key: cord-0813891-09rzjhwu authors: Yılmaz, Kamil; Şen, Velat; Aktar, Fesih; Onder, Cihan; Yılmaz, Engin Deniz; Yılmaz, Zulfikar title: Does Covid‐19 in children have a milder course than Influenza? date: 2021-06-27 journal: Int J Clin Pract DOI: 10.1111/ijcp.14466 sha: d12478c13b726e953b8faf8de18bb923eed85db5 doc_id: 813891 cord_uid: 09rzjhwu BACKGROUND: In December 2019, a novel type of coronavirus infection emerged in the Wuhan province of China and began to spread rapidly. In this study, we aimed to determine the differences between COVID‐19 disease and Influenza. METHODS: This retrospective study included 164 children with COVID‐19, as well as 46 children with Influenza. The two groups were compared with respect to clinical and laboratory parameters and the rates of intensive care and mechanical ventilation requirement. RESULTS: In both groups, the most common admission complaints were fever and cough. As compared to the COVID‐19 group, the Influenza group had significantly higher rates of cough (37 [80.4%] and 38 [23.2%]), fever (31 [67.4%] and 34 [20.7%]), muscle pain (34 [73.9%] and 31 [18.9%]), vomiting (13 [28.9%] and 8 [4.9%]) and tachypnea (32 [69.6%] and 3 [1.8%]) (P < .01 for all comparisons). The mean WBC count (7.10 ± 1.08 vs. 10.90 ± 1.82), mean neutrophil count (3.19 ± 0.58 vs. 6.04 ± 0.97), APTT, CRP, procalcitonin, ALT, and LDH levels were significantly lower in the COVID‐19 group compared to the Influenza group (P < .05 for all comparisons). There was, however, no significant difference between the mean lymphocyte counts of both groups. The Influenza group had significantly higher rates of intensive care requirement (19 [41.3%] vs. 3 [1.8%]) and mechanical ventilation requirement (16 [34.8%] vs. 2 [1.2%]) as well as a significantly higher mortality rate (7 [15.2%] vs. 2 [1.2%]) than the COVID‐19 group (P < .01). CONCLUSION: COVID‐19 and Influenza may share similar clinical features. According to our findings, however, we believe that COVID‐19 disease has a milder clinical and laboratory course than Influenza in children. In December 2019, a novel type of coronavirus infection emerged in the Wuhan province of China and began to spread rapidly. The disease is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Since then, the virus has affected more than Studies have shown that the SARS-CoV-2 virus binds to angiotensin-converting enzyme 2 (ACE2) receptors to infect epithelial cells that line the inner surface of the respiratory and gastrointestinal tracts. 2 The virus is highly contagious and is transmitted from symptomatic or asymptomatic infected persons via close contact or aerosols. 3 Many studies have shown that COVID-19 disease may have a milder or asymptomatic course in children compared to adults. 4 Of note, however, the number of Multisystem Inflammatory syndrome in Children (MIS-C) cases that develop after SARS-Cov-2 infection Results: In both groups, the most common admission complaints were fever and cough. As compared to the COVID- 19 and tachypnea (32 [69.6%] and 3 [1.8%]) (P < .01 for all comparisons). The mean WBC count (7.10 ± 1.08 vs. 10 .90 ± 1.82), mean neutrophil count (3.19 ± 0.58 vs. 6 .04 ± 0.97), APTT, CRP, procalcitonin, ALT, and LDH levels were significantly lower in the COVID-19 group compared to the Influenza group (P < .05 for all comparisons). There was, however, no significant difference between the mean lymphocyte counts of both groups. The Influenza group had significantly higher rates of intensive care requirement ( has started to increase gradually. 5 Nevertheless, the clinical course of COVID-19, the pathophysiology of MIS-C, and its long-term complications in children remain unclear. Influenza is an acute respiratory disease caused by Influenza A, B, and rarely Influenza C viruses. It emerges, especially in the autumn and winter. Symptoms such as fever, cough, sore throat, and malaise are commonly observed. Although it usually leads to a selflimiting and uncomplicated disease in healthy children, it may be a source of morbidity and mortality due to underlying chronic disorders and age. 5 Both SARS-COV-2 and influenza viruses have the potential of human-to-human transmission via droplets. Children exposed to these viruses may have mild symptoms such as fever, cough, muscle pain, and sore throat, but they may also have clinical presentations severe enough to require intensive care or advanced respiratory support. 