Hide and seek in a pandemic: review of SARS-CoV-2 infection and sequelae in children.

Children infected with SARS-CoV-2 have a clinical phenotype that is distinct from that observed in adult cases. They can present with a range of respiratory, gastrointestinal and neurological symptoms, or with a delayed hyperinflammatory syndrome (paediatric multisystem inflammatory system temporally associated with SARS-CoV-2; PIMS-TS) that frequently requires treatment in an intensive care unit. These manifestations may be related to unique expression of transmembrane receptors and immune physiology in children. The clinical features and inflammatory profile of PIMS-TS are similar to other inflammatory disorders that occur in children such as Kawasaki disease, macrophage activation syndrome and sepsis. Given children are infected less frequently and have less severe disease due to COVID-19 compared to adults, their physiological profile is of great interest. An understanding of the unique mechanisms of infection and disease in children could aid the identification of potential therapeutic targets. Like adults, children can have long-term complications of SARS-CoV-2 infection, including neurological and cardiac morbidity. Vaccination against SARS-CoV-2 is not yet authorised in children aged <12 years, and hence we anticipate ongoing paediatric presentations of COVID-19 in the coming months.