):e20201576. [CrossRef]
5. Yılmaz K, Gozupirinççioğlu A, Aktar F, et al. Evaluation of the novel coronavirus disease in Turkish children: Preliminary outcomes. Pediatr Pulmonol. 2020;55(12):3587-3594. [CrossRef]
6. Verma S, Lumba R, Dapul HM, et al. Characteristics of hospitalized children with SARS-CoV-2 in the New York City metropolitan area. Hosp Pediatr. 2021;11(1):71- 78. [CrossRef]
7. European Centre for Disease Prevention and Control. Rapid risk assessment: paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children. https ://ww w.ecd c.eur opa.e u/en/ publi catio ns-da ta/pa ediat ric-i nflam mator y-mul tisys tem-s yndro me-an d-sar s-cov -2-ra pid-r isk-a ssess ment; 2020. Solna, Sweden: ECDC.
8. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS) Student Course Manual. 9th ed. Chicago, IL: American College of Surgeons; 2012.
9. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6):e20200702. [CrossRef]
10. Micallef S, Piscopo TV, Casha R, et al. The first wave of COVID-19 in Malta; a national cross-sectional study. PLOS ONE. 2020;15(10):e0239389. [CrossRef]
11. Maltezou HC, Magaziotou I, Dedoukou X, et al. Children and adolescents with SARS-CoV-2 infection: epidemiology, clinical course and viral loads. Pediatr Infect Dis J. 2020;39(12):e388-e392. [CrossRef]
12. Zhen-Dong Y, Gao-Jun Z, Run-Ming J, et al. Clinical and transmission dynamics characteristics of 406 children with coronavirus disease 2019 in China: a review. J Infect. 2020;81(2):e11-e15. [CrossRef]
13. Jahangir M, Nawaz M, Nanjiani D, Siddiqui MS. Clinical manifestations and outcomes of COVID-19 in the paediatric population: a systematic review. Hong Kong Med J. 2021;27(1):35-45. [CrossRef]
14. Arslan G, Aktürk H, Duman M. Clinical characteristics of pediatric COVID-19 and predictors of PCR positivity. Pediatr Int. 2021. [CrossRef]
15. Mehta NS, Mytton OT, Mullins EWS, et al. SARS-CoV-2 (COVID-19): what do we know about children? A systematic review. Clin Infect Dis. 2020;71(9):2469-2479. [CrossRef]
16. Jiehao C, Jin X, Daojiong L, et al. A case series of children with 2019 novel coronavirus infection: Clinical and epidemiological features. Clin Infect Dis. 2020;71(6):1547- 1551. doi:10.1093/cid/ciaa198.
17. Hoang A, Chorath K, Moreira A, et al. COVID-19 in 7780 pediatric patients: A systematic review. EClinicalmedicine. 2020;24:100433. [CrossRef]
18. Qiao MY, Chen N, Zou X, et al. How to early identify and prevent the SARS-CoV-2 infection in children for families? Front Pediatr. 2020;8:542. [CrossRef]
19. Tiruneh FT. Clinical profile of Covid-19 in children, review of existing literatures. Pediatr Health Med Ther. 2020;11:385-392. [CrossRef]
20. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174(9):868-873. [CrossRef]
21. Panahi L, Amiri M, Pouy S. Clinical characteristics of COVID-19 infection in newborns and pediatrics: A systematic review. Arch Acad Emerg Med. 2020;8(1):e50.
22. Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: An observational cohort study. Lancet Infect Dis. 2020;20(6):689-696. [CrossRef]30198-5)
23. Desai A, Mills A, Delozier S, et al. Pediatric patients with SARS-CoV-2 infection: Clinical characteristics in the United States from a large global health research network. Cureus. 2020;12(9):e10413. [CrossRef]
24. Moutchia J, Pokharel P, Kerri A, Uchai S, Nji M. Clinical laboratory parameters associated with severe or critical novel coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLOS ONE. 2020;15(10):e0239802. [CrossRef]
25. Streng A, Hartmann K, Armann J, Berner R, Liese JG. COVID-19 in hospitalized children and adolescents. Monatsschr Kinderheilkd. 2020:1-12. [CrossRef]
26. Gilliam WS, Malik AA, Shafiq M, et al. COVID-19 transmission in US child care programs. Pediatrics. 2021;147(1):e2020031971. [CrossRef]
27. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. [CrossRef]
28. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177-1179. doi:10.1056/ NEJMc2001737.
29. Yonker LM, Neilan AM, Bartsch Y, et al. Pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Clinical presentation, infectivity, and immune responses. J Pediatr. 2020;227:45-52.e5. [CrossRef]
30. Park YJ, Choe YJ, Park O, et al. Contact tracing during coronavirus disease outbreak, South Korea, 2020. Emerg Infect Dis. 2020;26(10):2465-2468. [CrossRef]