6 A review of the literature indicates that a limited number of studies have compared these two diseases in children. [6] [7] [8] In the present study, we aimed to compare the clinical and laboratory features of the pediatric cases caused by SARS-CoV-2 and influenza viruses, which have different characteristics and to determine if they have any differences. Twenty-three patients in the Influenza group and 11 patients in the COVID-19 group were excluded from the study due to missing or incomplete medical records. Clinical and laboratory data, intensive care requirement, and mortality rate of the two groups were compared. Patients who were older than 18 years, as well as patients whose clinical and laboratory data could not be accessed, were excluded from both groups. The study was conducted based on the rules of the Declaration of Both SARS-COV-2 and influenza viruses have the potential of human-to-human transmission via droplets. Fever and cough were the most common symptoms in the COVID-19 and Influenza patients. Children exposed to these viruses may have mild symptoms such as fever, cough, muscle pain, and sore throat, but they may also have clinical presentations severe enough to require intensive care or advanced respiratory support. Fever, cough, sore throat, and myalgia were much more prominent in Influenza patients. COVID-19 patients had significantly lower WBC and neutrophil counts and APTT, CRP, procalcitonin, ALT, and LDH levels compared to the Influenza patients, whereas the two groups had similar lymphocyte counts. We determined that the Influenza patients had higher rates of intensive care and mechanical ventilation requirement. rates of intensive care and mechanical ventilation requirement. the Kaplan-Meier method and compared using the log-rank test. A P value < .05 was considered significant. There was no significant difference between the two groups with respect to mean age and sex distribution (P = .47, P = .18, respectively). The Influenza patients had a significantly higher length of hospitalization, higher rates of intensive care and ventilatory support requirement, and higher mortality rate as compared with the COVID-19 group (Chi-square test) (Table 1) (P < .01). When we compare the 2 groups in terms of treatment; Oseltamivir, steroid and oxygen usage rates were significantly higher in influenza patients (P < .01). However, according to the Kaplan-Meier analysis, no significant difference was found between the two groups in terms of length of hospitalization and survival rate (Figure 1 ). The median follow-up time was 3 days (range: 1-28 days). Cough, fever, muscle pain, and malaise were the most common admission complaints in both groups. As compared with the COVID-19 group, the Influenza group had significantly higher rates of cough ( The Influenza group had lower mean hemoglobin and red blood cell distribution width (RDW) but significantly higher white blood cell (WBC) and neutrophil counts than the COVID-19 group (P < .05). There was no significant difference between the two groups in terms of the mean thrombocyte and lymphocyte counts and the mean platelet volume (P > .05). Among the coagulation parameters, only APTT was significantly greater in the Influenza group (P < .01) ( Table 4 . Common clinical symptoms may be seen in infections affecting the respiratory tract. A review of the previous studies comparing the Influenza and COVID-19 symptoms revealed that fever and cough were the most common symptoms in both groups. 6, 8, 13 It was also reported that the rates of fever, cough, respiratory difficulty and gastrointestinal symptoms were significantly higher in Influenza patients compared to COVID-19 patients. 7, 8, 13 Our study results, which indicated that fever, cough, and myalgia were the most common symptoms in both groups, are also in accordance with literature reports. However, fever, cough, myalgia, respiratory difficulty, sore throat, vomiting, and nasal discharge were significantly more common in the Influenza patients compared to the COVID-19 patients. Our results indicate that, although the same symptoms may be seen in both diseases, lower rates of fever, cough, 20 Our results support this view. Our study had some limitations. Our study data were retrospectively obtained from the medical records of patients hospitalized in a single center. Another study limitation is that the number of Influenza patients was smaller than that of the COVID-19 patients. In addition, the absence of a vaccination history in any of the Influenza patients in our study group may have led to different results than the previous studies. In conclusion, the clinical symptoms and laboratory parameters of the Influenza and COVID-19 diseases may share similar features. Fever and cough were the most common symptoms in the COVID-19 and Influenza patients. However, fever, cough, sore throat, and myalgia were much more prominent in Influenza patients. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. The data that support the findings of this study are available from the corresponding author upon reasonable request. 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