Reduced development of COVID-19 in children reveals molecula
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Our children, often a source of hope and optimism, have provided one of the few encouraging notes, a “silver lining” perhaps, in the dismal landscape of the current pandemic. Children have thus far been relatively protected from developing severe COVID-19 pneumonia. Understanding the basis for why children have generally done better than adults provides important insights into the pathogenesis of COVID-19, which may guide our understanding of susceptibility to infection and may provide further clues for therapeutics.

The reduced development of COVID-19 for children compared to adults provides some tantalizing clues on the pathogenesis and transmissibility of this pandemic virus.

First, ACE2, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor, is reduced in the respiratory tract in children.

Second, coronavirus associated with common colds in children may offer some protection, due to cross-reactive humoral immunity and T cell immunity between common coronaviruses and SARS-CoV-2.

Third, T helper 2 immune responses are protective in children. Fourth, surprisingly, eosinophilia, associated with T helper 2, may be protective. Fifth, children generally produce lower levels of inflammatory cytokines.

Finally, the influence of the downturn in the global economy, the impact of living in quarters among families who are the most at risk, and factors including the openings of some schools, are considered. Those most disadvantaged socioeconomically may suffer disproportionately with COVID-19.

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