ROCHESTER, Minn. — Globally and locally, children have so far been relatively unscathed in the coronavirus pandemic.

Following a worldwide trend, children in Minnesota continue to account for the smallest percentage of statewide COVID-19 virus infections.

As of Wednesday, April 1, of the 689 confirmed cases in Minnesota, 22 cases are in people 19 years old or younger.

Preliminary numbers show children account for only about 1.5% of COVID-19 cases in Italy and China — two of the countries hardest hit by the pandemic so far, said Dr. Nipunie Rajapakse, Mayo Clinic pediatric infectious disease and public health expert.

Those numbers might be skewed higher, due in part to children’s resilience when it comes to this virus, she added. Children are probably being infected at similar rates, but require less treatment or even testing.

“Testing has really been mostly limited to people who have been hospitalized or have more severe signs of illness,” she said. “We only test those that are symptomatic.”

Rajapakse said experts have three main theories why children have fared relatively well so far.

One is that COVID-19 is similar in some ways to other respiratory illnesses, including the common cold.

“There’s a theory maybe because kids get colds so often, maybe the antibodies they develop help them better manage this one,” Rajapakse said.

Another theory is that children tend to not have other underlying or chronic health conditions.

“They’re starting out with healthier hearts and lungs, so potentially that is giving them some protection from severe illness,” she added.

Children’s immune systems might also respond to the virus differently than adult immune systems and not rev up to attack the virus as aggressively, Rajapakse said.

That doesn’t mean the virus is harmless to children. A study published online in the journal Pediatrics that looked at more than 2,100 children in China infected with COVID-19 found more than 5% of children developed severe cases.

Children also likely play a large role in transmission of the illness, Rajapakse said.

“Some studies suggest they can shed high levels of virus in respiratory secretions even if they have, themselves, recovered,” she said.

What is less clear is the risk to infants born to mothers who test positive for COVID-19.

Rajapakse said she has seen data on a small sample — 33 pregnant women who had the virus. Of them, three of their infants later tested positive for the virus.

“We need to understand a bit better whether that infection had happened before the baby was born through the placenta or after the baby was born and in close contact with the mother,” she said.

In those cases, two of the infants had mild forms of the illness and showed no signs of infection seven days later. One, who was born prematurely, needed more treatment but also recovered and was clear of the virus some time later, Rajapakse said.

The main concern for pediatricians are children with underlying health conditions, such as asthma, compromised immune systems or recovering from transplants.

“Those are the kids we really need to learn more about,” she said.

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