Comparing life-threatening flu and COVID-19 illness in kids

Sept. 15, 2022
Study suggests similar outcomes between critically ill kids hospitalized for COVID and influenza, with 1 in 3 children in multi-hospital cohort needing invasive breathing support.

Flu and COVID-19 symptoms can look similar in kids – both are known to cause fever, coughing and fatigue and prompt parents to keep children home from school.

And while rare, the chance of either virus leading to critical illness in children may also be similar, suggests research by a team of pediatric intensive care researchers.

One in three children in a multi-hospital cohort who was admitted to the pediatric intensive care unit for either COVID-19 or influenza required mechanical ventilation, according to the study in Clinical Infectious Diseases conducted by the multi-hospital Pediatric Intensive Care Influenza (PICFLU) network’s Overcoming COVID-19 Investigators team.

About 16% of flu patients and 9% of COVID patients also had a secondary bacterial infection.

Researchers compared 179 children with influenza infection to 381 with COVID-19 at 16 United States hospitals. Patients with critical COVID-19 stayed longer in the PICU than kids with critical influenza and mortality was low (2-3%) but similar in both groups.

The study – led by Natasha Halasa, M.D., pediatric infectious diseases expert at Vanderbilt University Medical Center – also suggests slight differences in the viruses’ impact on different age and demographic groups.

Children hospitalized with COVID-19 were generally older than those with influenza. Almost half of the children with flu were between eight months old to under age five while more than four fifths of those with COVID-19 were aged 5–17 – of which more than half comprised the oldest age group, 13–17 years.  

Two thirds of children in the study hospitalized with influenza or COVID-19 also had an underlying medical condition but a third were otherwise healthy. Respiratory conditions were the most common underlying condition in both groups.

About half of the children with critical influenza and a fourth with COVID-19 were white. In comparison, about 40% of children with influenza and over two thirds of those with COVID-19 were Black or Hispanic.

The study excluded 850 children who were diagnosed with a rare but serious COVID-linked condition called multi-system inflammatory syndrome, or MIS-C.

MIS-C, which causes severe inflammation in vital organs and tissues, has been linked to more than 8,000 pediatric cases and 70 deaths across the country. Children with the condition were separated in this specific research because MIS-C is considered a post-acute infection, says Flori, who notes the network has focused other studies specifically on MIS-C.

U of M Health release