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Hospitalization rates for the flu and COVID-19 are strikingly similar among children

This fall, many children will be hospitalized for seasonal influenza A and B while the COVID-19 pandemic is still ongoing. The prevalence of co-circulating respiratory viruses will make it difficult to recognize and prevent coronavirus infection. 

Researchers at the Children’s National Hospital have compared the clinical features of children with COVID-19 to those with seasonal flu. The study revealed that there are no statistically significant differences in the rates of hospitalization, admission to the intensive care unit, or mechanical ventilator use between the two groups.

According to Dr. Xiaoyan Song, another unexpected finding was that more patients with COVID-19 reported fever, cough, diarrhea or vomiting, headache, body ache or chest pain at the time of diagnosis compared to those with seasonal influenza.

“I didn’t see this coming when I was thinking about doing the study,” said Dr. Song. “It took several rounds of thinking and combing through the data to convince myself that this was the conclusion.”

The knowledge that children have more symptoms at the time of COVID-19 diagnosis is valuable information, especially considering that there are still so many unknowns about the disease.

“It’s a good cue from a prevention and planning perspective,” said Dr. Song. “We always emphasize early recognition and early isolation with COVID. Having a clinical picture in mind will assist clinicians as they diagnose patients with symptoms of the coronavirus.”

The study was focused on 315 children who tested positive for COVID-19 between March 25 and May 15, 2020, and 1,402 children who were diagnosed with influenza A or B during the last flu season at Children’s National. 

Of the patients who tested positive for COVID-19, 52 percent were male with an average age of 8.4 years. In this group, 17.1 percent were hospitalized, including 5.7 percent who were admitted to the intensive care unit (ICU) and 3.2 percent who received mechanical ventilator treatment.

Among the patients who tested positive for influenza A or B, 52 percent were male with an average age of 3.9 years. The hospitalization rates were strikingly similar to those recorded among pediatric COVID-19 patients – 21.2 percent were hospitalized, 7 percent were admitted to the ICU, and 1.9 percent received mechanical ventilator support. In both groups, fever was the most often reported symptom at the time of diagnosis followed by cough. 

The experts identified an abrupt decline of influenza cases at Children’s National after local schools closed in March due to COVID-19. Dr. Song noted that the impact of school closures on the spread of COVID-19 is the next area of study for her research team.

“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 COVID-19 and burdens on the health care system.”

Dr. Song urges members of the community to, first and foremost, stay calm and be strong. “We’re learning new and valuable things about this virus each day, which in turn improves care. The collision of the flu and COVID-19 this fall could mean an increase in pediatric hospitalizations. That’s why it’s important to get your flu shot, because it can help take at least one respiratory virus out of circulation.”

The study is published in the journal JAMA Network Open.

By Chrissy Sexton, Staff Writer


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