Distinguishing COVID-19 From Flu in Kids Remains Challenging

Medscape
16 Sep, 2020 ,

According to results of a study published online today in JAMA Network Open, children with COVID-19, rates of hospitalization, ICU admission, and ventilator use were similar to those of children with influenza, but rates differed in other respects. The retrospective cohort study included 315 children diagnosed with laboratory-confirmed COVID-19 between March 25 and May 15, 2020, and 1402 children diagnosed with laboratory-confirmed seasonal influenza A or influenza B between October 1, 2019, and June 6, 2020, at Children's National Hospital.

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For children with COVID-19, rates of hospitalization, ICU admission, and ventilator use were similar to those of children with influenza, but rates differed in other respects, according to results of a study published online today in JAMA Network Open.

As winter approaches, distinguishing patients with COVID-19 from those with influenza will become a problem. To assist with that, Xiaoyan Song, PhD, director of the Office of Infection Control and Epidemiology at Children's National Hospital in Washington, DC, and colleagues investigated commonalities and differences between the clinical symptoms of COVID-19 and influenza in children.

"Distinguishing COVID-19 from flu and other respiratory viral infections remains a challenge to clinicians. 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," Song said. "Until future data show us otherwise, clinicians need to prepare for managing coinfections of COVID-19 with flu and/or other respiratory viral infections in the upcoming flu season."

The retrospective cohort study included 315 children diagnosed with laboratory-confirmed COVID-19 between March 25 and May 15, 2020, and 1402 children diagnosed with laboratory-confirmed seasonal influenza A or influenza B between October 1, 2019, and June 6, 2020, at Children's National Hospital. The investigation excluded asymptomatic patients who tested positive for COVID-19.

Patients with COVID-19 and patients with influenza were similar with respect to rates of hospitalization (17% vs 21%; odds ratio [OR], 0.8; 95% CI, 0.6 – 1.1; P = .15), admission to the ICU (6% vs 7%; OR, 0.8; 95% CI, 0.5 – 1.3; P = .42), and use of mechanical ventilation (3% vs 2%; OR, 1.5; 95% CI, 0.9 – 2.6; P =.17).

The difference in the duration of ventilation for the two groups was not statistically significant. None of the patients who had COVID-19 or influenza B died, but two patients with influenza A did.

No patients had coinfections, which the researchers attribute to the mid-March shutdown of many schools, which they believe limited the spread of seasonal influenza.

Patients who were hospitalized with COVID-19 were older (median age, 9.7 years; range, 0.06 – 23.2 years) than those hospitalized with either type of influenza (median age, 4.2 years; range, 0.04 – 23.1). Patients older than 15 years made up 37% of patients with COVID-19 but only 6% of those with influenza.

Among patients hospitalized with COVID-19, 65% had at least one underlying medical condition, compared with 42% of those hospitalized for either type of influenza (OR, 2.6; 95% CI, 1.4 – 4.7; P = .002).