text: Pathophysiology of COVID 19 Why Children Fare Better than Adults The world is facing Coronavirus Disease 2019 COVID 19 pandemic which is causing a large number of deaths and burden on intensive care facilities It is caused by Severe Acute Respiratory Syndrome coronavirus 2 SARS CoV 2 originating in Wuhan China It has been seen that fewer children contract COVID 19 and among infected children have less severe disease Insights in pathophysiological mechanisms of less severity in children could be important for devising therapeutics for high risk adults and elderly Early closing of schools and day care centers led to less frequent exposure and hence lower infection rate in children The expression of primary target receptor for SARS CoV 2 i e angiotensin converting enzyme 2 ACE 2 decreases with age ACE 2 has lung protective effects by limiting angiotensin 2 mediated pulmonary capillary leak and inflammation Severe COVID 19 disease is associated with high and persistent viral loads in adults Children have strong innate immune response due to trained immunity secondary to live vaccines and frequent viral infections leading to probably early control of infection at the site of entry Adult patients show suppressed adaptive immunity and dysfunctional over active innate immune response in severe infections which is not seen in children These could be related to immune senescence in elderly Excellent regeneration capacity of pediatric alveolar epithelium may be contributing to early recovery from COVID 19 Children less frequently have risk factors such as co morbidities smoking and obesity But young infants and children with pre existing illnesses could be high risk groups and need careful monitoring Studies describing immune pathogenesis in COVID 19 are lacking in children and need urgent attention 