A Surge in Pediatric Coronavirus Disease 2019 Cases: The Experience of Texas Children’s Hospital From March to June 2020

Abstract

Background An understanding of the clinical characteristics of children with coronavirus disease 2019 in diverse communities is needed to optimize the response of healthcare providers during this pandemic. Methods We performed a retrospective review of all children presenting to the Texas Children’s Hospital system with testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 10, 2020, through June 28, 2020. Demographics were recorded for all patients undergoing testing and clinical characteristics and outcomes were recorded for children with positive tests. Results Of 16 554 unique patients ≤ 21 years of age who were tested for SARS-CoV-2, 1215 (7.3%) patients tested positive. Infants under 1 year of age and patients aged 18–21 years had the highest percent of positive tests at 9.9% (230/2329) and 10.7% (79/739), respectively. Hispanic children accounted for 66% (802/1215) of positive tests, though they only represented 42.1% (6972/16 554) of all children tested for SARS-CoV-2. Of the 1215 children with a positive test, 55.7% had fever, 40.9% had cough, 39.8% had congestion or rhinorrhea, 21.9% had gastrointestinal complaints, and 15.9% were asymptomatic. Only 97 (8%) patients were hospitalized (of which 68% were Hispanic). Most of the hospitalized patients had underlying medical conditions (62/97, 63.9%), including obesity. Thirty-one hospitalized patients (31/97, 32%) required respiratory support and 9 patients (9/97, 9.3%) received SARS-CoV-2 antiviral therapy. Two patients died. Conclusions A relatively high percentage of Hispanic children tested positive for SARS-CoV-2 and were hospitalized. Most of the children with detection of SARS-CoV-2 had uncomplicated illness courses; some children were critically ill; and 2 patients died.

Evaluation of Epidemiological, Demographic, Clinical Characteristics and Laboratory Findings of COVID-19 in the Pediatric Emergency Department

“…The rate of test positivity in pediatric patients varies. In a study conducted in Texas, the test positivity rate was 7.3%, while it was found to be 4% in the first peak period of the pandemic in England [15,16]. In this study, the test positivity rate was 19.9%.…”

“…COVID-19 usually presents with symptoms of the upper RTI. Cough, fever, nasal symptoms and sore throat were reported as the most common complaints in children [15,22]. GI symptoms, such as abdominal pain, diarrhea and vomiting, may also be seen in pediatric patients.…”

A systematic review and meta-analysis of otorhinolaryngological manifestations of coronavirus disease 2019 in paediatric patients

“…The commonest otorhinolaryngological symptom was cough, followed by sore throat and nasal discharge. Previous reviews 109 have revealed the commonest presenting symptoms in children to be fever (pooled prevalence of 51 per cent; 95 per cent CI = 45-57) and cough (pooled prevalence of 41 per cent; 95 per cent CI = [35][36][37][38][39][40][41][42][43][44][45][46][47]. By comparison, the commonest otorhinolaryngological symptoms noted in adult patients, by Qiu et al, 110 were olfactory dysfunction (47 per cent), sneezing (27 per cent) and nasal congestion (19 per cent).…”

Severe Acute Respiratory Syndrome Coronavirus 2 Testing Trends Among Persons Aged <18 Years in an Outpatient Pediatric Practice — Metropolitan Atlanta, Georgia, May–December 2020

“…Our findings therefore might not be generalizable to other pediatric populations, and our finding that there were no differences in test positivity by racial or ethnic group had low power. Testing of 16,554 children at Texas Children's Hospital in Houston, a city where 46% of individuals identify as Hispanic or Latino, during this time period found 66% of Hispanic children (42% of all children) had positive tests [ 13 , 14 ]. Third, testing volume and positivity trends might have been influenced by time of year and activity entry requirements.…”