Abstract The impact of the disease caused by the novel coronavirus, SARS-CoV-2, COVID-19, has been widespread, with over 120,000 cases diagnosed in more than 100 countries since the virus was identified in January of 2020. Preliminary data focused on severe respiratory manifestations, seen predominantly in adults, with scant initial data on the burden of COVID-19 in children. We therefore read with interest the findings of Dong and colleagues in this volume of Pediatrics, who reported a series of over 2000 children with suspected or confirmed COVID-19. The authors found that 13% of virologically-confirmed cases had asymptomatic infection, a rate that almost certainly understates the true rate of asymptomatic infection, since many asymptomatic children are unlikely to be tested. Among symptomatic children, 5% had dyspnea or hypoxemia (a substantially lower percentage than what has been reported for adults) and 0.6% progressed to acute respiratory distress syndrome (ARDS) or multiorgan system dysfunction, a rate that is also lower than that seen in adults. Preschool-aged children and infants were more likely to have severe clinical manifestations than older children.
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