Comparison of the Disease Course of COVID-19 and Seasonal Coronavirus Infections in Children

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To the Editors: We have read with great interest the article by Bayhan et al1 entitled “Is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Now More Like the Seasonal Coronaviruses Following Its Evolution?” Although SARS-CoV-2 is considered endemic in many parts of the world, the extent to which COVID-19 shares clinical findings with seasonal coronaviruses (sCoVs) is not yet fully understood. This article stated that sCoV infections have a higher lower respiratory tract infection (LRTI) risk than COVID-19 and COVID-19 has a milder course than sCoV infections in children. However, the study period was different for each group, particularly patients infected with sCoVs were included in postpandemic period. Herein, we shared our data about pediatric patients due to SARS-CoV-2 during pandemic period between April 2020 and December 2021 versus sCoV. Therefore, our data provide more clear opportunity to understand the actual nature of disease courses of the mentioned infections within the same environment. This retrospective-cohort study was conducted in Ihsan Dogramaci Children Hospital, Turkey. Specimens were analyzed by multiplex real-time polymerase chain reaction and patients were divided into 3 groups: outpatients and inpatients with sCoV infection and inpatients with COVID-19 (Table 1). Of all 427, the age of inpatients infected with sCoV (2 years) and SARS-CoV-2 (10 years) was different (P < 0.001). Most of the patients (69.2%) had underlying disease in the inpatient sCoV group; 56.9% of them had LRTI, 3.1% had myocarditis and 6.2% presented with sepsis. Similarly, 69.3% of patients with COVID-19 had LRTI, 4% had myocarditis and 8% had sepsis. The leukocyte count was higher in sCoV inpatients (9.6 × 103/μL) than in COVID-19 inpatients (6.1 × 103/μL) (P = 0.003). The absolute lymphocyte count was 0.9 × 10³/uL in COVID-19 group and 2.8 × 10³/uL in inpatients with sCoV infection (P < 0.001). Respiratory support rate was significantly lower in inpatients infected with sCoV (26.2%) than COVID-19 group (66.7%) (P < 0.001). The length of hospital stays, pediatric intensive care unit admission and infection-related mortality rates were similar in both groups. COVID-19 presented with higher disease severity and increased risk of death compared with sCoV-infected adults, but there are few studies in children.1–3 In the light of the studies, the disease course of COVID-19 looks similar to sCoV infection1,2; however, it should be kept in mind that the need for respiratory support is more common in patients diagnosed with COVID-19 in the pandemic period. This is an indirect indicator of how appropriate the measures taken are to avoid increasing the burden on hospitals during the pandemic. This slightly severe disease course of the patients with COVID-19 might be attributed to the lower leukocyte and absolute lymphocyte count, but it is still not known why COVID-19 affects older children compared with sCoV. TABLE 1. - Demographic and Clinical Data of Pediatric With Seasonal Coronavirus Infection and COVID-19 Seasonal Coronavirus Infections COVID-19 Inpatients (n = 75) P Value Outpatient (n = 287) Inpatient (n = 65) Age (yrs), median (IQR) 2 (1–5) 2 (0–6.5) 10 (3–15) 0.796*, <0.001† Male, n (%) 156 (54.4) 42 (64.6) 48 (64) 0.132*, 0.94† Underlying diseases, n (%) <0.001*, 0.195† No disease 169 (58.9) 20 (30,8) 31 (41.3) Clinical symptoms, n (%) NA*† URTI 215 (74.9) 0 0 LRTI 53 (18.5) 37 (56.9) 52 (69.3) AGE 1 (0.3) 0 (0) 1 (1.3) AGE and URTI 9 (3.1) 2 (3.1) 1 (1.3) Sepsis 0 4 (6.2) 6 (8) Myocarditis 0 2 (3.1) 3 (4) Rash 5 (1.7) 0 1 (1.3) Encephalitis 0 2 (3.1) 1 (1.3) Others 4 (1.4) 3 (4.6) 4 (5.3) Laboratory, median (IQR) White blood cell (×103/μL) 8.9 (6.3–11.2) 9.6 (5.9–14.8) 6.1 (3.8–11) 0.162, 0.003† ANC (×103/μL) 3.7 (2.6–6) 4.6 (2.1–8.3) 3.9 (2.2–7.4) 0.344, 0.574† ALC (×103/μL) 2.8 (1.4–4.4) 2.8 (1.1–4.4) 0.9 (0.6–2.1) 0.689, <0.001† Platelets (×103/μL) 281 (220–347) 283 (199–399) 222 (139–295) 0.769, 0.003† Procalcitonin (ng/mL) 0.12 (0.07–0.18) 0.14 (0.07–0.54) 0.15 (0.07–0.64) 0.275, 0.723† CRP (mg/dL) 0.8 (0.4–1.9) 1.6 (0.7–6.1) 2.3 (0.6–8.7) 0.008, 0.580† Sedimentation (mm/h) 9 (3–16.5) 14.5 (2–42) 17 (7–33) 0.32, 0.575† Respiratory support, n (%) – <0.001† None 48 (73.8) 25 (33.3) Oxygen 9 (13.8) 15 (18.7) NIMV 3 (4.6) 24 (32) IMV 5 (7.7) 12 (16) LOS in hospital, median (IQR) - 8 (4–17) 7 (5–12) 0.663† PICU admission, n (%) - 6 (9.2) 9 (12) 0.597† Infection-related mortality 3 (4.6) 4 (5.3) 0.846† Overall mortality 8 (12.3) 8 (10.7) 0.761† Boldface indicates statistically significant values.*Outpatient and inpatient with seasonal coronavirus infection.†Inpatient with seasonal coronavirus infection and inpatient with COVID-19.AGE indicates acute gastroenteritis; ALC, absolute leukocyte count; ANC, absolute neutrophil count; CRP, C-reactive protein; IMV, invasive mechanic ventilation; IQR, interquartile range; LOS, length of stay; NA, not applicable; NIMV, noninvasive mechanic ventilation; PICU, pediatric intensive care unit; URTI, upper respiratory tract infection. Among the patients with COVID-19, there was a greater need for respiratory support compared with sCoV-infected cases with no difference in pediatric intensive care unit admission and infection-related mortality. In other words, both members of the Coronaviridae family pose risks in terms of severe disease. It is essential to pay attention to pediatric patients with sCoV and consider public health interventions and clinical management strategies.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.