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Why are children 'missing' from coronavirus outbreak cases?

Children wear surgical masks as protection against the coronavirus as Hong Kong marked the Lunar New Year on Jan. 27, 2020.
Children wear surgical masks as protection against the coronavirus as Hong Kong marked the Lunar New Year on Jan. 27, 2020.
(Image: © ANTHONY WALLACE/AFP via Getty Images)

The outbreak of a new coronavirus in China has killed more than 900 people, but one group has escaped with minimal damage: children.

Youth can certainly contract the virus. Among the infected are at least two newborns, according to Chinese health officials. But few children are among those sick enough to be diagnosed with the coronavirus, according to an article published Feb. 5 in the Journal of the American Medical Association. According to the data analyzed in that article — and numbers are changing quickly as the outbreak evolves — the median age of patients skews older, between 49 and 56 years old.

It's not entirely clear why children seem to be escaping the worst effects of the virus, dubbed 2019-nCoV. But a similar pattern holds for many infectious diseases, from the familiar, such as chickenpox and measles, to the newly emerged, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), doctors say.

Related: Live updates on the new coronavirus, 2019-nCoV

"We don't fully understand the phenomenon — it may be because of differences in the immune responses of children compared to adults," Dr. Andrew Pavia, the chief of the Division of Pediatric Infectious Diseases at the University of Utah, told Live Science in an email. "One hypothesis is that the innate immune response, that is the early response that is aimed broadly at groups of pathogens, tends to be more active," in children, he said.

Infectious disease in kids

The innate immune system is the first line of defense against pathogens. Cells in that system respond immediately to foreign invaders. (The adaptive immune system, by contrast, learns to recognize specific pathogens, but takes longer to join the battle.) If the innate immune response is stronger in children exposed to 2019 nCoV, they may fight off infection more readily than adults, suffering only mild symptoms.

Other coronaviruses, including SARS and MERS, also show this pattern, said Krys Johnson, an epidemiologist at the Temple University College of Public Health.

"The case we're seeing with the [emerging] coronaviruses is not that the children are not having any symptoms at all, they're actually having viral pneumonia," Johnson told Live Science, referring to the presence of infected fluid in the lungs. "But because their immune systems are so robust, it doesn't lay them out the way it would as an adult."

Similarly, Johnson said, adults are 25 times more likely to die from chickenpox than children are. And though influenza can be devastating for infants, older children usually make it through with more ease than adults, Johnson said. Seasonal flu death rates in adults are 10 times that of death rates in children.

Related: How does the new coronavirus compare with the flu?

Aging and the immune system

It's hard to know for sure how many kids have contracted the new coronavirus, which emerged in Wuhan, China, in December. This uncertainty reflects both the rapidly changing information coming out of China as the outbreak continues and the fact that children with mild symptoms probably won't be tested and confirmed to have the virus.

Two new case studies of 2019-nCoV, published Feb. 6 in the journal JAMA, found that cases requiring hospitalization had a median age of 56 for 138 patients admitted to Zhongnan Hospital in Wuhan between Jan. 1 and Jan. 28. A little more than half of those patients were men. A case study of 13 patients with the infection in Beijing included one 2-year-old and one 15-year-old. The authors of that case study, also published in JAMA, noted that most of the infected individuals were healthy young or middle-age adults, with only one patient older than 50.

Related: 11 Surprising Facts About the Immune System

Kids aren't any less likely than adults to be exposed to respiratory ailments, Pavia said, so it seems most likely that they are catching the infection but recovering more easily than their parents and grandparents. There are other possible reasons beyond the strength of the innate immune system that could explain this resilience.

One is that kids might have healthier respiratory tracts because they've been exposed to less cigarette smoke and air pollution than adults, Pavia said. Another factor seems to be that kids are healthier in general, with fewer chronic health conditions, Johnson said. In both the SARS outbreak of 2003 and the MERS outbreak of 2012, adults with chronic health conditions were at a higher risk of death than adults without co-occurring conditions, she said. These conditions could include anything from diabetes to autoimmune disorders to cardiovascular disease, or even simple obesity.

