Comment regarding pediatric severe acute respiratory syndrome coronavirus 2: clinical presentation, infectivity, and immune responses

To the Editor:

In the report by Yonker et al, despite having tested 11 asymptomatic children with 3 positives, there are no details about this group selection and there is no information about the viral load in this group.¹ It would be important to compare this group with the group study, instead of comparing asymptomatic/early infection with adults at a later stage of the disease. One study found a higher viral load in adults during the first week of symptoms with a progressive decrease over time, as observed in the present study in children, reinforcing that comparing viral load at different stages of the disease may be inadequate.² Also, they correlated multisystem inflammatory syndrome in children with low viremia, and posed it as an obstacle to control strategies as reopening schools. However, studies show that multisystem inflammatory syndrome in children is a later complication, with a low incidence and mortality.^{3 , 4}

Data suggest that the majority of pediatric cases are mild or asymptomatic.^{5 , 6} Therefore, we should ponder the impact of quarantine on childhood. There are psychological and physical burdens imposed on children with home confinement and school closure: lack of children-children interaction and inadequate eating patterns generate distress, obesity/malnutrition, depression, and many other behavioral and neurodevelopmental disorders. Additionally, vulnerable children like those exposed to domestic violence and abuse have no place to shelter.^{7 , 8} Furthermore, in low-income countries, socioeducational disparity may be enhanced, because there is no universal access to audiovisual system or Internet access; in addition, some children receive vital nutritional assistance in schools that has been halted since the pandemic began.⁷

Mitigating the psychosocial impact may require risk stratification of children, teachers, and their household contacts and contact tracing all symptomatic individuals making isolation possible.⁹ The central question after their findings is if there is direct correlation between viral load and transmissibility.¹⁰