Lessons From COVID-19 in Children: Key Hypotheses to Guide Preventative and Therapeutic Strategies

Clin Infect Dis. 2020 Nov 5;71(8):2006-2013. doi: 10.1093/cid/ciaa547.


The current pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), reveals a peculiar trend of milder disease and lower case fatality in children compared with adults. Consistent epidemiologic evidence of reduced severity of infection in children across different populations and countries suggests there are underlying biological differences between children and adults that mediate differential disease pathogenesis. This presents a unique opportunity to learn about disease-modifying host factors from pediatric populations. Our review summarizes the current knowledge of pediatric clinical disease, role in transmission, risks for severe disease, protective immunity, as well as novel therapies and vaccine trials for children. We then define key hypotheses and areas for future research that can use the pediatric model of disease, transmission, and immunity to develop preventive and therapeutic strategies for people of all age groups.

Keywords: COVID-19; SARS-CoV-2; children; pediatrics; vaccines.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Betacoronavirus
  • COVID-19
  • Child
  • Child, Preschool
  • Comorbidity
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / immunology
  • Coronavirus Infections* / transmission
  • Humans
  • Infant
  • Infant, Newborn
  • Pandemics*
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / immunology
  • Pneumonia, Viral* / transmission
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index