This study was hospital-based record review conducted in a tertiary care center attached to a government medical college. Data of all children (aged up to 18 years) positive for SARS-CoV-2 by RT-PCR of respiratory secretions (nasopharyngeal/oropharyngeal/nasal swab), admitted in COVID-19 ward of the hospital, from 1 April, 2020 to 31 May, 2020 were included in study. All children coming to COVID-19 OPD/ Influenza like illness OPD and suspected for COVID-19 according to ICMR guidelines, were tested by RT-PCR of respiratory secretions [3].

Nasopharyngeal or oropharyngeal or nasal swab was tested for SARS-CoV-2 by real time polymerase chain reaction (RT-PCR). We further tested all cases by RT-PCR on day 0,3,6,9,12 and 14. We repeated the RT-PCR after 24 hours of first negative test, and viral clearance was considered after two consecutive negative tests. Those with inconclusive RT-PCR for SARS-CoV-2 were re-tested. We documented history, physical examination laboratory investigations, and chest X-ray from the records. Laboratory investigations included complete blood count, liver function tests, kidney function tests, inflammatory markers (erythrocyte sediment reaction (ESR), C-reactive protein (CRP) and ferritin) and prothrombin time-international normalized ratio (PT-INR). High-resolution computed tomography chest was done in children with severe disease. Severity of illness was classified as per Dong, et al. [4] in four groups, viz. asymptomatic, uncomplicated illness, moderate disease, severe pneumonia/severe illness. All cases were treated as per institutional protocol and their clinical course was analyzed. Discharge criteria used was normal body temperature for >3 days plus two negative results on RT-PCR for SARS-CoV-2. This study was approved by the institutional ethics committee. Written consent was obtained from guardians of patients.

We took first negative RT-PCR, out of two consecutive negative tests, for deciding day of viral clearance. It was considered the number of days from symptom onset to the first negative sample defining the duration of clearance.

Statistical analyses: Data were summarized in proportions and median (IQR) was computed for viral clearance days. Chi square test was used for association between viral clearance days, age, sex and severity of disease. Results were computed using SPSS 22.0 (trial version).

Eighty-five eligible cases were enrolled in the study, of which 82 were discharged after fulfilling discharge criteria and three children died during the study. History of contact with COVID-19 cases could be traced in 52 children, out of which 24 (28.2%), 10 (11.8%) and 18 (21.2%) cases had contact with parents [father (n=10), mother (n=9) and both (n=5)], with family member other than parents (siblings and grandparents) and with COVID-19 cases other than family members, respectively. None of the children had no known medical co- morbidity.

All the three three children who died had surgical co-morbidities. One patient had ruptured liver abscess with peritonitis, another had multiple laryngeal papillomatosis, and the third child had been recently operated for ileal atresia.

Of the 16 (18.8%) symptomatic children, 7(40.4%) had severe symptoms and 4 (25%, all >5 years of age) had moderate symptoms. Viral clearance distribution in terms of sex, age, and symptoms is shown in Table I. The median (IQR) duration of viral shedding was 7(5-10) days with range of 2 to 45 days. Almost all children (98.8%) showed viral clearance in 15 days. None of the cases presented as pediatric multisystem inflammatory syndrome (PIMS) in present study.