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A single-center study of 315 pediatric COVID-19 patients and 1,402 children with seasonal flu found no difference in rates of hospitalization, intensive care unit (ICU) admission, or mechanical ventilation between the two groups.
The retrospective cohort study, published today in JAMA network open, compared the clinical characteristics of children diagnosed with coronavirus between March 25 and May 15, 2020, with those diagnosed with influenza between October 1, 2019 and June 6, 2020 at Children’s National Hospital in Washington , DC.
Fifty-four of 315 COVID-19 patients (17%) were hospitalized, 18 (6%) of whom were admitted to the ICU. Ten (3%) required mechanical ventilation.
Of 1,402 patients who tested positive for influenza A or B, 291 (21%) required hospitalization (143 [49%] of which had type A and 148 (51%) of which had type B). Ninety-eight of the 1,402 influenza patients (7%) required ICU care and 27 (2%) required mechanical ventilation.
There were no significant differences in the duration of mechanical ventilation between the two groups of patients (mean, 10.1 days for COVID-19 patients vs 7.0 for influenza patients). No patient had both coronavirus and flu.
Flu cases fell sharply after pandemic-related school closings began on March 15 and authorities issued stay-at-home orders on April 1. The flu-positive test rate decreased from 22% in mid-March to 0.3% (one case only) from March 22 to June 6. Two patients with influenza A died; no deaths were reported among patients with COVID-19 or influenza B.
Age, symptoms, underlying diseases
Hospitalized patients with COVID-19 were older than those hospitalized with influenza A or B (mean, 9.7 vs. 4.2 years). Thirty-seven percent of COVID-19 patients were over the age of 15, compared to just 6% of flu patients. Although the study population was primarily pediatric, the age range for both groups was wide, 0.03 to 35.6 years for COVID-19 patients and 0.04 to 40.4 years for patients with flu.
Thirty-five of 54 hospitalized patients with COVID-19 (65%) had one or more underlying illnesses, which was significantly higher than the rate in hospitalized patients with influenza (121 of 291 [42%]). The most common underlying conditions in COVID-19 patients were neurological problems related to global developmental delay or seizures (11 of 54 COVID-19 patients [20%] vs 24 of 291 patients with influenza [8%]).
Both groups had similar rates of asthma, heart and blood conditions, and cancer, and more frequently reported symptoms of fever and cough. There was no difference between the percentages of patients reporting cough, congestion, sore throat, or shortness of breath.
But compared to flu patients, a higher percentage of hospitalized coronavirus patients reported fever (76% of COVID-19 patients vs. 55% of flu patients), diarrhea, or vomiting (26% vs. 12% ]headache (11% vs. 3%), body or muscle aches (22% vs. 7%), and chest pain (11% vs. 3%).
More hospitalized COVID-19 patients had fever, cough, diarrhea or vomiting, and body and muscle aches than hospitalized influenza A patients, while there were no significant differences in those symptoms or in headache and chest pain among coronavirus patients and those with influenza B.
Fall flu shots
The authors said that given the large percentage of hospitalized COVID-19 patients with underlying conditions, vulnerable people should get a flu shot to prevent serious illnesses that could require hospitalization during the fall and winter.
Noting the large drop in flu cases and the lack of coronavirus and flu co-infections after school closings and stay-at-home orders were issued, they also called for more studies on the potential benefits of such community interventions to reduce infection rates and ease hospital burdens. during waves of disease.
Lead author Xiaoyan Song, PhD, MSc, MB, said the study has important implications for school closure decisions. “We want to assess the quantitative impact of school closings in order to determine at what point the cost of closing schools and staying home outweighs the benefit of reducing COVID-19 transmission and burdens on the healthcare system,” he said in a press release from the hospital.
