Factors Associated with the Time to Clinical Recovery from Coronavirus Disease 2019 in Pediatric Patients

Background: The epidemic of disease due to SARS-CoV-2 has caused massive destruction to the world economy and overburdened health care systems worldwide. To date, information about the epidemiological features and potential factors related to the clinical recovery of pediatric COVID-19 patients is lacking. Methods: This retrospective study examined 233 pediatric cases confirmed COVID-19 admitted to 12 tertiary hospitals in China from January 1, 2020 to April 17, 2020. We retrieved the electronic medical records of these cases, including the patient epidemiological characteristics, laboratory results, and clinical information. Findings: The median age of the cohort was 7·50 (IQR: 2·92,12·17) years, and 133 (57·1%) patients were male. Forty-two patients were evaluated as asymptomatic, while 162 and 25 patients were classified as mild or moderate cases, respectively. The most common clinical symptoms were fever (40·8%), cough (35·6%), nausea (16·3%), and coughing productive of excess saliva (9·9%). In the Cox regression analysis, longer time to recovery was associated with having SARS-CoV-2-infected family members (HR [95%CI]: 0·56 [0·41–0·79]), and comorbidities (HR [95%CI]: 0·57 [0·37–0·89]). Regarding the clinical disease types, only severe disease was associated with longer recovery time (HR [95%CI]: 0·14 [0·03–0·59]). Interpretation: The transmission chain between adult and child COVID-19 patients is not one-way, and it is possible for the virus to transmit from adult patients to children in the household setting, and vice versa. The proportion of asymptomatic pediatric patients could be underestimated due to detection difficulties. Funding Statement: The Bill & Melinda Gates Foundation (Grant No. INV-006277). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the ethics committee of the National Children’s Medical Center, Children’s Hospital of Fudan University, and followed the Declaration of Helsinki. Written consent was obtained from the guardians of the patients.