Infectious Disease

A 3rd of kids with COVID-19 are asymptomatic

December 11, 2020

2 min read

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About a third of the children who tested positive for SARS-CoV-2 were asymptomatic, an observational study in Canada showed.

The researchers warned that while cough and rhinorrhea were two of the most common symptoms in infected children, these symptoms were also commonly reported in around 500 children with negative test results and “did not predict” a positive SARS-CoV-2 test.

“Identifying children who are likely to be infected is challenging.” James A. King, MSc, an analyst with Provincial Research Data Services in Canada, and colleagues wrote.

The researchers reviewed data from 2,463 children who were tested for SARS-CoV-2 infection using a swab or other test between April 13 and September 30, 2020.

The results published in the CMAJ showed that 1,987 of the children tested positive for SARS-CoV-2 infection (mean age 9.3 years) and 35.9% of them were asymptomatic. Rhinorrhea and cough were two of the most common symptoms in children with positive test results (24.5% and 19.3%, respectively), but these symptoms were also common in children with negative test results (mean age 8.5 years). no prediction for a positive test (positive probability ratio) [LR] = 0.96; 95% CI, 0.81-1.14 and positive LR = 0.87; 95% CI, 0.72-1.06).

Finlay McAlister

“We can fill out any COVID-19 questionnaire we want, but if a third of the children are asymptomatic the answer is no to all questions – and yet they are infected.” Finlay McAlister, MD, MSc, A professor of medicine at the University of Alberta in Canada said in a press release.

According to the researchers, anosmia / ageusia (positive LR = 7.33; 95% CI, 3.03-17.76), nausea / vomiting (positive LR = 5.51; 95% CI, 1.74-17.43 ), Headache (positive LR = 2.49; 95%) CI, 1.74-3.57) and fever (positive LR = 1.68; 95% CI, 1.34-2.11) were the symptoms who best predicted a positive SARS-CoV-2 test in children. The positive LR for the combination of anosmia / ageusia, nausea / vomiting, and headache was 65.92 (95% CI, 49.48-91.92).

King and colleagues found that many of the symptoms seen in children who tested positive are closely the same as in adults. “It should be emphasized, however, that most of the symptoms associated with SARS-CoV-2 positivity in children were unusual and would therefore be of low sensitivity to a possible screening test.”

In a related editorial Nisha Thampi, MD, MSc, FRCPC, An assistant professor and advisor in pediatric infectious diseases at Children’s Hospital in Eastern Ontario and colleagues wrote that King and colleagues’ findings underscore the critical role hand hygiene, improved ventilation, masking, outdoor learning, and physical distancing play in preventing the spread of infection in children of school age.

References::

King JA et al. CMAJ. 2020; doi: 10.1503 / cmaj.20206.

Thampi N et al. CMAJ. 2020.doi: 10.1503 / cmaj.202568.

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Robert W. Frenck Jr., MD

This interesting article focuses on symptoms in children from a single province in Canada who tested positive for COVID-19. The symptoms they report as an indication of a positive SARS-CoV-2 test – anosmia / ageusia, nausea / vomiting, headache, and fever – are similar to what I saw in the clinic. Therefore, if you see pediatric patients with all of these symptoms, or if you are lucky enough to have a patient tell you they have them, then you should test the patient for COVID-19. However, all of these symptoms are likely to affect only a minority of children. In addition, most young children do not have the verbal precocity to say that their senses of taste and smell have disappeared.

The most common COVID-19 symptoms are those that are virtually similar to any other viral disease. Therefore, in a few weeks, when we have more cases of flu, it will be difficult to differentiate between COVID-19 and flu. Because of this, it is more important than ever to offer and encourage flu vaccination to all of your patients so that you can eradicate this as the cause of their illness.

Robert W. Frenck Jr., MD

Director of the Vaccine Research Center at Cincinnati Children’s Hospital Professor, Department of Pediatrics, University of Cincinnati

Disclosure: Frenck does not report any relevant financial information.

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