Children with COVID-19 behaving milder may challenge the public policies: A Systematic Review and Meta-Analysis

Background: The emerging virus is rampaging globally. Great efforts are needed to cut down the transmission. Clinical characteristics of infected children have been described previously. No meta-analysis on this subgroup have been published. Methods: : A single-arm meta-analysis was conducted. We searched PubMed, Google Scholar, Web of Science, three preprints websites and other Chinese database for studies presenting characteristics of children confirmed with Coronavirus Disease 2019 (COVID-19) from December 1 2019 to March 28 2020. Quality Appraisal of Case Series Studies Checklist was used to assess quality and publication bias was analyzed by Egger’s test. Random-effect model was used to calculate the pooled incidence rate (IR) or mean difference (MD) with 95% confidence intervals (CI), or a fixed model instead when I 2 <50%. We conducted subgroup analysis according to geographic region. Additionally, we searched United Nations Educational Scientific and Cultural Organization to see how different countries act to the education disruption in COVID-19. Results: : 14 studies (two unpublished) with 361 pediatric patients were included. The mean age was 5.5 (95% CI: 0.344–0.765) years old. 23.4% of children were asymptomatic (95%CI: 0.112-0.377). 32.3% (95%CI: 0.163-0.503) showed normal computed tomography imaging, besides, four children were admitted in intensive care units (0, 95%CI: 0.000-0.001) and one death was reported (0, 95%CI: 0.000-0.001). Up to 191 countries have implemented nationwide school closures, affecting over 91% of the world’s students. Conclusion: Children were also susceptible to SARS-CoV-2, while critical cases or death were rare. Characterized by mild presentation, the dilemma that children may become a potential spreader in the pandemic, while strict managements like prolonged school closures, may undermine their well-beings. Thus, the public policies are facing challenge.