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The world faces an existential, once in a lifetime pandemic due to a novel coronavirus (SARS-CoV-2) which has to date infected over 25 million people across the world, with nearly 850 000 deaths.1 The disease, labelled COVID-19 by the WHO, has now spread to almost all the countries of the world and crippled the global economy. While high-income countries have been able to tap into their resources and reserves, for many low-income and middle-income countries, rising unemployment, population lock downs and closure of businesses have inflicted crippling damage on fragile economies, with rising inequalities and worsening poverty.
While early reports of the infection2 3 suggested that the infection may be generally mild in children with COVID-19, with general case fatality rate less than 1%, there are increasing reports of complications among children and adolescents.4 In addition, a recent series of cases with multisystem inflammatory response merits reconsideration of these risks.5 There are also clear signals of predictors for adverse outcomes from COVID-19 infections. The disease has disproportionately taken a toll among the elderly population in long-term care facilities, with many dying without even being tested for COVID-19 infection.6 There is clear evidence of excess mortality in subgroups, especially those with comorbidities, most commonly related to non-communicable diseases (NCDs), such as diabetes, hypertension, obesity, heart disease and cancer.7 The same appears to be true among paediatric COVID-19 infections. A systematic review analysed a total of 7780 paediatric COVID-19 positive cases globally, and found that patients with information on underlying conditions (n=655) included the following comorbidities: immunosuppression (30.5%), respiratory conditions (20%) and cardiovascular disease (14%).8 A recent report from the UK of 651 hospitalised children with COVID-19 from 260 hospitals identified comorbidities in 42% (276/651) of cases.9 Comorbidities most commonly associated with …
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