Dear Editor,

We read with keen interest the remarks made by Al-Mendalawi,1 and thank him for his interest in our manuscript.2

In our study, we described the epidemiological aspects of the first 1304 laboratory-confirmed cases (incidence) in Oman. Oman has a strong communicable disease surveillance system across all governorates and regions within the country. It is unlikely we have missed some cases, particularly in the pediatric age group, as the country was providing the COVID-19 screening services to all health facilities free of charge at the time of the study.

The role of children in spreading the coronavirus has been a key question since the early days of the COVID-19 pandemic. In addition, the reality aspect of COVID-19 is that children appear to be infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), far less frequently than adults and, when infected, typically have mild symptoms in up to 80% of cases. 3 About six months into the pandemic, an accumulating evidence have shown that children, particularly school-aged children, are far less important drivers of SARS-CoV-2 transmission than adults.3–5

Furthermore, another possibility is that because schools and nurseries closure occurred across the country in March 2020, which is in earlier stages of the pandemic, along with or before widespread physical distancing orders, most close contacts became limited to households, reducing opportunities for children to become infected in the community and present as index cases. This supports the low cases among the pediatric age group.

In our study, children and adolescents under 18 years old represented a smaller fraction of confirmed COVID-19 cases. These findings are largely consistent with a report on pediatric COVID-19 patients reported in China, Spain, and the US.3,6,7

Oman has already started (since 14 July 2020) implementing a nationwide sero-prevalence survey among different age groups through which the country will be able to know the prevalence of the disease among different age groups.

references

1. Al-Mendalawi MD. Is the Prevalence of the Pediatric COVID-19 Infection in Oman Underestimated? Oman Med J 2020;35(6):e208.
2. Khamis F, Al Rashidi B, Al-Zakwani I, Al Wahaibi AH, Al Awaidy ST. Epidemiology of COVID-19 infection in Oman: analysis of the first 1304 cases. Oman Med J 2020 May;35(3):e145.
3. 208. Hoang A, Chorath K, Moreira A, Evans M, Burmeister-Morton F, Burmeister F, et al. COVID-19 in 7780 pediatric patients: a systematic review. E Clinical Medicine 2020 Jun;24:100433.
4. 2. CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. Morb Mortal Wkly Rep 2020 Apr;69(14):422-426.
5. 3. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020 Jun;145(6):e20200702.
6. 4. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020 Apr;323(13):1239-1242.
7. 5. Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in madrid, Spain. JAMA Pediatr 2020 Apr:e201346.