Infants are more susceptible to COVID-19 than children
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Abstract
Angiotensin-converting enzyme 2 (ACE2) has been found to mediate the host cell entry of SARS-CoV-2 that causes COVID-19. However, the link between ACE2 and the observed susceptibility of SARS-CoV-2 infection remains elusive. In contrast, observational studies can help identify the susceptibility biomarker of SARS-CoV-2 infection, those associated with age for example. Data of all PCR tests performed in the state of São Paulo of Brazil were gathered from the government database and were analyzed using multivariate logistic regression. Adjusted odds ratios for positive test results were calculated with the adjustment of age, gender, and comorbidities. Over 1.7 million test results were included in the study of which 38% were positive. Elderly was most vulnerable to SARS-CoV-2 infection. While underages were less susceptible than adults aged below 60 years, susceptibility was not equal among different pediatric groups. It is found that age and susceptibility to SARS-CoV-2 infection are not inversely related, but U-shaped, with infants more susceptible than children. Biomarkers that are linearly associated with age cannot explain the reduced susceptibility in children. These include lymphocyte count and cross-reactive antibodies against other coronaviruses that offers cross-protection. The expression level of ACE2 may still be able to explain but further investigations are needed.
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SciScore for 10.1101/2021.05.02.21256474: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Selection bias is the major limitation of the study. For instance, symptomatic patients seeking medical care are more likely to be tested. However, the database also included asymptomatic patients that had epidemiologic links to confirmed cases and …
SciScore for 10.1101/2021.05.02.21256474: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Selection bias is the major limitation of the study. For instance, symptomatic patients seeking medical care are more likely to be tested. However, the database also included asymptomatic patients that had epidemiologic links to confirmed cases and asymptomaticity was included in the statistical analysis to reduce the selection bias. Unless all individuals in São Paulo were tested, selection bias remains. In this regard, the studied cohort represented a significant proportion of the population to reduce the bias. With a population of 44 million in São Paulo and 1.72 million PCR tests performed, the test rate is approximately 3,910 per 100,000 inhabitants, about the same as Belgium and above Germany and France [26].
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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