TY - JOUR T1 - What do differences in case fatality ratios between children and adults tell us about COVID-19? JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01852-2020 VL - 56 IS - 1 SP - 2001852 AU - Fabio Midulla AU - Luca Cristiani AU - Enrica Mancino Y1 - 2020/07/01 UR - http://erj.ersjournals.com/content/56/1/2001852.abstract N2 - We thank S. Ebmeier and A.J. Cunnington for their commentary on our editorial [1], providing another point of view on such a controversial topic. In their letter, S. Ebmeier and A.J. Cunnington assume that the greater burden of coronavirus disease 19 (COVID-19) in adults may be related to the absence in the population of prior immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as occurred in fully susceptible populations during previous viral epidemics. In particular, Shanks et al. [2] report that the measles mortality rate in a fully susceptible population during the 1846 measles epidemic was higher in adults and in children aged <2 years. However, nowadays, children younger than 5 years and adults older than 20 years are still more likely to suffer from measles complications, despite not being fully susceptible [3]. Moreover, Strebel et al. [4] reported that the case fatality ratio is still high in children aged <1 year, lower in children aged 1–9 years, and then rises again in teenagers and adults. The reported data suggest that greater morbidity and mortality in adults is not a unique feature of first-contact measles epidemics.Other reasons, rather than absence of prior immunity, could play a crucial role in the coronavirus dilemma that surrounds children https://bit.ly/36BzTaD ER -