Of the 8,626 SARS-CoV-2 RT-PCR tests performed in children (0–17 y) from March 2020 to July 2021, 1470 (17%) were positive, including 711/4821 (14.7%) during the first wave (July 2020 to January 2021), and 759/3583 (21.2%) children during the second wave (February 2021 to July 2021) (Table 1). Of these 1470 children [ages 3 d to 17 y; 790 (53.7%) boys], 731 (49.7%) were managed at home, while 739 (50.3%; 417 in the first wave and 322 in the second wave) were admitted for a non-COVID illness (620/739) or since parent(s) were admitted for COVID-19 (119/739). The patients in both the waves were similar in age distribution [median (IQR) 9 (3, 14) versus 8 (2, 13) y], gender (55.3% males versus 52.9% males) and presentation (mildly symptomatic 74.1% versus 80.2%). None of the children had COVID pneumonia. Fifteen children had diarrhea (without dehydration). None had central nervous system manifestations. Overall, 5 children died (0.3%), all of a serious primary non-COVID disease (one each with end-stage renal disease; acute lymphoblastic leukemia and tumor lysis syndrome; GM2 gangliosidosis and status epilepticus; toxic shock syndrome; and end-stage renal disease with uremic encephalopathy). These pediatric deaths formed only 0.5% of all 1053 deaths among those with SARS-CoV-2 infection at the authors' institute. Out of the 1470 children in this report, 89 were neonates. Their ages ranged from 3 to 28 d, respectively. Five of them had low grade fever, while 10 had mild cough. The rest were asymptomatic. None of these had respiratory distress or required oxygen. There were no neonatal deaths.

Seventy-three cases of MIS-C [median (range) 4.5 y (0.2, 14); 63% males] during August 2020 to July 2021, including 8 (10.9%) who were positive for SARS-CoV-2 RNA were identified. Though these children had significant illness including myocardial dysfunction [40 (54.8%)], coronary artery aneurysms [29 (39.7%)], oxygen requirement [10 (13.7%)], mechanical ventilation [7 (9.6%)] and inotropes [22 (30.1%)], the mortality was low (2/73; 2.7%). Those with Kawasaki phenotype [33 (45.2%)] required intravenous immunoglobulin, the remaining required methylprednisolone. Both the children who died of MIS-C had arrived late, with refractory shock and endotracheal intubation. Out of the 73 cases of MIS-C, 43 were from Puducherry, and the rest from other states.