New Research at UH Rainbow Babies & Children's Hospital Evaluates Critical Illness from COVID-19 vs Influenza in Children

CLEVELAND, Ohio – Researchers at University Hospitals Rainbow Babies & Children’s Hospital (UH Rainbow) published new findings today that show COVID-19 is not equivalent to influenza infection for pediatric patients. Among 66 pediatric intensive care units (ICU) in the United States, the number of patients admitted each quarter with a primary diagnosis of COVID-19 or multisystem inflammatory syndrome in children (MIS-C) during the first 15 months of the pandemic was twice as high as that for influenza before the pandemic.

“We wanted to do this study because of the frequent comparisons between COVID-19 and flu, particularly around kids and in discussions for public health measures,” says the study’s principal investigator, Steven L. Shein, MD, Chief of Pediatric Critical Care Medicine at UH Rainbow. “We found the impact to pediatric hospitalization among the two viruses are not equivalent and, in fact, children admitted with COVID-19 or MIS-C experienced longer stays and required more invasive treatments like mechanical ventilation than children admitted with the flu.”

Researchers used the Virtual Pediatric Systems database (VPS) to compare epidemiology and outcomes of patients in the pediatric ICU with a primary diagnosis of influenza (April 2018 to March 2020) or COVID-19 and MIS-C (April 2020 to June 2021). The VPS database identified 1,561 pediatric ICU patients with influenza (~200 per quarter) and 1,959 patients with COVID-19 (~400 per quarter). Patients with COVID-19 had a higher risk of mortality, but actual mortality did not differ.

The influenza data is from a time with no public health measures in place, while the data for COVID-19 occurred during masking, social distancing and remote learning. “It’s important to note those measures did help to decrease critical illness from many respiratory viruses and nearly eliminated influenza admissions to pediatric ICUs,” says Dr. Shein, who is also the Linsalata Chair in Pediatric Critical Care and Emergency Medicine, and Associate Professor of Pediatrics at Case Western Reserve University School of Medicine. “Without them in place, especially for this largely unvaccinated population, we can assume COVID-19 would have led to even more critically ill children.”

The study includes limitations, including the different severities associated with strains of COVID-19. Also, the vaccine was not widely available to this population, so the findings best represent unvaccinated children. Lastly, public health measures and pediatric ICU admissions have been associated with negative learning and mental health outcomes. These outcomes warrant consideration but were unmeasurable in this study.

This study was financially supported by the UH Rainbow Department of Pediatrics.