Childhood Rheumatic Diseases and COVID-19 Pandemic: An Intriguing Linkage and a New Horizon

As it is known, we are all in a pandemic situation due to a novel coronavirus, officially named “Severe Acute Respiratory Syndrome Coronavirus 2” and the disease caused by the virus named “Coronavirus disease-2019”. The virus seems to has propensity to infect older male individuals with underlying disease. The clinical features were on a large scale that varies from being an asymptomatic carrier to acute respiratory distress syndrome and multiorgan dysfunction. Fever, dry cough and fatigue are the most common symptoms. Not only, the disease seems to be rare and have a milder course in pediatric age but also respiratory failure, multiorgan dysfunction, and death are extremely rare. Although several comorbidities such as hypertension, diabetes and cardiovascular diseases are defined as a risk factor for developing the acute respiratory syndrome and need for intensive care; immune-compromised situations such as rheumatic disease which require immunosuppressive treatment strikingly are not found to be a risk factor for more severe disease course. However, there is a lack of data regarding the effects of “Coronavirus disease-2019” on pediatric patients with rheumatic diseases. Additionally, there are three controversial circumstances that patients with rheumatic diseases are believed to be more likely to have viral infections like “Severe Acute Respiratory Syndrome Coronavirus 2”, on the other hand, antirheumatic drugs may have a protective and therapeutic role in Coronavirus disease-2019 and children are more unlikely to have serious disease course. Therefore, we aimed to have a contributor role for explaining this conundrum and present a bird’s eye view regarding this equivocal issue in this review. In December 2019, a cluster of acute viral pneumoniae cases with unknown origin emerged in Wuhan, Hubei province, China (1). Most of the cases had a common exposure to the Huanan wholesale seafood market (2). Several days later, causative viral agent was analyzed with deep sequencing and indicated as a novel coronavirus, officially named 2019 novel coronavirus (2019 nCoV) (3). Coronavirus Study Group (CSG) of the International Commission on Virus Classification named this novel coronavirus “Severe Acute Respiratory syndrome Coronavirus 2 (SARS-CoV-2)” on February 11, 2020 and on the same day, the World Health Organization (WHO) named the disease caused by SARS-CoV-2, “Coronavirus disease-2019 (COVID-19)” (4). In a couple of weeks, severe COVID-19 cases were all over the world, and on the basis of disease severity and spread, finally WHO characterized the COVID-19 situation as a pandemic on March 11th, 2020 (5). In the past two decades, addition to this current pandemic, we experienced two different coronavirus outbreaks, and previous two were named “Severe Acute Respiratory Syndrome Coronavirus” (SARS-CoV) and “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV) (6). Bats are known to be reservoir hosts for SARS-CoV and MERS-CoV (7). Given the findings of genomic analyze of SARS-CoV-2, bats are assumed to be origin of also COVID-19 pandemic (8). Although intermediary animals between bats and humans are uncertain, pangolin and snakes seem to be leading suspects (2).