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Utility of illness symptoms for predicting COVID-19 infections in children
Geena Y Zhou1, Nicole Y Penwill2, Grace Cheng3
1Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
Insights
COVID-19 testing policies for children should focus on exposure, not common symptoms like runny noses. Many school days are missed unnecessarily due to symptoms not specific to coronavirus disease 2019 (COVID-19).
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Current guidelines recommend symptomatic children stay home and get tested for COVID-19.
- Differentiating COVID-19 symptoms from other childhood illnesses is crucial for school exclusion policies.
- This can help reduce unnecessary missed school days.
Purpose of the Study:
- To analyze symptoms and exposures in children tested for SARS-CoV-2.
- To identify symptoms that are non-specific to COVID-19.
- To inform revised school exclusion and testing policies.
Main Methods:
- Retrospective analysis of symptom and exposure data from 2,167 children (0-18 years).
- Children were tested for SARS-CoV-2 at outpatient sites (April-November 2020).
- Calculated likelihood ratios, number needed to screen, and estimated missed school days.
Main Results:
- 88.9% of children tested negative for COVID-19.
- Only self-reported exposure to COVID-19 significantly increased the likelihood of a positive test.
- Common symptoms like nasal congestion and sore throat were not associated with positive COVID-19 tests.
Conclusions:
- Many school days are missed for symptoms not specific to COVID-19.
- Revising exclusion policies for non-specific symptoms can improve school attendance.
- Testing policies should prioritize children with known exposure to COVID-19.
Background:
The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that symptomatic children remain home and get tested to identify potential coronavirus disease 2019 (COVID-19) cases. As the pandemic moves into a new phase, approaches to differentiate symptoms of COVID-19 versus other childhood infections can inform exclusion policies and potentially prevent future unnecessary missed school days.
Methods:
Retrospective analysis of standardized symptom and exposure screens in symptomatic children 0-18 years tested for SARS-CoV-2 at three outpatient sites April to November 2020. Likelihood ratios (LR), number needed to screen to identify one COVID-19 case, and estimated missed school days were calculated.
Results:
Of children studied (N = 2,167), 88.9% tested negative. Self-reported exposure to COVID-19 was the only factor that statistically significantly increased the likelihood of a positive test for all ages (Positive LR, 5-18 year olds: 5.26, 95% confidence interval (CI): 4.37-6.33; 0-4 year olds: 5.87, 95% CI: 4.67-7.38). Across ages 0-18, nasal congestion/rhinorrhea, sore throat, abdominal pain, and nausea/vomiting/diarrhea were commonly reported, and were either not associated or had decreased association with testing positive for COVID-19. The number of school days missed to identify one case of COVID-19 ranged from 19 to 48 across those common symptoms.
Conclusions:
We present an approach for identifying symptoms that are non-specific to COVID-19, for which exclusion would likely lead to limited impact on school safety but contribute to school-days missed. As variants and symptoms evolve, students and schools could benefit from reconsideration of exclusion and testing policies for non-specific symptoms, while maintaining testing for those who were exposed.
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