Nasopharyngeal reverse-transcriptase polymerase chain reaction assay for SARS-CoV-2 is considered the gold standard for diagnosing COVID-19 infections. However, multiple reports in adults with acute COVID-19 have shown positive tracheobronchial reverse-transcriptase polymerase chain reaction for SARS-CoV-2 despite initial negative nasopharyngeal testing.1–5  Furthermore, viral nucleic acid appears to persist longer in the lower respiratory tract than in the upper respiratory tract in adults, suggesting that the lower respiratory tract may be a more accurate sampling site later in the course of infection.

Children with COVID-19 generally have less severe symptoms than adults, including significantly fewer cases of respiratory compromise and an increased likelihood of asymptomatic infection.7–9  Lack of symptoms is insufficient to rule out lower respiratory tract disease, and characteristic ground glass opacities have been observed on chest computed tomography in asymptomatic children.10  However, it...

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