Hospitalization, hypoxemia (abnormally low level of oxygen in the blood), pneumonia, and other complications were found more frequently in children who had COVID-19 compared to those who had the seasonal flu, according to a study published in Pediatrics.
The researchers drew from databases in the US, Europe (the Netherlands, Spain, the UK, Germany and France) and Asia (South Korea and China) to analyze data on over 240,000 18 years and younger diagnosed as having COVID-19 from January to June 2020, 4.0% of whom were hospitalized.
The investigators then comprehensively characterized this large international cohort of pediatric and adolescent patients infected with SARS-CoV-2 and almost 2 million with previous seasonal influenza (during the 2017-18 season) across 5 countries. They compared 30-day outcomes, including hospitalization, death, pneumonia, and multi-system inflammatory syndrome in children (MIS-C).
Among the COVID-19 patients, asthma was the most common comorbidity, ranging from 10.1% in Spain to 28.1% in the United States. Obesity was the second most common condition (1.9% in France; 19.0% in US).
Health conditions were more prevalent among the hospitalized: For instance, in the US IQVIA-OpenClaims database, 34.1% had asthma, 29.7% had heart disease, 18.0% were obese, 14.0% had congenital malformations, and 9.3% had cancer. In the two US databases covering about 2,300 hospitalized patients with no prior observation, 54.2% to 57.1% of 2,267 patients were 4 or under. In the three databases with hospitalized subgroups with 1 year of prior observation (one South Korean, two American), those percentages dwindled from 17.1% to 27.3% among roughly 7,500 children.
Hospitalization rates were higher for COVID-19 than for flu in all databases save one. For example, it was 3.5% versus 0.9%, 33.2% versus 7.4%, and 30.8% versus 3.7% in three US databases. In the OPTUM-EHR-US system, though, hospitalization rates were 7.6% for COVID-19 and 10.6% for flu.
The study highlights that complications including hospitalization, hypoxemia and pneumonia were more frequent in children/adolescents with COVID-19 than with influenza. Dyspnea (shortness of breath), anosmia (partial or complete loss of the sense of smell) and gastrointestinal symptoms could help differential diagnosis.
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Dr. Melvin Sanicas (@Vaccinologist) is a physician-scientist specializing in vaccines, infectious diseases, and global health.