New York—COVID-19 is not just like a bad case of the flu, even in children and adolescents.

That is according to a new global study of 30-day outcomes in children and adolescents with COVID-19. Columbia University researchers and colleagues determined that, while death was uncommon, infection with SARS-CoV-2 produced more symptoms and complications than seasonal influenza. Asthma and obesity—prevalent among a general pediatric population—were the most common baseline comorbidities.

The study, which was published online in the journal Pediatrics, also found wide variation in how children and adolescents hospitalized with COVID-19 were treated.

In response to views that ranged from COVID-19 in children and adolescents being no more than the common flu to a significant danger to lesser-developed immune systems, the Observational Health Data Sciences and Informatics (OHDSI) global network, which is based at Columbia, gathered real-world observational data on more than 242,000 children and adolescents diagnosed with COVID-19, including nearly 10,000 hospitalized youths. They then compared that information to more than 2 million in that cohort diagnosed with influenza across five countries—France, Germany, South Korea, Spain, and the United States.

The study team determined that neurodevelopmental disorders, heart disease, and cancer were more common among hospitalized patients versus those just diagnosed with COVID-19. The researchers also report that dyspnea, bronchiolitis, anosmia, and gastrointestinal symptoms were more common in COVID-19 than influenza.

The study noted that in-hospital prevalent treatments for COVID19 included repurposed medications (<10%) and adjunctive therapies including:
• Systemic corticosteroids (6.8%-7.6%)
• Famotidine (9.0%-28.1%)
• Antithrombotics such as aspirin (2.0%-21.4%)
• Heparin (2.2%-18.1%)
• Enoxaparin (2.8%-14.8%).

Hospitalization occurred in 0.3% to 1.3% of the COVID-19–diagnosed cohort, with a 30-day fatality rate so small it was undetectable. Other 30-day outcomes, including pneumonia and hypoxemia, were more frequent in COVID-19 than influenza, however.

“Despite negligible fatality, complications including hospitalization, hypoxemia and pneumonia were more frequent in children/adolescents with COVID-19 than with influenza,” the authors wrote. “Dyspnea, anosmia and gastrointestinal symptoms could help differentiate diagnoses. A wide range of medications was used for the inpatient management of pediatric COVID-19.”

The authors point out that knowledge was limited early in the pandemic, with estimates of COVID-19 hospitalization rates for children and adolescents ranging from 5.7% to 63%.

“This study addressed critical questions that were weighing down on both the healthcare community and the general population—how was COVID-19 impacting our youngest population,” explained lead investigator Talita Duarte-Salles, PhD, an epidemiologist at IDIAP Jordi Gol in Barcelona, Spain. “While some last year claimed that COVID-19 was no different than the flu, the real-world evidence we generated through open science showed something quite different. It was a relief to see that fatality was rare, but clearly, both complications and symptoms showed the COVID-19 was no flu in children and adolescents.”
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