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Why children avoid the worst coronavirus complications might lie in their arteries
Since the coronavirus outbreak began, scientists have been trying to work out why children are much less likely than adults to experience severe complications from the infection. Now research suggests that the answer might lie in children’s healthy blood vessels.
Children make up only a small proportion of those infected by SARS-CoV-2, the virus that causes COVID-19. A large survey by the US Centers for Disease Control and Prevention in Atlanta, Georgia, found that children aged 17 and under, who make up 22% of the US population, account for fewer than 2% of confirmed COVID-19 infections across the United States. And, of 2,572 children included in the survey, only 5.7% went to hospital and only three died.
Several theories have been proposed to explain why children aren’t getting so ill. These include the possibility that they have a stronger and more effective initial immune response to the virus than adults do, and that they might have some immunity from recent exposure to similar viruses. But a growing number of researchers think that the difference between adults and children might be the condition of their blood vessels.
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Many adults with serious COVID-19 experience clotting in their blood vessels, which leads to heart attacks or strokes. The clotting seems to be linked to a malfunctioning endothelium, the smooth tissue that lines blood vessels and normally prevents clotting, says Frank Ruschitzka, a cardiologist at the University Hospital Zurich in Switzerland. Normally, blood clots form only to stop bleeding from an injury, but if the endothelium is damaged, clots can also form.
Ruschitzka and colleagues have found that SARS-CoV-2 can infect endothelial cells, which are found throughout the body. In a study of three people with COVID-19, two of whom died, Ruschitzka’s team found that SARS-CoV-2 had infected the patient’s endothelium and caused inflammation and signs of clotting 1. The study was small so such complications will need to be investigated further, but problems with the endothelium seem to be involved in most cases of COVID-19 that progress to severe or fatal disease in adults, he says.
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Nature 582, 324-325 (2020)
doi: https://doi.org/10.1038/d41586-020-01692-z
References
Varga, Z. et al. Lancet https://doi.org/10.1016/S0140-6736(20)30937-5 (2020).
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