Covid-19 and flu can be equally dangerous for children and cause serious forms of infection, warns study
As fall approaches, pediatric hospitals are expecting to see children with seasonal flu. At the same time, Covid-19 will be co-circulating in communities with the flu and other respiratory viruses, making it more difficult to identify and prevent the novel coronavirus, say experts. A research team has now confirmed that both Covid-19 and flu can be dangerous for children. They did not find any significant difference in the rates of hospitalization, admission to the intensive care unit (ICU), and mechanical ventilator use between children who had either Covid-19 or seasonal influenza A and B. This suggests that children with Covid-19 or flu can be equally susceptible to severe illness.
“Our study confirmed that both Covid-19 and flu can be dangerous to children. Both viruses can cause serious forms of infection leading to hospitalization, ICU care, and the use of a mechanical ventilator. Considering that Covid-19 has been associated with Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but severe condition that has been reported approximately 2-4 weeks after the onset of Covid-19 in children and adolescents, we are concerned that Covid-19 may pose a greater risk on the health of kids than influenza,” the study’s principal investigator Dr Xiaoyan Song, director of infection control and epidemiology at Children’s National Hospital, US, told MEA WorldWide (MEAWW). She adds, “Therefore, it is prudent to protect children and adolescents from getting Covid-19. Strategies like wearing masks, avoiding crowds, maintaining social distancing and washing hands frequently are very effective. We urge parents to incorporate these strategies into their kid’s daily life.”
According to the investigators, another unexpected finding was that more patients with Covid-19 than those with seasonal influenza reported fever, cough, diarrhea or vomiting, headache, body ache, or chest pain at the time of diagnosis. Given that much remains unknown about Covid-19, the discovery that children with the disease present with more symptoms at the time of diagnosis is a valuable one, says the team. “I didn’t see this coming when I was thinking about doing the study. It took several rounds of thinking and combing through the data to convince myself that this was the conclusion. It’s a good cue from a prevention and planning perspective. We always emphasize early recognition and early isolation with Covid-19. Having a clinical picture in mind will assist clinicians as they diagnose patients with symptoms of the coronavirus,” explains Dr Song, also a professor of pediatrics at the George Washington University School of Medicine and Health Sciences.
What did the researchers find?
The cohort study included 315 children who were diagnosed with laboratory-confirmed Covid-19 between March 25 and May 15, 2020, and 1,402 children who were diagnosed with laboratory-confirmed seasonal influenza between October 1, 2019, and June 6, 2020, at Children’s National Hospital. Asymptomatic patients who tested positive for Covid-19 during preadmission or preprocedural screening were excluded from the study.
Of the 315 patients who tested positive for coronavirus, 52% were male, with a median age of 8.4 years. Of these patients, 54 (17.1%) were hospitalized, including 18 (5.7%) who were admitted to the ICU and 10 (3.2%) who received mechanical ventilator treatment. Among the 1,402 patients who tested positive for influenza A or B, 52% were male, with a median age of 3.9 years, and 291 (21.2%) were hospitalized, including 143 for influenza A and 148 for influenza B. Ninety-eight patients (7%) were admitted to the ICU, and 27 (1.9%) received mechanical ventilator support. “Patients with Covid-19 and those with seasonal influenza had a similar hospitalization rate, intensive care unit admission rate, and use of mechanical ventilators,” write authors in the study published in JAMA Network Open.
The study showed a slight difference in the age of children hospitalized with Covid-19 compared to those hospitalized with seasonal influenza. Patients hospitalized with coronavirus had a median age of 9.7 years versus those hospitalized with seasonal influenza who had a median age of 4.2 years. Compared with patients hospitalized with seasonal influenza (42%), a greater proportion of patients hospitalized with Covid-19 (65%) had underlying medical conditions.
In both groups, fever was the most often reported symptom at the time of diagnosis followed by cough. A greater proportion of patients hospitalized with Covid-19 than those hospitalized with seasonal influenza reported fever (76% versus 55%), cough (48% versus 31%), diarrhea or vomiting (26% versus 12%), headache (11% versus 3%), body ache/myalgia (22% versus 7%), and chest pain (11% versus 3%). More patients hospitalized with Covid-19 than those with seasonal influenza reported sore throat or congestion (22% versus 20%) and shortness of breath (30% versus 20%), but the differences were not statistically significant.
“There may have been either an under or overestimation of the potential severity of Covid-19 in children. This paper now places that estimate in the context of something clinicians are familiar with: influenza. Although our study showed that patients with Covid-19 were more likely than patients with flu to report fever, gastrointestinal, and other clinical symptoms at the time of diagnosis, the two groups do have many overlapping clinical symptoms,” emphasizes Dr Song. She adds, “Distinguishing Covid-19 from flu and other respiratory viral infections remains a challenge to clinicians. Until future data shows us otherwise, clinicians also need to prepare for managing co-infections of Covid-19 with flu and/or other respiratory viral infections in the upcoming flu season.”
During the study period, the researchers noticed an abrupt decline of influenza cases at Children’s National after local schools closed in mid-March and stay-at-home orders were implemented about two weeks later to combat the community spread of Covid-19. The impact of school closures on the spread of Covid-19 among children is the next area of study for the investigators. “We want to assess the quantitative impact of school closures so we can determine at what point the cost of closing schools and staying at home outweighs the benefit of reducing transmission of coronavirus and burdens on the healthcare system,” says Dr Song.
Recommendations
The collision of the flu and coronavirus this fall could mean an increase in pediatric hospitalizations, and that is why it is important to get the flu shot because it can help take at least one respiratory virus out of circulation, suggest researchers. “Get kids vaccinated with the influenza vaccine now. Especially for kids with underlying medical conditions, it is extremely important to get the flu vaccine to prevent flu in the first place and to prevent flu-related complications if one catches flu,” recommends Dr Song.
According to the team, early diagnosis and early treatment remain key for optimal patient outcomes. “Diagnosis tests are available for both Covid-19 and flu. Antiviral treatment for flu is available and is more effective when used according to instructions. Collectively, clinicians and healthcare providers already have many great tools on hand. Judicious use of these tools will protect the health of providers, protect kids, and protect well-beings at large,” emphasizes Dr Song.