· The editorial team at JAMA explains their decision to publish the Lenze et al study "Fluvoxamine vs placebo and clinical deterioration in outpatients with symptomatic COVID-19: a randomized clinical trial." While it is a preliminary study with limitations, authors argue it warranted publication due to its design as a placebo-controlled, double-blind randomized clinical trial and the authors' methodological adjustments to conduct study activities without physical contact, such as arranging oxygen and medications deliveries for self-quarantining patients and obtaining consent virtually. The team suggests that the Lenze et al pilot study provides an excellent example of pandemic-appropriate research methods and lays the groundwork for research into preventing outpatients with COVID-19 from deteriorating into a more severe disease status.
· A retrospective cohort study that analyzed pediatric electronic health record data from PEDSnet (n=135,794 patients <25 years) from found 4% of patients were infected with SARS-CoV-2 (n=5,374), while Kawasaki Disease prevalence decreased in 2020 compared to 2018 or 2019*. Risk factors for SARS-CoV-2 infection included preexisting chronic disease and increased age. Additionally, subjects of Hispanic, Black, or Asian race/ethnicity had a higher likelihood of positive test result compared to White race/ethnicity, though they received fewer tests per population. These results provide large-scale data on pediatric risk factors, which authors hope will add to the growing knowledge on SARS-CoV-2 and host biology in pediatric populations.
· Leaders in the United Kingdom's Department of Health conducted a systematic review and narrative synthesis of literature on SARS-CoV-2 infection in children published through March 9, 2020 (24 articles) and found that children under age 10 had similar infection rates to adults, but the observed rate of infection in children was perceived as lower since children often had undetected milder infections, and transmission usually occurred within familial clusters when children were exposed to an infected adult. Authors suggest further data collection is necessary to understand child to child transmission of SARS-CoV-2 and to detail the clinical course of COVID-19 in children.
Understanding the Pathology
· A cohort-control study by pediatric infectious disease specialist in Ankara, Turkey evaluated cytokine and chemokine levels from serum samples of 60 COVID-19 positive patients (30 pediatric, 30 adult) and found that COVID-19 patients had higher levels of IP10 and MIP-3B compared to 30 healthy controls (15 pediatric, 15 adult; p<0.001), while IP-10 was a predictor for disease severity in children and IL-6 a predictor for disease severity in adults. They suggest these findings provide insight into potential treatment targets for COVID-19 and further elucidate potential uses for inflammatory markers as prognostic indicators for pediatric and adult COVID-19 severity.