COVID-19 infection - clinical picture in adults and children

COVID-19 is a respiratory tract infection caused by the novel coronavirus, SARS-CoV-2. It was first diagnosed in Wuhan, China, in December 2019.

Genetic sequencing of the virus indicates that it is a beta-coronavirus closely related to the SARS virus (1). While most people with COVID-19 develop only mild or uncomplicated disease, approximately 14% develop severe disease requiring hospitalization and oxygen therapy, and 5% require admission to an intensive care unit (1). In severe cases of COVID-19 infection, sepsis, severe damage to the lungs, heart and kidneys may occur.
It has not been proven that newborns infected with the SARS-CoV-2 virus have an increased risk of severe infections and complications. 
The possibility of vertical transmission of SARS-CoV-2 virus from mother to newborn has not been proven so far.
Transmission of the SARS-CoV-2 virus from mother to newborn after birth through contact with infectious respiratory secretions of the diseased mother is possible.  
A confirmed case of COVID-19 infection occurs when the infection is confirmed by laboratory findings, regardless of clinical signs and symptoms. 
A mother with a proven infection may breastfeed/feed her own breastmilk to her baby if she has a mild clinical picture of the disease or a mild form of pneumonia.

Mild clinical picture of the disease 

Patients with uncomplicated viral upper respiratory tract infection may have non-specific symptoms, such as fever, fatigue, cough (with or without sputum), anorexia, muscle pain, sore throat, shortness of breath, nasal congestion, or headache. Rarely, patients may have diarrhea, nausea, and vomiting.

Pneumonia - a milder form

  • Adults without signs of severe pneumonia do not need additional oxygen.
  • A child with mild pneumonia who has cough or difficulty breathing + rapid breathing (child under 2 months has ≥ 60 breaths/minute; infant 2–11 months ≥ 50 breaths/minute; child 1-5 years has ≥ 40 breaths per minute).

Severe pneumonia

  • Adolescents or adults: fever or suspected respiratory infection, plus > 30 breaths/minute; severe respiratory distress; or percutaneous saturation ≤ 93% in room air
  • A child with cough or difficulty breathing, plus at least one of the following: central cyanosis or percutaneous saturation <90%; severe respiratory distress; general signs of danger: inability to breastfeed or drink, lethargy or fainting or convulsions. 

ARDS - Acute respiratory distress syndrome 

  • Within one week of the diagnosis, the respiratory symptoms worsen. Chest image (radiography, CT, or lung ultrasound) shows bilateral opacity. The patient requires the help of a breathing apparatus.

Sepsis

  • Adults with signs of sepsis: life-threatening, altered mental status, difficult or rapid breathing, low oxygen saturation, decreased urine output, rapid heart rate, weak pulse, cold extremities or low blood pressure, skin spots or laboratory evidence of coagulopathy, thrombocytopenia, acidosis, high lactate or hyperbilirubinemia.
  • Children with sepsis: suspected or proven infection and ≥ 2 age-related systemic inflammatory response syndrome criteria, of which an abnormal temperature or white blood cell count must be present.

Septic shock

  • Adults: low blood pressure despite fluid replacement.
  • Children: low blood pressure, tachycardia or bradycardia (prolonged capillary refill (> 2 sec) or weak pulse; tachypnea; spotty or cold skin or petechial or purple skin rash; increased lactates; weak urination; high or low temperature).