J Korean Med Sci.  2021 May;36(20):e148. 10.3346/jkms.2021.36.e148.

Characteristics in Pediatric Patients with Coronavirus Disease 2019 in Korea

Affiliations
  • 1Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
  • 2Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  • 3Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
  • 4Department of Pediatrics, Korea University, Seoul, Korea

Abstract

Background
Based on the reports of low prevalence and severity of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, the Korean government has released new SARS-CoV-2 infection response and treatment guidelines for children under the age of 12 years. The government has further directed school reopening under strict preventive measures. However, there is still considerable concern on the impact of school reopening on community transmission of Coronavirus disease 2019 (COVID-19). In the present study, we aimed to evaluate the appropriateness of these directives and the severity of SARS-CoV-2 infections in children as compared to adults using sufficient national sample data.
Methods
In the present study, we evaluated the severity of SARS-CoV-2 infection in pediatric patients as compared to adults by analyzing the length of hospital stays (LOS), medical expenses, and hospital and intensive care unit (ICU) admission rates. A multivariate linear regression analysis was carried out to examine the effects of COVID-19 patients that the characteristics on the LOS and medical expenses, and multivariate logistic regression analysis were performed to identify COVID-19 characteristics that affect hospital and ICU admission rates and to prove the low SARS-CoV-2 infection severity in pediatric patients.
Results
The hospitalization period for children aged 0–9 was 37% shorter and that of patients aged 10–19 years was 31% shorter than those of older age groups (P < 0.001). The analysis of the medical expenses by age showed that on average, medical expenses for children were approximately 4,900 USD lower for children than for patients over 80 years of age. The linear regression analysis also showed that patients who were 0–9 years old spent 87% and those aged 10–19 118% less on medical expenses than those aged 70 and over, even after the correction of other variables (P < 0.001). The probability of hospitalization was the lowest at 10–19 years old (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.03–0.09), and their ICU admission rate was also the lowest at 0.14 (OR, 0.14; 95% CI, 0.08–0.24). On the other hand, the likelihood of hospitalization and ICU admission was the highest in children aged 0–9 years, and among patients under the age of 50 years in general.
Conclusion
This study demonstrated the low severity of SARS-CoV-2 infection in younger patients (0–19 years) by analyzing the LOS, medical expenses, hospital, and intensive care unit admission rates as outcome variables. As the possibility to develop severe infection of coronavirus at the age of 10–19 was the lowest, a mitigation policy is also required for middle and high school students. In addition, children with underlying diseases need to be protected from high-risk infection environments.

Keyword

COVID-19 Pandemic; Pediatric Patient; Severity of Illness; Preventive Measures

Figure

  • Fig. 1 Flow chart for people inclusion and exclusion criteria, and the final sample size.We have had NHIS-COVID DB for 129,120 patients who were enrolled in the National health insurance service and have been treated in Hospital between January 1 and May 30, 2020. Among them, 8,070 were COVID-19 patients, and we selected finally 7,969 COVID-19 patients except for those with no record of medical expenses.COVID-19 = coronavirus disease 2019.


Cited by  1 articles

Complications of the Central Nervous System in Pediatric Patients With Common Cold Coronavirus Infection During 2014–2019
Hwanhee Park, Kyung-Ran Kim, Hee Jae Huh, Yoonsun Yoon, Esther Park, Joongbum Cho, Jiwon Lee, Jeehun Lee, Ji Hye Kim, Yae-Jean Kim
J Korean Med Sci. 2023;38(46):e358.    doi: 10.3346/jkms.2023.38.e358.


