Children's Hospital

Obesity and Immune Response in Kids with COVID-19

Age, by far, is the most important risk factor for bad outcomes with COVID-19. But after that, it’s become clear that obesity is an important risk for bad outcomes. In children, of course, serious cases are relatively rare. But lately they have been cropping up more frequently in the U.S. Now, a new report in JAMA Pediatrics suggests that obesity may be a factor for the severity of COVID-19 in kids.

At the same time, though, we are seeing a different pattern to the immune response in kids who have trouble with COVID-19, compared to adults.

A Small Case Series

The insights about obesity and COVID-19 in kids come from a small case series – just 50 children and teens at a single hospital in New York City. Half of them were Hispanic. The hospital serves mostly a Hispanic community. What they found was that kids present in very diverse ways when they are hospitalized with COVID-19. Infants and immune compromised children don’t appear to have an increased risk. But in this small series of patients, children with obesity did.

In fact, two thirds of the patients who needed a ventilator had obesity.

A Different Immune Response

A separate, detailed report from Wuhan Children’s Hospital describes the immune status of 157 patients with mild, moderate, and severe disease. The authors found that the “cytokine storm” noted in adult patients rarely occured in these pediatric patients. What they did find was immune responses that were altered from normal, but different from the response typically seen in adult patients. “Systemic inflammation rarely occurred in pediatric patients with COVID-19,” they wrote.

All of this leaves us with incomplete information. Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious, but rare complication of COVID-19. Is it related to a cytokine storm seen more often in adults? Some researchers have suggested this. But it also seems likely immune responses of kids with COVID-19 are different from those of adults.

We also have data suggesting that obesity might be a risk factor for kids with COVID-19. But right now, those data are very limited. We have much to learn.

Click here for the report from JAMA Pediatrics, here for an editorial about it, and here for the report from Wuhan. For further perspective, click here.

Children’s Hospital, photograph © Chelsea Stirlen / flickr

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June 6, 2020