Is cardiorespiratory disease associated with increased susceptibility of SARS‐CoV‐2 in children?

Background There are limited data in pediatric populations evaluating whether chronic cardiorespiratory conditions are associated with increased risk of coronavirus disease 2019 (COVID‐19). We aimed to compare the rates of chronic cardiac and respiratory disease in children testing positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2[+]) compared with those testing negative (SARS‐CoV‐2[−]) at our institution. Method Prospective cohort with nested case–control study of all children tested by polymerase chain reaction (PCR) for SARS‐CoV‐2 by nasopharyngeal/oropharyngeal sampling between March and October 2020. Children were identified prospectively via laboratory notification with age and sex‐matching of SARS‐CoV‐2[+] to SARS‐CoV‐2[−] (1:2). Clinical data were extracted from the electronic medical record. Results In total, 179 SARS‐CoV‐2[+] children (44% females, median age 3.5 years, range: 0.1–19.0 years) were matched to 391 SARS‐CoV‐2[−] children (42% female, median age 3.7 years, range: 0.1–18.3 years). The commonest comorbidities showed similar frequencies in the SARS‐CoV‐2[+] and [−] groups: asthma (n = 9, 5% vs. n = 17, 4.4%, p = 0.71), congenital heart disease (n = 6, 3.4% vs. n = 7, 1.8%, p = 0.25) and obstructive sleep apnoea (n = 4, 2.2% vs. n = 10, 2.3%, p = 0.82). In the SARS‐CoV‐2[+] group, the prevalence of symptomatic disease was similar among children with and without cardiorespiratory comorbidities (n = 12, 75% vs. n = 103, 57%, p = 0.35). A high proportion of children hospitalized with SARS‐CoV‐2 infection had cardiac comorbidities (23.8%). Conclusions In this single site data set, rates of pre‐existing cardiorespiratory disease were similar in SARS‐CoV‐2[+] and SARS‐CoV‐2[−] children. Rates of symptomatic infection were similar between children with and without cardiorespiratory comorbidity. High rates of comorbid cardiac disease were observed among hospitalized children with COVID‐19 warranting further research to inform vaccine prioritization.