Adults are also more susceptible to a detrimental immune response that causes a condition called acute respiratory distress syndrome (ARDS), said Dr. James Cherry, a professor of pediatrics and infectious diseases at UCLA's Geffen School of Medicine. A complicated imbalance of immune cell activity sends inflammation in the lungs into overdrive, ultimately causing fluid to fill the alveoli, or air sacs, according to research published in the journal Annals of Translational Medicine. The red blood cells flow into these alveoli to pick up new oxygen. When they sacs flood, they stop working. The person can no longer breathe. Studies suggest that about 40% of people with ARDS die

ARDS "was frequently fatal in adults with the SARS coronavirus," Cherry told Live Science. "Whereas even though children [with SARS] had pneumonia, they didn't get the immunologic complications that adults have." 

Originally published on Live Science.

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  • Eamonn Kenny
    Is it possible that the virus originated from mice? I remember in the 90s when I was 25 years old that doctors could not record my T3 and T4 because they had to inject my blood into a mouse to obtain an allergic reaction. They could never obtain the correct reaction from my blood because as an adult I had some sort of mice immunity. The doctors said at the time, "Only kids under 10 have this sort of immunity, that disappears later. You are a rare case." So if most kids have this natural immunity to mice, can they have this natural immunity to Coronavirus, and if so, are they related immunity?
    Reply
  • Knowledge is power
    Flu kills 630,000 per year. Yet who stops travelling when you hear of it? Did any stop travelling to the US last time it was killing so many?
    Reply
  • Seng
    The cause of death is hypercytokinemia. Probably, the cytokine production in adult is much stronger than children. Children immune system is not fully developed and produce "just nice" level of inflammatory genes (cytokines).
    Reply
  • robinhood46
    Seng said:
    The cause of death is hypercytokinemia. Probably, the cytokine production in adult is much stronger than children. Children immune system is not fully developed and produce "just nice" level of inflammatory genes (cytokines).
    I'm wondering if photochemical oxydation of primary pollutants isn't messing around with the immune response increasing oxydative stress and causing the increased inflammation.
    Reply
  • DazzyW
    Since children are, presumably, growing/regenerating cells at higher rate than adults, is it possible that the net of cells destroyed/compromised by the virus is lower in children and therefore results in less severe problems?
    Reply
  • 10acious74
    Knowledge is power said:
    Flu kills 630,000 per year. Yet who stops travelling when you hear of it? Did any stop travelling to the US last time it was killing so many?
    I’m glad to see that I’m not the only one that has questioned that.
    Reply
  • sababa
    Knowledge is power said:
    Flu kills 630,000 per year. Yet who stops travelling when you hear of it? Did any stop travelling to the US last time it was killing so many?
    lack of knowledge is lack of power!
    the RO rate of the flu meaning retransmission how many people each person with the flu will get sick is between 1.0 to 2.0 the RO of covid19 2.5 to 3.5
    flu kills .05 percent of people who get it covid19 again between 2 to 3.5 percent of people who get it die while all the facts aren't known and some are debate able if covid19 spreads like the flu it will kill millions of people and it definitely seems to have the ability to spread alot better than the flu. and besides for the above the amount of severe hospitalization is 20 percent for covid19 for the flu out of 40 million American 200,000 hospitalization that's not 20 percebt
    Reply
  • sababa
    while not everything coming out of chine can be trusted and the article may be true I personally have seen clips from inside Wuhan of lined up corpses of children did I use scientific method to verify the clips no but did they seem legit yes ..the data china is providing the USA isn't either legit
    Reply
  • Roger Des Roches
    Knowledge is power said:
    Flu kills 630,000 per year. Yet who stops travelling when you hear of it? Did any stop travelling to the US last time it was killing so many?
    630,000 worldwide???? Could you cite your sources? At its peak, «2009 H1N1 Flu Pandemic – about 18,300 deaths in the United States and up to 203,000 deaths worldwide».
    Reply
  • Nevada Smith
    We have to be careful of jumping to unwarranted conclusions. Two things to keep in mind. First is the nature of the reporting coming out of China. I seriously doubt we are getting the true story from China.

    Second is the population we see exposed to the coronavirus. Most of the travelers and tourist are adults. Children are being evacuated from Wuhan, but no mention of the number. I suspect that number is low. Or the 350 Americans evacuated from cruise ship in Japan. I think most of them were elderly with few if any children. Adults brought back to the United States are isolated and have little chance of spreading coronavirus to the general population which include children.

    I'm not so sure of the children's super immunity theory. "Since 2014, federal health officials have confirmed over 500 cases of acute flaccid myelitis (AFM) in the United States―a very rare but serious illness that can cause sudden polio-like symptoms such as weak muscles and paralysis. Most of these cases have been in children around 5 years old." Or the illegal immigrate children getting sick in custody.
    Reply