With the onset of the influenza season coupled with the novel coronavirus disease (COVID-19) pandemic, clinicians warn that these respiratory viruses may cocirculate and present similarly among children.

In a comparison of pediatric patients who were diagnosed with either COVID-19, seasonal influenza A, or seasonal influenza B, researchers found no statistically significant differences in clinical factors including hospitalization rates and mechanical ventilator use. Full study results have been published in JAMA Network Open.

Pediatric patients who were diagnosed with laboratory-confirmed COVID-19 between March 25 and May 15, 2020, and children who were diagnosed with laboratory-confirmed seasonal influenza between October 1, 2019, and June 6, 2020, were included in the study. Medical record review was performed to collect patients’ underlying medical conditions and symptoms at the time of diagnosis.

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A total of 315 patients tested positive for COVID-19; 52% were male, and the median age was 8.4 years. Of these patients, 17% required hospitalization including 6% who required admission to the intensive care unit (ICU) and 3% who underwent treatment with a mechanical ventilator.

A total of 1402 patients tested positive for either influenza A or B; 53% were male, and the median age was 3.9 years. Of these patients, 21% were hospitalized (49% for influenza A and 51% for influenza B). Seven percent were admitted to the ICU and 2% required mechanical ventilator support.

A greater number of patients with COVID-19 reported fever, diarrhea or vomiting, headache, body ache and myalgia, and chest pain than patients who had influenza A or B. No difference was found in the number of patients hospitalized with COVID-19 vs those with seasonal influenza who reported congestion, sore throat, and shortness of breath.

Compared with patients with seasonal influenza, patients with COVID-19 had a similar rate of admission to the ICU. Rates of mechanical ventilator use as well as ventilator use duration were also similar. No patients were hospitalized with coinfection, and only 2 patients with influenza A died.

Patients hospitalized with COVID-19 were older than those hospitalized for seasonal influenza. The majority of patients hospitalized with COVID-19 had at least 1 underlying condition (65%) compared with only 42% of those with influenza. In both groups, fever was the most often reported symptom at the time of diagnosis followed by cough.

“As the COVID-19 pandemic continues and the 2020-2021 influenza season approaches, findings from our study may inform the prompt identification and treatment of children with a respiratory viral infection in health care facilities,” concluded the authors.


Song X, Delaney M, Shah RK, Campos JM, Wessel DL, DeBiasi RL. Comparison of clinical features of COVID-19 vs seasonal influenza A and B in US children. JAMA Netw Open. 2020;3(9):e2020495.