According to the recommendations for the diagnosis, prevention, and control of COVID-19 in children (first interim edition) [5], the children were diagnosed with suspected SARS-CoV-2 infection if both of the following criteria were met:

Epidemiological history: History of travel or residence in Wuhan within 14 days before disease onset; or contact with patients with fever and respiratory symptoms or clusters of SARS-CoV-2 infection (in Hubei Province) within 14 days before disease onset.

Clinical manifestations: a) Fever, fatigue, and dry cough (some children may have no or low fever); b) possible radiological features of pneumonia such as multiple ground-glass opacities and/or infiltrative shadows in the lungs; c) normal or decreased total white blood cell count, or decreased lymphocyte count in the early stage of onset; and d) clinical manifestations that cannot be fully explained by other etiologies.

Children with suspected SARS-CoV-2 infection were confirmed if they tested positive for SARS-CoV-2 nucleic acid in nasopharyngeal or throat swabs, and lower respiratory tract secretions by real-time fluorescence RT-PCR.

The infected children can be divided into five categories [5], as follows:

Asymptomatic infection: The children have no clinical symptoms and signs, the chest imaging examination are normal, but the 2019⁃nCoV nucleic acid test is positive, or the serum specific antibody are positive by the retrospective diagnosis.

Mild: The children mainly have acute upper respiratory tract infection, including fever, fatigue, myalgia, cough, sore throat, runny nose and sneezing symptoms. Pharyngeal congestion can be seen in physical examination, but lungs have no positive signs. Some children may have no fever, but only with nausea, vomiting, abdominal pain, diarrhea or other gastrointestinal symptoms.

Common type: The children are manifested as pneumonia. They often have fever and cough, initially mostly dry cough, then sputum cough, and some can have wheezing but no obvious shortness of breath and other hypoxia. Coarse rales, dry rales and/or wet rales can be heard from the lungs. Some of the children did not have any clinical symptoms and signs, but chest CT showed pulmonary lesions, which were subclinical.

Severe type: Early respiratory symptoms such as fever and cough can be accompanied by digestive symptoms such as diarrhea. The disease usually progresses in about 1 week with dyspnea, central cyanosis, saturation of pulse oximetry < 0.92 without oxygen inhalation and other hypoxia manifestations.

Critical type: The children may rapidly progress to acute respiratory distress syndrome (ARDS) or respiratory failure, and may also develop multiple organ dysfunction such as shock, encephalopathy, myocardial injury or heart failure, coagulation dysfunction and acute kidney injury, which can be life-threatening.

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