More hospitalization, complications for kids with COVID-19 than with flu
Hospitalization and respiratory complications were more frequent in children and adolescents with COVID-19 during the early months of the pandemic than in those diagnosed as having influenza in past flu seasons, an international team of researchers reported today in Pediatrics.
The multinational cohort study reviewed 19 databases in the United States, Germany, France, Spain, and South Korea for data on patients under the age of 18 with a clinical diagnosis of COVID-19 or a positive test result from SARS-CoV-2 from January through June 2020. The researchers described baseline demographics, comorbidities, symptoms, and outcomes, and included a cohort of children and adolescents diagnosed with influenza during the 2017-18 flu season for comparison.
A total of 242,158 children and adolescents with COVID-19, and 9,769 hospitalized for COVID-19, were included in the study. Most of the hospitalizations were seen in children ages 0 to 4. Comorbidities including asthma, heart disease, obesity, cancer, chromosomal disorder, and congenital malformations were more common in hospitalized COVID-19 patients than in those diagnosed as having COVID-19. The most commonly observed symptoms were fever and cough. Hospitalization was observed in 0.3% to 1.3% of the cohort, with undetectable 30-day fatality. Hypoxemia and pneumonia were the most common complications.
Comparison of outcomes in those with COVID-19 versus more than 2 million children diagnosed as having flu in 2017-18 showed that hospitalization was between 5-fold and 13-fold higher for COVID-19. Pneumonia and hypoxemia were more common for children and adolescents with COVID-19, as was multisystem inflammatory syndrome in children (MIS-C), which was rare among both cohorts. Children with COVID-19 also presented with higher rates of breathing difficulty, loss of smell, and gastrointestinal symptoms than children with seasonal influenza.
“Overall, all outcomes were more frequent in children and adolescents with COVID-19 diagnosis than those with a diagnosis of seasonal influenza in 2017–2018, suggesting more severe disease prognosis in children with COVID-19 than influenza,” the study authors write. “Future research is needed to characterize and determine the long-term outcomes of children and adolescents affected with COVID-19.”
Aug 20 Pediatrics study
Survey shows health not at baseline 1 month after COVID hospitalization
Almost 85% of COVID-19 patients hospitalized said they were not back to their pre-COVID health 1 month after discharge, and even short hospital stays were tied to prolonged symptoms, according to survey results published in the Journal of Hospital Medicine yesterday.
The researchers interviewed US adults hospitalized for COVID-19 a median of 47 days after their hospitalization, which took place from Aug 24, 2020, to Jan 26, 2021. Respondents were a median of 60 years old and stayed a median of 5 days. More than half (54.9%) reported new or worsened cardiopulmonary symptoms, 16% had new or increased oxygen use, and 52.8% had problems with daily living. Overall, 84.2% said their health was not what it was pre-COVID, and 16.8% said that on a scale of 0 to 100, with 100 being pre-COVID health, they were at 50 or less.
A longer hospital stay was associated with increased odds of cardiopulmonary issues, such as coughing, and it was also linked to disability (adjusted odds ratio [aOR], 1.82 per additional week and 2.06, respectively). Women were twice as likely to have new cardiopulmonary symptoms (aOR, 2.24), while Black and Hispanic people were less likely to report new symptoms (aOR, 0.31 and 0.38, respectively).
About 77% of patients with a new disability were discharged without home services, which the researchers say could have had an impact on their health.
“This isn’t patients saying, ‘I can’t run quite as far as I used to.’ This is them saying ‘I can’t walk, I can’t cook, I can’t shower.’ The effects are devastating,” said co-lead author C. Terri Hough, MD, in a University of Michigan (U of M) press release. “Unfortunately, we saw this even among patients with quite short hospital stays.”
The survey also looked at financial stressors post-hospitalization and found that 23% had used up their savings, 20% had to change their job or become unemployed, and 40% needed a loved one to take time off from work to look after them.
Aug 18 J Hosp Med study
Aug 18 U of M press release
Study highlights racial/ethnic disparities in excess deaths from COVID-19
A study today in Morbidity and Mortality Weekly Reports (MMWR) highlights high excess mortality from COVID-19 among racial and ethnic minorities in the United States.
Using data from the National Vital Statistics System, US researchers assessed US excess mortality incidence rates (IRs) by race/ethnicity and age-group from Dec 19, 2019, through Jan 2, 2021. Among all racial/ethnic groups, excess mortality IRs were higher in those ages 65 and older (426.4 to 1,033.5 excess deaths per 100,000 person-years) than in those ages 25 to 64 (30.2 to 221.1) and those 25 years of age and younger (2.9 to 14.1).
Among those under the age of 65, Blacks and American Indian or Alaska Native (AI/AN) had the highest excess mortality IRs, while Black and Hispanic persons had the highest excess IRs among those 65 and older. Among Black and Hispanic persons ages 65 and over, more than 1,000 excess deaths occurred per 100,000 person-years compared with the number of deaths expected to occur.
The findings also illustrate the changing impact of the pandemic over time for different subgroups. Among those aged 65 years and older, excess mortality IRs peaked from April to June 2020 for Black adults, while remaining consistently elevated among Hispanic adults, and increasing from April-June 2020 to October-December 2020 for AI/AN, non-Hispanic Native Hawaiian or other Pacific Islander (NH/PI), and White adults.
“These findings underscore the disproportionate prevalence of excess mortality during the COVID-19 pandemic in 2020 among racial/ethnic minority groups of all ages in the United States, which have been driven, in part, by factors such as occupational risk, socioeconomic factors, housing conditions, reduced access to health care, and discrimination,” the authors write.
“Identifying factors that contribute to racial/ethnic disparities in mortality, either directly or indirectly attributable to COVID-19, can help guide tailored public health prevention strategies and equitable allocation of resources, including COVID-19 vaccination (see related CIDRAP News story), to achieve greater health equity.”
Aug 20 MMWR study