Children have more complications with COVID than with flu, study finds

Hospitalization, hypoxemia, pneumonia, and other complications were found more in children who contracted COVID-19 than in those who had seasonal flu, according to a study today in Pediatrics.

The researchers drew from databases in France, Germany, Spain, South Korea, and the United States to analyze data on 242,158 youth (18 years and younger) diagnosed as having COVID-19 from January to June 2020, 4.0% of whom were hospitalized. They then compared 30-day outcomes, including hospitalization, death, pneumonia, and multi-system inflammatory syndrome in children (MIS-C), with 2,084,180 children who had the flu during the 2017-18 season.

Among the COVID-19 patients, asthma was the most common comorbidity, ranging from 10.1% in Spain to 28.1% in the United States. Obesity was the second most common condition (1.9% in France; 19.0% in US). Health conditions were more prevalent among the hospitalized: For instance, in the US IQVIA-OpenClaims database, 34.1% had asthma, 29.7% had heart disease, 18.0% were obese, 14.0% had congenital malformations, and 9.3% had cancer.

In the two US databases covering about 2,300 hospitalized patients with no prior observation, 54.2% to 57.1% of 2,267 patients were 4 or under. In the three databases with hospitalized subgroups with 1 year of prior observation (one South Korean, two American), those percentages dwindled to 17.1% to 27.3% among roughly 7,500 children.

Hospitalization rates were higher for COVID-19 than for flu in all databases save one. For example, it was 3.5% versus 0.9%, 33.2% versus 7.4%, and 30.8% versus 3.7% in three US databases. In the OPTUM-EHR-US system, though, hospitalization rates were 7.6% for COVID-19 and 10.6% for flu.

“Overall, all outcomes were more frequent in children/adolescents with COVID-19 diagnosis than those with a diagnosis of seasonal influenza in 2017-2018, suggesting more severe disease prognosis in children with COVID-19 than influenza,” the researchers write.

Despite this, the researchers said they were reassured that 30-day mortality was negligible and that particular complications were low, such as MIS-C : 0.5% to 3.1% in non-hospitalized groups but up to 7.6% in hospitalized groups. Because shortness of breath, loss of smell or taste, and gastrointestinal symptoms were more pronounced in the COVID-19 cohort than the flu cohort, they add that those symptoms may help with diagnosis.
May 28 Pediatrics study

Colchicine lowers hospitalization, death rate in COVID-19 outpatients

Outpatients with lab-confirmed COVID-19 who received colchicine had lower hospitalization and death rates than those given a placebo, according to a randomized, controlled trial yesterday in The Lancet Respiratory Medicine. The anti-inflammatory drug has been used for ailments such as gout, pericarditis, and coronary disease.

The phase 3 study consisted of 2,235 outpatients who took 0.5 milligrams (mg) of colchicine twice a day for 3 days, then once a day for 27 days. These were matched with 2,253 outpatients who received a placebo. Participants were enrolled a median of 5.3 days after symptom onset from Mar 23 to Dec 22, 2020, and they hailed from Brazil, Canada, Greece, South Africa, Spain, and the United States.

All participants were above 40 years and had at least one high-risk criterion, such as being above 70 or being obese. The median age was 53 years, and 55.4% were women.

Hospitalization and death were not linked significantly with the colchicine intervention overall, but when the analysis was narrowed to outpatients confirmed by polymerase chain reaction (PCR) tests, data showed a 25% reduced likelihood (4.6% vs 6.0%; 95.1% confidence interval [CI], 0.57 to 0.99 odds ratio).

Serious adverse events occurred in 4.9% of colchicine patients and 6.3% of placebo recipients. Pneumonia was less prevalent in the intervention group (2.9% vs 4.1%), but diarrhea was more common (13.7% vs 7.3%). Overall, the researchers say that 24.2% of adverse events in the colchicine group and 15.5% in the placebo group were related to the trial.

“Is colchicine likely to become a first-line treatment for community management of early COVID-19? The answer is probably not,” Clark D. Russell, BmedSci, MBChB, of the University of Edinburgh, writes in a commentary. “This trial does however add proof of principle of two important therapeutic concepts—progression of COVID-19 lung injury can be inhibited to prevent hospital admission and anti-inflammatory therapy can achieve this.”
May 27 Lancet Respir Med study and commentary
Feb 5 CIDRAP News scan on small colchicine study

Black people have less trust in medicine, COVID vaccines, survey says

A survey of 1,835 Michigan residents found higher levels of medical mistrust and lower levels of COVID-19 vaccine acceptance in Black people, according to a JAMA Network Open study yesterday.

The survey was conducted from June to December 2020 with a convenience sample. Most respondents (79.3%) were women, and 52.4% were White. Black people made up the second largest racial/ethnic group, with 21.5%. Participants’ mean age was 49.4 years, and they were fairly split between three income levels. 

Overall, 75.0% reported a low willingness to participate in COVID-19 vaccination trials, and 51.5% had a low willingness to receive the vaccine in general. Black people displayed the most medical mistrust among the racial/ethnic groups: On a Likert scale where 1 was “definitely yes” and 5 was “definitely no,” the mean value for medical trust was 1.84, but Black people reported 2.35, followed by Hispanic people (who made up 4.6% of respondents), with 2.22.

Less vaccine trial rejection was found among men, those with lower medical mistrust scores, and those with at least a college degree. Those with income less than $35,000 a year were more likely to reject COVID-19 vaccines in general compared with those who made $35,000 to $75,000.

“In this survey study, racial/ethnic group-based medical mistrust partially mediated the association between Black race and lower acceptance of COVID-19 vaccine trial participation and actual vaccination,” the researchers write.
May 27 JAMA Netw Open study