The authors reply.

It is well recognized in the current coronavirus disease 2019 (COVID-19) pandemic that disease patterns in children are different compared with adults (1), recently published in Pediatric Critical Care Medicine. The disease has been milder and we are still discovering its varied manifestations in the critically ill, such as multisystemic inflammatory syndrome of children and adolescents. There are many unknowns and the pathogenesis, clinical features, and therapeutic options are likely to be revealed over time. We thank Lanziotti et al (2) for their thoughtful letter, highlighting the many unknowns with COVID-19 in children, revealing theories of immunopathogenesis in children, and how that could impact acute disease and the development of immunity, including vaccine design.

These are fundamental questions that the global community needs urgent answers on, and we encourage all of the readers to ensure maximal collaboration to answer these questions together. Given the relative rarity of pediatric disease requiring hospitalization or critical care, combining data, both biological and clinical, should be a fundamental goal of our community at this time. Understanding disease in children will provide tremendous insight into preventing and managing it across age groups, as well as guide population health interventions.