Salemi et al. point out that emerging evidence indicates that many children with COVID-19 are asymptomatic and this may be 80%, possibly higher, with therefore ≤20% who are symptomatic [1]. Dong et al. based their data on positive cases [2]. This may admittedly be a biased group and circulating, asymptomatic cases may greatly dilute the paper's findings, especially since asymptomatic carriage in the paediatric age group may be even higher [3,4].
For this reason, a correction factor of 15% and 5% symptomatic for overall and for paediatric respectively has been incorporated and the data for the worked example, Malta, revised in the following two tables. For all ages, including the paediatric population, the symptomatic proportion will vary, but the degree of variation is uncertain at the time of writing.
However, there is a large degree of potential error in all calculations at this point in time simply because we do not know enough about this virus. We will only know the truth in time, when large populations are randomly sampled and antibody statuses checked. Like Salemi et al., we hope that these calculations and estimates will provide (insofar as possible with extant knowledge) “reliable information to government officials, policy makers, and the pediatric medical community on the likelihood of capacity challenges.”
References
- 1.BMJ. 2020;369 doi: 10.1136/bmj.m1375. [DOI] [Google Scholar]
- 2.Dong Y., Mo X., Hu Y. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020 doi: 10.1542/peds.2020-0702. [DOI] [Google Scholar]
- 3.Grech V. COVID-19 admissions calculators: general population and paediatric cohort. Early Human Development. [DOI] [PMC free article] [PubMed] [Retracted]
- 4.Pathak E.B., Salemi J.L., Sobers N., Menard J., Hambleton I.R. COVID-19 in children in the United States: intensive care admissions, estimated total infected, and projected numbers of severe pediatric cases in 2020. J Public Health Manag Pract. 2020 doi: 10.1097/PHH.0000000000001190. [DOI] [PMC free article] [PubMed] [Google Scholar]

