Study suggests COVID-19 in children is milder than the flu

By Lakshmi Supriya, PhD.Jun 14 2021

Researchers retrospectively analyzed the medical records of children in Turkey hospitalized because of coronavirus disease 2019 (COVID-19) or influenza and found COVID-19 to be milder than influenza in this group.

Several studies have suggested that COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is milder in children than in adults. However, some children develop multisystem inflammatory syndrome in children (MIS-C) after recovering from COVID-19.

Just like COVID-19, another respiratory disease caused by viruses is influenza, with similar symptoms such as cough, fever, and sore throat. It also spreads by airborne transmission. In healthy children, it usually lasts for a few days, and then the children start to recover, but it can be fatal in very young children and those with other diseases.

There are few studies as yet that compare these two diseases in children. In a new study published recently, researchers from Dicle University School of Medicine in Turkey compared influenza and COVID-19 in children to determine if they have any differences.

Study: Does Covid-19 in Children Have a Milder Course than Influenza? Image Credit: FamVeld / Shutterstock

The team recently published their study in The International Journal of Clinical Practice.

Comparing symptoms and treatments

The study included 175 children less than 18 years old who had COVID-19 confirmed by RT-PCR tests. The children were hospitalized between March and November 2020. The study also included 69 hospitalized patients who were diagnosed with influenza A or B between January 2016 and November 2020. The authors analyzed their medical records to conduct their study.

Of the hospitalized COVID-19 patients, just over half were male. The children stayed in the hospital between 2 and 14 days. Two patients died, and three needed intensive care. Of the children hospitalized with influenza, 89% had the A subtype, just under half were male, and about 41% needed intensive care. Seven patients in this group died. None of these children had ever had a flu shot.

Upon analyzing the data, the team found that the flu patients had higher hospital stays, higher rates of intensive care and ventilatory support, and higher mortality compared to COVID-19 patients. Steroid and oxygen use rates were also higher in the children hospitalized for influenza.

Both groups of children complained of cough, fever, and muscle pain. Children with the flu had higher rates of several symptoms like cough, fever, sore throat, and muscle pain, similar to what has been found before.

The lower rates of fever, cough, sore throat, and other symptoms seen in COVID-19 patients suggest milder symptomatic infection compared to influenza. However, given the occurrence of MIS-C, it is possible that the outcomes may be different as we understand more about COVID-19 or with the emergence of new viral variants.

Testing biochemical parameters

The children admitted with flu also had lower red blood cell counts and higher white blood cell and neutrophil count than the children infected with COVID-19. These results are similar to what other studies have found, but more studies are needed to understand this further.

Other biochemical parameters like C-reactive protein, procalcitonin, and lactate dehydrogenase (LDH) were much higher in children with influenza compared to children with COVID-19. Studies have found the levels of these biochemicals increase in severe COVID-19, and monitoring these levels in COVID-19 patients is necessary. Based on their results, the authors also recommend this should be done in hospitalized children with COVID-19.

Previous studies have reported similar rates of admission to the intensive care unit (ICU) for children with influenza and COVID-19. However, in this study, the authors found higher rates of death, intensive care, and ventilator requirement than those found in previous studies. This could be because of other underlying conditions, the presence of MIS-C, or flu vaccination status of the individuals. In general, the study found COVID-19 to be milder in children than influenza.

Considering the possibility that COVID 19 will become permanent in our lives for  many  years, like Influenza, the results of our study may provide a preliminary idea to differentiate these two diseases sharing similar clinical and laboratory features in  cases where clinicians cannot isolate the causative virus,” write the study authors.