Symptomatic infants have higher nasopharyngeal SARS-CoV-2 viral loads but less severe disease than older children. (COVID special issue #2.)

ABSTRACT

This study reports NP viral load in infants, children, and adolescents hospitalised and discharged from 14 March to 24 April, 2020. Of the 57 patients who tested positive counted with SARS-CoV-2, 20 (35.1%) were infants 12 months of age or younger. Older children and adolescents range from 1 year old to 21 years old. The mean NP viral load in neonates was significantly higher than in older children and adolescents. However, the proportion of neonates with severe illness is significantly lower than in older patients. The mean time to positive test from onset of symptoms is shorter in neonates than in older children. Rates were similar in both groups examined within 7 days of symptom onset. The report suggests that symptomatic infants have higher NP viral loads at the time of presentation, but develop less severe disease than older children and adolescents. Whether this is due to a slightly earlier presentation to clinical care related to host biology is investigated. These data have implications for mitigating the spread, especially in collective settings (e.g. day care centers) or hospital units (e.g., primary care units) for infants that serve this group.