From COVID-19 to Influenza—Real-Life Clinical Practice in a Pediatric Hospital

Abstract

The COVID-19 pandemic, through the restrictions and the non-pharmaceutical interventions implemented, has importantly impacted the circulation and epidemiology of respiratory viruses. Specifically, the 2020/21 season was entirely dominated by SARS-CoV-2, while influenza activity reached an all-time low, despite initial warnings that a double concurrent epidemic could be possible. The current season, 2021/22, started with the shift of circulating SARS-CoV-2 variants from delta to omicron, which then rapidly spread globally, as most countries, including Romania, removed all restrictions and compulsory non-pharmaceutical interventions. In this report we present the clinical reality observed in March 2022 in a tertiary paediatric hospital in Bucharest, Romania, where we observed a sudden surge in influenza cases, after two consecutive years (March 2020 to March 2022) when influenza had stopped circulating in our country. Thus, in March 2022 the positivity rate of rapid influenza antigen tests unexpectedly increased to 33.5%, paralleled by a decrease to 7.5% in the positivity rate of rapid SARS-CoV-2 antigen tests. This significant increase in the influenza attack rate was observed from the first week (14.9% positivity rate), through the fourth week of March (42.1% positivity rate, p < 0.001), while the COVID-19 attack rate displayed a significant decreasing trend (from 11.2% to 4.8%, p < 0.001). These data serve as a warning about relaxing restrictions in a precipitous approach with minimised vigilance. The evolution of these observations needs to be followed very carefully in all countries, particularly in settings where epidemiological interactions and non-pharmaceutical interventions have so far led to the extensive circulation of only one of these viruses, and we should now be prepared to perform a correct differential diagnosis between influenza and COVID-19, in order to ensure the best quality of care and personalized management of each case of respiratory infection. The results of active influenza surveillance studies for the whole 2021/22 season are awaited, in order to quantify the joint influenza—COVID-19 burden among children.

Real-World Use of Molnupiravir in the Treatment of Outpatients with SARS-CoV-2 Infection—A Patient Profile Based on the Experience of a Tertiary Infectious Disease Center

“…Having learned important epidemiological lessons from influenza [25], it is important to be able to translate these findings into actionable clinical advice and to see to what extent we can extrapolate them to COVID-19. Therefore, now that antivirals against SARS-CoV-2 are becoming available, our main focus should be on identifying the patient population who would most benefit from treatment, ensuring timely access to treatment, and tailoring treatment to the patient's needs.…”

Remdesivir Efficacy and Tolerability in Children with COVID-19-Associated Allergic Comorbidities such as Asthma, Allergic Rhinitis, and Atopic Dermatitis

“…For children under 40 kg, a single dose of 5 mg/kg on day one was prescribed, followed by a daily dose of 2.5 mg/kg from day 2 up to 10 days of hospitalization. Children who were 40 kg or more at screening received a single 200 mg dose on day one, followed by a daily 100 mg dose for the next days (2)(3)(4)(5)(6)(7)(8)(9)(10). The severity of the disease was classified according to the national guidelines into mild, moderate, and severe disease.…”

“…In Romania, the prevalence of pediatric COVID-19 cases within the overall number of COVID-19 cases diagnosed between 1 July 2020 and 30 September 2022 had its peak hospitalization rate during the final pandemic months (See Figure 1). The peak during the Omicron variant was roughly higher than the peak during the previous Delta variant period, with the biggest differences occurring in infants [9,10].…”

“…The peak during the Omicron variant was roughly higher than the peak during the previous Delta variant period, with the biggest differences occurring in infants. [9,10]. The results of the pollen monitoring in Bucharest during the previous years revealed a sizable number of allergenic pollen.…”

Changing patterns of infectious diseases in children during the COVID-19 pandemic

“…The “see-sawing” and “upsurging” patterns were also observed for influenza infections. Following two years of decline in influenza virus circulation during the early COVID-19 pandemic, influenza infection rates increased in 2022, coinciding with a decrease in SARS-CoV-2 infections ( Miron et al., 2022a ; Lei et al., 2023 ; Rao et al., 2023b ). Relaxation of non-pharmacological interventions subsequently resulted in a significant accumulation of influenza infections, leading to a widespread influenza outbreak.…”