MONDAY, Nov. 30, 2020 — Among thousands of kids tested for COVID-19, an upset stomach, loss of taste/smell, fever and headache were symptoms most predictive of positive test results, a Canadian study found.
But one-third of children and teens with the coronavirus showed no symptoms, the researchers noted.
“Because more than one-third of pediatric patients who test positive for SARS-CoV-2 infection exhibit no symptoms, identifying children who are likely to be infected is challenging. Indeed, the proportion of asymptomatic SARS-CoV-2 infections in children is likely much higher than we have reported, given the likelihood that many would not present for testing,” Dr. Finlay McAlister, of the University of Alberta, Edmonton, and co-authors said.
Cough and a runny nose were also frequent among kids who tested positive, but the investigators said those same complaints were common among kids who tested negative and couldn’t be considered tell-tale signs of COVID-19 infection.
“Many other influenza-like symptoms (such as cough, [runny nose] and sore throat) were as common, or more common, in children testing negative for SARS-CoV-2,” and thus had limited predictive value for detecting COVID-19 in children,” the authors wrote in the Nov. 24 issue of the CMAJ (Canadian Medical Association Journal).
The findings suggest that “administrators of screening questionnaires for schools or daycares may wish to consider reassessing the symptoms they screen for to include only those that are most strongly associated with positive results for swabs for SARS-CoV-2 infection,” the researchers reported.
For the study, they assessed symptoms among more than 2,400 children in the province of Alberta, Canada, who were tested for the coronavirus between April 13 and Sept. 30, 2020.
Loss of smell/taste was seven times higher in kids with COVID-19; upset stomach was five times more likely, and headache was twice as likely, the investigators found. Fever was 68% more likely in kids with a positive test result.
In kids with loss of smell/taste combined with headache and upset stomach, the odds of a positive test were 65 times higher compared to children and teens without that cluster of symptoms, according to the study.
Children 4 years and younger were more likely to test negative, and teens aged 13 to 17 were more likely to test positive, the team said in a journal news release.
“Given the high proportion of children with SARS-CoV-2 who remain asymptomatic, it is unlikely that any symptom screening strategy will prevent every child with SARS-CoV-2 infection from entering school,” Dr. Nisha Thampi, an infectious diseases pediatrician at Children’s Hospital of Eastern Ontario, and colleagues wrote in an accompanying editorial.
“Therefore, school-based health and safety measures beyond screening — including physical distancing, hand hygiene, masking, improved ventilation and outdoor learning opportunities — play an essential role in preventing the spread of infection in this setting,” Thampi and colleagues added.
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