Reference

1. Korea Centers for Disease Control and Prevention. The updates on COVID-19 in Korea as of 17 February. Updated 2021. Accessed February 18, 2021. http://ncov.mohw.go.kr/bdBoardList_Real.do?brdId=1&brdGubun=11&ncvContSeq=&contSeq=&board_id=&gubun=.
2. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020; 145(6):e20200702. PMID: 32179660.
Article
3. Wang D, Ju XL, Xie F, Lu Y, Li FY, Huang HH, et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi. 2020; 58(4):269–274. PMID: 32118389.
4. COVID-19 Response Team. Coronavirus disease 2019 in children—United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(14):422–426. PMID: 32271728.
5. Han MS, Choi EH, Chang SH, Jin BL, Lee EJ, Kim BN, et al. Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea. JAMA Pediatr. 2021; 175(1):73–80. PMID: 32857112.
Article
6. Central Disaster Management Headquarters, Central Disease Control Headquarters. Coronavirus-19 [Self-treatment guide]. Cheongju: Korea Centers for Disease Control and Prevention;2020.
7. Macartney K, Quinn HE, Pillsbury AJ, Koirala A, Deng L, Winkler N, et al. Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study. Lancet Child Adolesc Health. 2020; 4(11):807–816. PMID: 32758454.
Article
8. Heavey L, Casey G, Kelly C, Kelly D, McDarby G. No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveill. 2020; 25(21):2000903.
Article
9. Kim EY, Ryu B, Kim EK, Park YJ, Choe YJ, Park HK, et al. Children with COVID-19 after reopening of schools, South Korea. Pediatr Infect Vaccine. 2020; 27(3):180–183.
Article
10. Yonhapnews TV. Opening of schools nationwide... Kindergarten, Elementary 1-2, High School 3 go to school every day. Updated 2021. Accessed March 3, 2021. https://www.yonhapnewstv.co.kr/news/MYH20210302010500038?srt=l&d=Y.
11. National Health Insurance Sharing Service. Secondary National Health Insurance Sharing Service. Updated 2020. Accessed March 3, 2021. https://nhiss.nhis.or.kr/bd/ay/bdaya001iv.do.
12. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011; 173(6):676–682. PMID: 21330339.
Article
13. Pierce CA, Preston-Hurlburt P, Dai Y, Aschner CB, Cheshenko N, Galen B, et al. Immune responses to SARS-CoV-2 infection in hospitalized pediatric and adult patients. Sci Transl Med. 2020; 12(564):eabd5487. PMID: 32958614.
Article
14. Li XZ, Jin F, Zhang JG, Deng YF, Shu W, Qin JM, et al. Treatment of coronavirus disease 2019 in Shandong, China: a cost and affordability analysis. Infect Dis Poverty. 2020; 9(1):78. PMID: 32600426.
Article
15. Bajaj V, Gadi N, Spihlman AP, Wu SC, Choi CH, Moulton VR. Aging, immunity, and COVID-19: how age influences the host immune response to coronavirus infections? Front Physiol. 2021; 11:571416. PMID: 33510644.
Article
16. Lee JK, Kwak BO, Choi JH, Choi EH, Kim JH, Kim DH. Financial burden of hospitalization of children with coronavirus disease 2019 under the national health insurance service in Korea. J Korean Med Sci. 2020; 35(24):e224. PMID: 32567260.
Article
17. CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(12):343–346. PMID: 32214079.
18. Zheng F, Liao C, Fan QH, Chen HB, Zhao XG, Xie ZG, et al. Clinical characteristics of children with coronavirus disease 2019 in Hubei, China. Curr Med Sci. 2020; 40(2):275–280. PMID: 32207032.
Article
19. Mantovani A, Rinaldi E, Zusi C, Beatrice G, Saccomani MD, Dalbeni A. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis. Pediatr Res. 2021; 89(4):733–737. PMID: 32555539.
Article
20. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020; 109(6):1088–1095. PMID: 32202343.
Article
21. Bunyavanich S, Do A, Vicencio A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. JAMA. 2020; 323(23):2427–2429. PMID: 32432657.
Article
22. Schuler BA, Habermann AC, Plosa EJ, Taylor CJ, Jetter C, Negretti NM, et al. Age-determined expression of priming protease TMPRSS2 and localization of SARS-CoV-2 in lung epithelium. J Clin Invest. 2021; 131(1):140766. PMID: 33180746.
Article
23. Lingappan K, Karmouty-Quintana H, Davies J, Akkanti B, Harting MT. Understanding the age divide in COVID-19: why are children overwhelmingly spared? Am J Physiol Lung Cell Mol Physiol. 2020; 319(1):L39–44. PMID: 32491949.
Article
24. UNESCO. COVID-19 impact on education. Updated 2021. Accessed March 10, 2021. https://en.unesco.org/covid19/educationresponse.
25. Goyal MK, Simpson JN, Boyle MD, Badolato GM, Delaney M, McCarter R, et al. Racial and/or ethnic and socioeconomic disparities of SARS-CoV-2 infection among children. Pediatrics. 2020; 146(4):e2020009951. PMID: 32759379.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr