• More than half of 2,500 cases of coronavirus in under 18s were among boys
  • Analysis by the CDC also showed US children don't always have symptoms 
  • But children are less likely to be admitted to intensive care than adults, at 2%
  • A separate CDC report revealed the risks for those with health conditions
  • Half of diabetics and smokers with coronavirus are hospitalised and/or go to ICU
Up to one in five children who catch coronavirus need hospital care and the deadly infection is more common in boys, official US figures show. 
Fifty-five per cent of the 2,500 coronavirus cases in under-18s were boys, a report by the Centers for Disease Control and Prevention (CDC) found. Forty-two per cent were girls, while the gender was unknown for another three per cent.
Compared with adults, children are less likely to suffer the tell-tale symptoms and may not show any signs of the virus at all. And they are far less likely to be admitted to intensive care (two per cent) or die (0.1 per cent), according to the analysis.  
A separate CDC report of almost 75,000 patients also showed exactly how different conditions raise the risk of developing coronavirus complications in adults.
For example, half of former smokers or diabetics needed to be hospitalised and/or placed in intensive care because of complications. 
But the figures also showed only 1.3 per cent of the 7,000 patients for which there was full data available for were current smokers. In comparison, around 14 per cent of US adults smoke. 
Other studies in China have also had surprisingly low rates of smokers, and one team of scientists from Wuhan - where the pandemic began - even suggested smokers may actually be at lower risk. 
Leading experts who have scoured all of the available evidence collated on smoking and COVID-19 warn smokers are at higher risk of complications.
But they say the current warnings about smokers being at higher risk of catching the infection are based on assumptions and further trials are needed.  
More than half (55 per cent) of cases were boys, 42 per cent were girls and 13 per cent are not known
A third of the paediatric cases were found in New York City, which has become the epicentre of the US outbreak
Coronavirus is more prevalent in boys, analysis of children with coronavirus in the US found. The CDC reports that a third of the paediatric cases were found in New York City
Compared with adults, children are less likely to have the tell-tale symptoms and may not show any signs of the virus at all. Pictured: Around 73 per cent of US children have a fever, cough or shortness of breath, compared with 93 per cent of adults
Compared with adults, children are less likely to have the tell-tale symptoms and may not show any signs of the virus at all. Pictured: Around 73 per cent of US children have a fever, cough or shortness of breath, compared with 93 per cent of adults
The CDC research on children, part of the weekly Morbidity and Mortality Weekly Report, found an estimated 5.7 per cent to 20 per cent of 2,500 children needed hospital care. Infants under the age of one were most at risk of needing hospitalisation (pictured)
The CDC research on children, part of the weekly Morbidity and Mortality Weekly Report, found an estimated 5.7 per cent to 20 per cent of 2,500 children needed hospital care. Infants under the age of one were most at risk of needing hospitalisation (pictured)
The CDC research on children - called Coronavirus Disease 2019 in Children - formed part of the Morbidity and Mortality Weekly Report.
More than 355,000 people in the US have tested positive for the disease, with coronavirus-related deaths crossing the 10,000 mark on Monday. 
Among 149,760 COVID-19 cases in the US analysed, the age had been reported in 99.6 per cent. 
Although children under age 18 make up 22 per cent of the US population, they account for only 1.7 per cent of diagnosed cases (2,572).
Forty-two per cent of infected children were girls and 55 per cent were boys, which matches up with data on adults, in which 53 per cent were males. In thirteen per cent of cases, the gender was not reported. 
Several studies have reported a majority of COVID-19 cases among men and a higher fatality rate compared with women.
Previously scientists have theorised that higher smoking rates or alcohol use have been behind gender disparity of COVID-19 cases, because both habits are linked to health conditions.
But this cannot explain the differences in infants and teenagers.The researchers said the higher rate of boys testing positive 'suggests that biologic factors might play a role in any differences in COVID-19 susceptibility by sex'. 

WHY ARE MALES - BOTH MEN AND BOYS - MORE AT RISK OF COVID-19? 

The  Centers for Disease Control and Prevention (CDC) today reported that 57 per cent of child coronavirus cases were boys, and 53 per cent of adult cases were men.
Several studies have reported a majority of COVID-19 cases among men and a higher fatality rate compared with women.
Until more research helps to conclude why, there are several schools of thought. 
Adults 
The disparity between adult men and women has largely been put down to behaviours, including drinking alcohol, smoking, and eating unhealthily.
Dr James Gill, a locum GP and honorary clinical lecturer, Warwick Medical School, said theories lie on the assumption that simply men don’t look after their bodies as well, with higher levels of smoking, alcohol use, obesity and other deleterious health behaviours.
These would put men at a higher risk of health conditions - which has been confirmed to be detrimental to COVID-19 outcomes.  
The sex differential in smoking is especially marked in some countries such as China, where 50 per cent of men smoke compared to five per cent  in women.
However, Dr Gill said: 'Whilst smoking is a plausible factor, globally, across various different cultures, where smoking rates do differ, we are still seeing the sustained difference in mortality between men and women. 
'Whilst we don’t have a definitive answer on why there is a difference between how men and women respond a COVID19 infection at the immunological level - yet - currently it is a fair assumption that there will be a significant interplay between the biology and the environmental facts.' 
Children
The slight increase in boys being infected with coronavirus compared to girls cannot be the result of behaviours such as smoking. 
Philip Goulder FMedSci, professor of immunology in the Department of Paediatrics, University of Oxford, explained how males and females have genetically different immune responses, which would be present from birth.
He said: 'It is becoming increasingly recognised that there are substantial differences in the immune system between males and females and that these have significant impact on outcome from a wide range of infectious diseases. 
'Several factors contribute to this, but these include the fact that females have two X chromosomes compared to one in males, and a number of critical immune genes are located on the X chromosome. 
'In particular, the protein by which viruses such as coronavirus are sensed is encoded on the X chromosome. As a result, this protein is expressed at twice the dose on many immune cells in females compared to males, and the immune response to coronavirus is therefore amplified in females.'
This effect can be seen in how the body responds to vaccines.
The immune response throughout life to vaccines and infections is typically more aggressive and more effective in females compared to males, Professor Goulder said. 
Females are believed to have a stronger immune system due to genetic differences, making them more resilient to fight off infections like SARS-CoV-2.
Philip Goulder, professor of immunology in the department of paediatrics, University of Oxford, said: 'It is becoming increasingly recognised that there are substantial differences in the immune system between males and females and that these have significant impact on outcome from a wide range of infectious diseases. 
'Several factors contribute to this, but these include the fact that females have two X chromosomes compared to one in males, and a number of critical immune genes are located on the X chromosome. 
'In particular, the protein by which viruses such as coronavirus are sensed is encoded on the X chromosome. 
'As a result, this protein is expressed at twice the dose on many immune cells in females compared to males, and the immune response to coronavirus is therefore amplified in females.' 
However, it could simply be that females are less likely to show symptoms, and therefore be diagnosed. 
Information on hospitalisation status was available for around a third of the US child coronavirus cases studied by CDC.
An estimated 5.7 per cent to 20 per cent needed hospital care.
Babies under the age of one are most likely to be in that group, according to the government's first in-depth analysis.
Between 0.58 per cent and two per cent (15 children) were admitted to intensive care, and three sadly died. 
The rates for children are significantly lower than for adults between 18 and 65, up to a third of whom require hospital care with up to 4.5 per cent needing intensive care.
CDC researchers emphasised the findings are still based on incomplete data, as most cases lacked information on disease symptoms, severity or patients' underlying conditions.
But despite the limitations, the data show COVID-19 may be producing different symptoms in the young.
That confirms published studies from China, where the virus originated, suggesting the illness known as COVID-19 might be overlooked in children even as they are spreading it to adults.
Where data was available, it was found that 56 per cent of children had a fever, compared with 71 per cent in adults. 
Cough was a symptom in 54 per cent of children versus 80 per cent of adults. Shortness of breath developed in 13 per cent of those under 18 versus 43 per cent of adults under age 65.
Muscle aches and pains, sore throat, headache, and diarrhea were also less common in children. One child who tested positive for the disease had no symptoms at all. 
A third of the paediatric cases were found in New York City, which has become the epicentre of the US outbreak.
Some 23 per cent were from the rest of New York, 15 per cent were in New Jersey and 29 per cent were from the rest of the country.
A separate CDC report aimed to breakdown the risk of coronavirus complications - which has already been done for Chinese and Italian patients.
Of 122,653 cases, information on underlying health conditions and known risk factors was available for 7,162 (5.8 per cent).
The data showed 28 per cent of current smokers and 47 per cent of former smokers needed to be hospitalised or placed in intensive care. 
But only 2.3 per cent of the CDC cases had a history of smoking, which doesn't represent the 14 per cent smoking rate in the general population..
HOW DO OUTCOMES COMPARE IF COVID-19 ADULT PATIENTS HAVE OR HAVEN'T GOT A HEALTH CONDITION?

HospitalisedICU
Underlying health conditionUnderlying health condition
AgeYesNoYesNo
19-6418.1-19.9%6.2-6.7%8.5-9.4%1.8-2%
65 +41.7-44.5%16.8-18.3%20.8-22.2%5.8-6.3%
Total 19+27.3-29.8%7.2-7.8%13.3-14.5%2.2-2.4%
HOW MANY PATIENTS WITH EACH CONDITION NEEDED HOSPITAL CARE? 
Underlying health conditionTotal in dataPercentage that were hospitalisedPercentage that went to ICURecovered without hospitalisationHospital status unknown
Diabetes78432%19%42%7%
Chronic lung disease65623%14%55%7%
Heart disease64737%20%37%5%
Former smoker16528%20%48%4%
Current smoker9623%5%64%8%
Pregnant14322%3%50%25%

A separate CDC report also showed exactly how different conditions raise the risk of developing coronavirus complications. Half of former smokers or diabetics needed to be hospitalised and/or placed in intensive care. Pictured, ventilation for coronavirus patients
A separate CDC report also showed exactly how different conditions raise the risk of developing coronavirus complications. Half of former smokers or diabetics needed to be hospitalised and/or placed in intensive care. Pictured, ventilation for coronavirus patients
It either means the data doesn't include enough smokers, or that smokers are at less risk of catching the coronavirus in the first place.
Studies of coronavirus patients who smoke have produced contrasting findings - at least one study has suggested they are at lower risk of getting infected. 
The data analysis showed one in ten diagnosed patients had diabetes - the most common problem. Less than half of these patients recovered at home.
Two-thirds of patients with heart disease (nine per cent of cases studied), needed care in hospital or ICU. 
The findings reveal what scientists have been warning off for weeks - those with health conditions are more likely to become seriously ill.
Up to 30 per cent of those with existing health conditions had to be hospitalised, compared to around 7.6 per cent of COVID-19 patients who were typically healthy.
Some 14 per cent with pre-existing health problems were admitted to an ICU, compared with 2.3 per cent of those without. 
More than seven in ten people receiving hospital care - because their symptoms were persistent - were people with existing conditions.
This rose to eight in ten for people receiving ICU care, which includes ventilation or intravenous fluids. 
A staggering 94 per cent of deaths were reported in those with at least one health condition.
 WHAT ARE THE OUTCOMES FOR US COVID-19 PATIENTS DEPENDING ON WHAT HEALTH CONDITION THEY HAVE?
Underlying health condition/%Not hospitalisedHospitalised, without ICUICUHospitalisation status unknown
Diabetes (10.9%)6%24%32%10%
Chronic lung disease (9.2%)7%15%21%9%
Heart disease (9%)5%23%29%6%
Immunocompromised condition (3.7%)3%6%9%4%
Chronic kidney disease (3%)1%9%12%2%
Chronic liver disease (0.6%)1%1%2%0.20%
Former smoker (2.3%)2%4%7%1%
Current smoker (1.3%)1%2%1%2%
Pregnancy (2%)1%3%1%7%
Neurological disease (0.7%)0.30%2%2%1%
One or more conditions (37.6%)27%71%78%41%
Coronavirus warning for smokers: Experts says addicts face a greater risk of complications - but Chinese studies suggest they may be LESS likely to end up in hospital in the first place 
Smokers face a greater risk of coronavirus and put their loved ones at risk, according to a stark warning from Public Health England.
Health chiefs said there has 'never been a more important time' to quit the habit than now because of the ever-worsening outbreak in Britain. 
PHE also claimed family, including children, will also be at a higher risk of serious COVID-19 complications, as a result of inhaling secondhand smoke.
They based their advice on a 'small but impactful' study in China, which suggests smokers are more likely to see their disease progress. 
But one team of experts from Wuhan - where the pandemic began - were mystified after finding smokers were less likely to catch the deadly virus in the first place.
However, leading experts who have scoured all of the available evidence collated so far say the proof is scarce and warnings are based solely on assumptions.  
Scientists have called for further trials to clarify if smoking poses a real threat, but admit, in general, smokers are more susceptible to infection.
The tiny hairs inside the airways and lungs, which help move pathogens and mucus away, are often damaged by the toxic chemicals in cigarette smoke. 
Smokers face a greater risk of coronavirus and put their loved ones at risk, according to a stark warning from Public Health England.

Smokers face a greater risk of coronavirus and put their loved ones at risk, according to a stark warning from Public Health England.
The largest study which analyses health profiles of patients is published in the New England Journal of Medicine. Of the 173 patients who had severe symptoms, 16.9 per cent of them were current smokers and 5.2 per cent had previously smoked. In comparison, of the patients with less-severe symptoms, 11.8 per cent were current smokers and 1.3 per cent were former smokers

The largest study which analyses health profiles of patients is published in the New England Journal of Medicine. Of the 173 patients who had severe symptoms, 16.9 per cent of them were current smokers and 5.2 per cent had previously smoked. In comparison, of the patients with less-severe symptoms, 11.8 per cent were current smokers and 1.3 per cent were former smokers

Researchers at the Zhongnan Hospital of Wuhan University made the conclusion that only 1.4 per cent of 140 hospitalised patients were smokers

Researchers at the Zhongnan Hospital of Wuhan University made the conclusion that only 1.4 per cent of 140 hospitalised patients were smokers
A study of 41 patients found that none of the 13 patients who needed to be admitted to ICU were current smokers. In contrast, 11 per cent (three) of those who did not need intensive care were smokers

A study of 41 patients found that none of the 13 patients who needed to be admitted to ICU were current smokers. In contrast, 11 per cent (three) of those who did not need intensive care were smokers 
One study of 140 coronavirus patients found that among the 58 patients who severely ill, 3.4 per cent (two people) were current smokers and 6.9 per cent (four) were former smokers. In comparison, of the 82 with milder symptoms, none were current smokers and 3.7 per cent (three) were former smokers

One study of 140 coronavirus patients found that among the 58 patients who severely ill, 3.4 per cent (two people) were current smokers and 6.9 per cent (four) were former smokers. In comparison, of the 82 with milder symptoms, none were current smokers and 3.7 per cent (three) were former smokers

WHAT DO THE FIVE STUDIES LOOKING AT SMOKERS SHOW? 

Leading experts who have scoured all of the available evidence collated so far say the proof smoking raises the risk of coronavirus is limited.
The group of experts even admitted warnings made by health chiefs were based mainly on assumptions, given the known infection risks of smoking. 
The team, based at the Harvard School of Dental Medicine and the University of Crete in Greece, reviewed five of the first studies on smoking and COVID-19.
Research showed smokers do face a greater risk of suffering complications but others suggested they were less likely to be infected in the first place.
The review of the evidence, led by Harvard's Dr Constantine Vardavas, was published in the journal Tobacco Induced Diseases
Study 1:  Wei Liu and colleagues at three tertiary hospitals in Wuhan, China.
How many people were involved?
78
How many of them were smokers?
Unclear
Where were the results published?
What did it find?
The patients who progressed had a 'significantly' higher number smokers compared to the patients who got better – 27 per cent compared three per cent.
Study 2: Guan et al at 552 hospitals in 30 provinces or regions of China.
How many people were involved?
1,099
How many of them were smokers?
A total of 12.6 per cent (137) were current smokers and 1.9 per cent (21) were former smokers.
Where were the results published?
What did it find?
Among the 173 patients with severe symptoms, 16.9 per cent (29) were current smokers and 5.2 per cent (nine) were former smokers.
In comparison, 11.8 per cent (108) of the 926 with milder symptoms were current smokers, and 1.3 per cent (12) were former smokers.
In the group of patients that either needed mechanical ventilation, admission to an ICU or died, 25.5 per cent were current smokers and 7.6 per cent were former smokers.
But in the group of patients that did not have these adverse outcomes, only 11.8 per cent were current smokers and 1.6 per cent were former smokers.
Study 3: Jin-jin Zhang and colleagues at No. 7 Hospital of Wuhan, China.
How many people were involved?
140
How many of them were smokers?
Some 6.4 per cent were either current smokers (two) or past smokers (seven).
Where were the results published?
What did it find?
Among the 58 patients who severely ill, 3.4 per cent (two people) were current smokers and 6.9 per cent (four) were former smokers.
In comparison, of the 82 with milder symptoms, none were current smokers and 3.7 per cent (three) were former smokers. 
Study 4: Fei Zhou and colleagues at Jinyintan Hospital and Wuhan Pulmonary Hospital, Wuhan, China.
How many people were involved?
191
How many of them were smokers?
Six per cent (11 people) were current smokers
Where were the results published?
What did it find?
Among those that died (54), nine per cent (five people) were current smokers. Of those who survived, four per cent (six people) were smokers.
Study 5: Chaolin Huang, of Jin Yin-tan Hospital, Wuhan, China, and colleagues.
How many people were involved?
41
How many of them were smokers?
Seven per cent (three people) were current smokers
Where were the results published?
What did it find?
None of the 13 patients who needed to be admitted to ICU were current smokers. In contrast, 11 per cent (three) of those who did not need intensive care were smokers.
ARE THE STUDIES REPRESENTATIVE OF THE REAL SMOKING POPULATION? 
In all of the studies, fewer than 15 per cent of the patients were smokers - a figure that clashes with China's smoking rate. 
The WHO says 300million people in China smoke - roughly a fifth of the country's total population and a third of the world's total.
Data from a national survey conducted by China in 2015 found up to 60 per cent of men between the ages of 45 and 64 smoke.
British researchers were clueless as to why the NEJM study, the largest studies on this topic, had such low rates of smokers (12.6 per cent), especially given 28 per cent of patients were between 50 and 64. 
In a statement, PHE said: 'If you smoke, you are not only putting yourself at greater risk of developing severe disease from the COVID-19 virus, but those around you exposed to second hand smoke, including children, are also put at increased risk.
'The repetitive hand to mouth movement provides an easy route of entry for the virus, putting smokers at greater risk of contracting COVID-19.' 
PHE said COVID-19 - the disease caused by the SARS-CoV-2 virus - attacks the respiratory system, 'which explains why smokers are at greater risk'.
It pointed to one 'small but highly impactful survey' which took place at The Central Hospital of Wuhan, China. Wuhan is the city where the pandemic began in December.
Doctors followed 78 COVID-19 patients with pneumonia for two weeks, to assess how their health profile affected their outcomes. The findings were published in the Chinese Medical Journal.
The patients whose conditions worsened had a 'significantly' higher number smokers compared to the patients who got better – 27 per cent compared three per cent.
Researchers who led the study also concluded that a history of smoking was a risk factor for disease progression, increasing the odds by 14 times. 
The study was one of five evaluated by a team of experts led by the Harvard School of Dental Medicine, who aimed to settle whether the debate over whether smokers should be concerned.
All of the five studies reviewed looked at either the risk of infection, disease progression or death among smokers in Chinese patients.
The largest of them all, published in the New England Journal of Medicine in February, involved 1,099 patients.
Of the 173 patients who had severe symptoms, 16.9 per cent of them were current smokers and 5.2 per cent had previously smoked.
In comparison, of the patients with less-severe symptoms, 11.8 per cent were current smokers and 1.3 per cent were former smokers.
In a group of patients that either needed mechanical ventilation, admission to an intensive care unit, or ultimately died, a quarter were current smokers – more than twice the rate than in patients who did not have such adverse outcomes. 
It confirmed the findings of a smaller study in Wuhan which showed more than ten per cent of COVID-19 patients who were severely ill were either smokers or former smokers.
In comparison, of those with milder symptoms, none we current smokers. Just under four per cent had smoked previously, the findings in Allergy show.  
Another study of 191 patients, published in The Lancet, showed a higher proportion of smokers among victims (nine per cent) than survivors (four per cent).  
But not all the evidence suggests a negative prognosis for smokers. A study published in The Lancet made no connection between serious COVID-19 illness and smokers.
Among 41 patients, none of the 13 who needed to be admitted to intensive care were current smokers, the team in Wuhan said. But there were smokers in the group who fared better. 
Similarly, researchers at Zhongnan Hospital of Wuhan University - whose work was not included in the meta-analysis - were mystified after finding smokers were less likely to catch the deadly virus in the first place.
They made the conclusion that only 1.4 per cent of 140 hospitalised patients were smokers.
Writing in the journal The Lancet,  the researchers added: 'The exact underlying causes of the lower incidence of COVID‐19 in current smokers are still unknown.' 
But they admitted: 'The outcome of SARS‐CoV‐2 infection in smokers may be more severe.'
Although further research is warranted, smoking is 'most likely associated with the negative progression and adverse outcomes of COVID-19', the Harvard team concluded in the journal Tobacco Induced Diseases
Doctors across the world have echoed the concern and called for further trials, aware that smokers generally are in danger of picking up more infections. 
Dr James Gill, a locum GP and honorary clinical lecturer, Warwick Medical School, said: 'Possibly one of the biggest reasons smokers are at increased risk of respiratory infections is the impairment and death of the cilia in the airways and lungs.
'In simple terms, the airways are lined with cilia - small brush-like hairs - these structures provide an absolutely vital function in moving mucous, inhaled debris and potentially infectious agents out of the airways and lungs before an infection can take hold.' 
Dr Tom Wingfield, a senior clinical lecturer and honorary consultant physician, Liverpool School of Tropical Medicine (LSTM), highlighted the tendency of smokers to have a health condition.
They have higher rates of high blood pressure, high disease and chronic lung, 'all of which themselves are risk factors for severe COVID-19'.
But Professor Gordon Dougan, department of medicine, University of Cambridge, said it's 'too early' to make a call on whether smoking impacts COVID-19 infection.
'However, we do know that smoking does impair normal lung function in many ways,' he said.  
Professor John Newton, director of health improvement at PHE said: 'In light of this unprecedented COVID-19 pandemic, there has never been a more important time to stop smoking. Not only for your own health but to protect those around you. It will also help alleviate the huge pressures on the NHS.' 

WHY MAY SMOKERS BE MORE AT RISK OF SEVERE CORONAVIRUS? 

Dr James Gill, a locum GP and honorary clinical lecturer, Warwick Medical School, said: 'Smoking is a significant risk factor for coronavirus infections and, in fact, infections generally. 
'There are many interlocking factors as to why smoking reduces the body’s ability to fight an infection.
'Possibly one of the biggest reasons smokers are at increased risk of respiratory infections is the impairment and death of the cilia in the airways and lungs.
'In simple terms, the airways are lined with cilia - small brush-like hairs - these structures provide an absolutely vital function in moving mucous, inhaled debris and potentially infectious agents out of the airways and lungs before an infection can take hold.'
Increased levels of carbon monoxide in the blood, a by-product of smoking, blocks the blood's ability to carry oxygen to cells in the body.
It puts smokers at a pre-disposed disadvantage if they catch coronavirus, considering the disease leaves patients unable to get enough oxygen into the bloodstream due to lung inflammation.
Dr Tom Wingfield, a senior clinical lecturer and honorary consultant physician, Liverpool School of Tropical Medicine (LSTM), said: 'Smoking both increases someone’s vulnerability to infection (repetitive touching of hand-to-face and hand-to-mouth) and reduces their ability to fight against it resulting in more severe disease.'
He highlighted the tendency of smokers to have a health condition, such as high blood pressure, high disease and chronic lung, 'all of which themselves are risk factors for severe COVID-19'.
Professor Gordon Dougan, department of medicine, University of Cambridge, said: 'The real danger lies in the lung and systems damage COVID causes. It will make people more vulnerable to secondary bacterial and viral infections. It is known that lung damage per say does that.
'I would recommend that people stop smoking but, having lost my own sister to lung cancer, know it is not easy.'

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