Do children with severe acute respiratory infection need cohorting & isolation before screening for COVID-19?

Area of Science:

• Pediatrics
• Infectious Diseases
• Public Health

Background:

• Severe acute respiratory infection (SARI) is a significant concern in pediatric populations.
• Understanding SARS-CoV-2 transmission patterns in children is crucial for effective healthcare management.
• The need for specialized isolation facilities for pediatric COVID-19 cases requires evidence-based evaluation.

Purpose of the Study:

• To determine the SARS-CoV-2 positivity rate in children aged 0-12 years with SARI.
• To compare this rate with children without SARI.
• To assess the necessity of a dedicated SARI isolation facility for pediatric COVID-19 care.

Main Methods:

• Retrospective analysis of case records from a tertiary care center in North India.
• Inclusion of 8780 children (0-12 yr) admitted and/or tested for SARS-CoV-2 between June 2020 and May 2021.
• Comparison of SARS-CoV-2 reverse transcription (RT)-PCR positivity rates between SARI and non-SARI pediatric groups.

Main Results:

• Overall SARS-CoV-2 positivity rate was 3.0% (262/8780).
• Children with SARI had a positivity rate of 4.3% (50/1155), compared to 2.8% (212/7625) in children without SARI.
• The absolute difference in positivity was 1.54%, with a positive predictive value of SARI as a screening test of 4.3%.

Conclusions:

• The marginal increase in SARS-CoV-2 positivity among children with SARI does not strongly support the need for dedicated isolation facilities.
• Cohorting 65 SARI children would identify only one additional SARS-CoV-2 positive case compared to non-SARI patients.
• These findings are particularly relevant for resource-limited settings, suggesting alternative strategies may suffice.