Comparison of acute pneumonia caused by SARS-COV-2 and other respiratory viruses in children: a retrospective multi-center cohort study during COVID-19 outbreak
Authors: Ren Guangli , Wang Xianfeng , Xu Jun , Li Jun , Meng Qiong , Xie Guoqiang , Huang Bo , Zhu Weichun , Lin Jing , Tang Chenghe , Ye Sheng , Li Zhuo , Zhu Jie , Tang Zhen , Ma Mingxin , Xie Cong , Wu Yingwen , Liu ChenXi , Yang Fang , Zhou Yuzong , Zheng Ying , Lan Shuling , Chen Jianfeng , Ye Feng , He Yu , Wu Benqing , Chen Long , Fu Simao , Zheng Chengzhong , Shi Yuan 
Published: September 2020

Abstract
Background Until July 14, 2020, coronavirus disease-2019 (COVID-19) has infected more than 130 million individuals and has caused a certain degree of panic. Viral pneumonia caused by common viruses such as respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses have been more common in children. However, the incidence of COVID-19 in children was significantly lower than that in adults. The purpose of this study was to describe the clinical manifestations, treatment and outcomes of COVID-19 in children compared to those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak. Methods Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study. A total of 64 children with COVID-19 were defined as the COVID-19 cohort, of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort. Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort. Results Compared to the viral pneumonia cohort, children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19 (53/64 vs. 23/284), were of older median age (6.3 vs. 3.2 years), and had a higher proportion of ground-glass opacity (GGO) on computed tomography (18/40 vs. 0/38) (all P＜0.001). Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases (1/40 vs. 38/284, P=0.048), and lower cases with high fever (3/40 vs 167/284, P＜0.001), requiring intensive care (1/40 vs32/284, P＜0.047) and with shorter symptomatic duration (median 5 vs 8 days, P＜0.001). The proportion of cases with evaluated inflammatory indicators, biochemical indicators related to organ or tissue damage, D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than in the viral pneumonia cohort (all P＜0.05). No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs (lopinavir-ritonavir, ribavirin, and arbidol) as compared to duration in 39 children without antiviral therapy [median 10 vs. 9 days, P=0.885].Conclusion The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonias. Lopinavir-ritonavir, ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19. During the COVID-19 outbreak, attention also must be given to children with infection by other pathogens infection.