Researchers from Australia and Switzerland have reviewed some of the mechanisms proposed regarding why COVID-19 is more severe among adults compared to children. The risk of hospitalization and death increases with increasing age.
Examples of factors that might increase the risk of severe disease among adults range from a higher prevalence of comorbidities, lower levels of vitamin D, to increased expression of SARS-CoV-2 host cell receptor angiotensin-converting enzyme 2 (ACE2).
As a person ages the expression of ACE2 in lungs and nasal tissues increases. It has also been proposed that ACE2 in children has a lower binding affinity for SARS-CoV-2 making it difficult for the virus to enter the host cell. Examples of factors that may protect children range from differences in gut microbiota, higher levels of melatonin, etc.
Children may have less exposure to less intense viral exposure while adults are subject to more exposure in the workplace. Activation of coagulation due to endothelial damage plays an important role in the severity of COVID-19, which could also lead to thrombotic complications.
The endothelium in children is less pre-damaged than in adults, making them less susceptible to abnormal clotting. Children also have more robust innate immune system responses and a higher level of natural killer cells compared to adults.
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