COVID-19 in Kids is Pretty Darn Flu-Like

With one big difference.

“It’s just the flu”.  We all heard that sentiment early on in the coronavirus crisis. But statements like that have died down as the death total has gone up. With nearly 200,000 Americans dead from COVID-19, compared to 50-60,000 dead from flu and pneumonia in a bad flu season, it’s pretty clear this ain’t the flu.

At least, for most of us.

But a new study in JAMA Network Open finds that, among kids, Coronavirus is, well, pretty darn flu-like.

Researchers from Children’s National Hospital in Washington, DC examined 315 kids with laboratory-confirmed COVID-19, and compared them to historical controls – kids with lab-confirmed influenza A and B.

The presenting symptoms were pretty similar across the groups – though fever and myalgia were a bit more common among kids with COVID-19. This is a problem, actually. 

In kids, COVID-19 presents an awful lot like every other respiratory virus they come down with. Winter is coming, and with it not just flu but RSV, adenovirus, rhinovirus and their ilk – the only way to tell if a kid has the common cold – read: can still go to school – is robust, rapid testing for coronavirus. And, right now, we don’t have it. That means a lot of kids will be sidelined due to non-COVID respiratory illness while they wait for test results.

But what about outcomes?  Not many differences here either.

Hospitalization rates, ICU rates, and vent rates were all pretty similar.  Kids with COVID were hospitalized a bit longer, but that may have been out of an abundance of caution given the novel nature of the disease.

Deaths? None in the COVID group, just 2 in the flu groups.

In contrast to Flu, which affects younger kids more, the kids with COVID were older. Fully 28% in the 15-20 year old age group compared to just 5% in the flu groups.

Looking at all this data, parents like me may breathe a bit easier. COVID, in kids at least, acts a lot like the flu.

But there’s a few gaps in the data to remember.  Most kids recover fully after a bout of the flu. We don’t yet know what the long-term consequences of COVID infection are. I would have liked a breakdown on how many of the kids in this study developed the multisystem inflammatory syndrome of children, for example, but we aren’t given that data.

And there’s one more, simpler concept to remember.  This study looked at kids who were already infected.  Even if the outcomes are similar between flu and COVID, more infections will mean more outcomes. And COVID is ongoing.

Deaths per capita, COVID vs. flu

It’s pretty hard to find reliable data on the infections per capita in various age groups, but the CDC does provide information about deaths per capita, stratified by age.  I compared the 2017 flu season, the H1N1 Swine Flu Pandemic in 2009, and COVID deaths per capita among younger ages. You can see the results here.

Overall, things look pretty similar, with COVID and the flu posing particularly high risks to those under age 1.  COVID, of course, starts outstripping flu by a large margin when it comes to deaths in the older age groups. But keep in mind, that COVID is ongoing. Those blue and green bars won’t change anymore, but as more kids get infected and some die, the red bars keep growing.

This commentary first appeared on medscape.com.