• Researchers are only starting to learn how early symptoms of COVID-19 and the seasonal flu can be differentiated in children.
• With flu season expected to start in October, parents could soon be trying to decipher if a sick child has the flu or COVID-19, which could necessitate a quarantine or trip to their doctor.
• Experts emphasize that it’s more important than ever to get your flu shot during the pandemic.

Flu season is on the way — right in the midst of the COVID-19 pandemic.

Both illnesses have similar symptoms, which means it could be hard to distinguish one from the other.

Researchers are only starting to learn how early symptoms of COVID-19 and the seasonal flu can be differentiated in children.

New research published in JAMA Network Open by a team out of Children’s National Hospital found there were no significant differences in hospitalization rates, intensive care unit (ICU) admission, or ventilator use in children with the flu or COVID-19.

Researchers were surprised to learn that more people with COVID-19 than the flu reported fever, cough, diarrhea, vomiting, headache, body ache, or chest pain when they were diagnosed.

With flu season expected to start in October, parents could soon be trying to decipher if a sick child has the seasonal flu or signs of COVID-19 that could necessitate quarantine or a trip to the doctor’s office.

Here’s what to look for when trying to decide if a child has the flu or COVID-19.

Flu vs. COVID-19

The Centers for Disease Control and Prevention (CDC) recently released guidance on the differences between the flu and COVID-19.

“While COVID-19 and flu viruses are thought to spread in similar ways, COVID-19 is more contagious among certain populations and age groups than flu,” the organization states.

The report found that the time it takes for symptoms to appear between exposure and an infection, as well as how long the virus spreads, differs between the flu and SARS-CoV-2, the virus that causes COVID-19.

“COVID-19 has been observed to have more superspreading events than flu. This means the virus that causes COVID-19 can quickly and easily spread to a lot of people and result in continuous spreading among people as time progresses,” according to the CDC website.

“As pediatricians, we are concerned that the actual impact of COVID in children still remains to be defined,” said Dr. Flor M. Munoz-Rivas, an associate professor of pediatrics at the Baylor College of Medicine.

Experts are emphatic that the impact of COVID-19 on children should not be minimized or based on data when children were sheltered at home, not going to school, and not being exposed to other people or viruses.

“This winter season will provide us with the opportunity to assess such impact. This is because even though social distancing and other measures of control of COVID remain in place, the population in general is returning to more ‘normal’ activities and control measures are not consistently applied,” Munoz-Rivas said.

Munoz-Rivas added that we don’t know what will happen if we see widespread cases of both influenza and COVID-19 this fall and winter.

Fever, cough more common in kids with COVID-19 than flu

As part of the study, researchers looked at 315 patients at the hospital who were diagnosed with COVID-19 between March 25, 2020, and May 15, 2020.

They compared the information to 1,402 children who were diagnosed with the flu between Oct. 1, 2019, and June 6, 2020. Children who were asymptomatic but positive for COVID-19 were not included in the cohort.

Of the COVID-19 cohort, 17.1 percent were hospitalized, 5.7 percent were put in the ICU, and 3.2 percent were on ventilators. Of children with flu, 21.2 percent were hospitalized, 7 percent were admitted to the ICU, and 1.9 percent were on ventilators.

Patients hospitalized with COVID-19 had a median age of 9.7, while those with the flu had a median age of 4.2 years old.

Fever was the most frequently reported symptom, followed by cough. More children with COVID-19 had fever and cough compared to those with flu.

A greater percent of those with COVID-19 reported symptoms including:

• diarrhea
• vomiting
• headache
• body aches
• chest pain

There wasn’t a statistically significant difference in children reporting congestion, sore throat, or shortness of breath.

Because the number of flu cases at the hospital decreased when schools closed during March, Dr. Xiaoyan Song, lead study author and director of Infection Control/Epidemiology at Children’s National Hospital, wants to look at the effects of school closures on COVID-19 spread.

“We want to assess the quantitative impact of school closures so we can determine at what point the cost of closing schools and staying at home outweighs the benefit of reducing transmission of COVID-19 and burdens on the healthcare system,” she said.

Overlapping symptoms

Another problem for parents is the fact that COVID-19 and flu can occur at the same time, the CDC stated.

“The symptoms of COVID-19 and influenza are very similar, and as this study shows there are few differences in the presentation,” said Dr. Nathaniel Beers, president of The HSC Health Care System and a pediatrician with Children’s National Medical Center who wasn’t affiliated with the research.

“Parents should contact their pediatrician if their child has fever, cough, vomiting or diarrhea, or sore throat to determine if they should be tested for COVID-19 and if they should also be tested for influenza,” he said.

Children can have fever from many other causes, so parents shouldn’t think COVID-19 is the only culprit, said Munoz-Rivas.

“Do call your doctor when children have fever, cough, sore throat, or any type of trouble breathing, eating, or sleeping,” Munoz-Rivas said. “ Doctors should test symptomatic patients for both flu and COVID if they are in an area where COVID is still prevalent, and follow local surveillance information for flu.”

Both flu and COVID-19 can cause severe illness in children, emphasized Dr. Sonja Rasmussen, a professor of pediatrics and epidemiology at the University of Florida (UFHealth).

“We’ve all heard that COVID-19 is milder in kids than in adults, but that doesn’t mean that it can’t cause severe illness in some kids,” she said, adding that children have died from it.

Flu shots critical, experts warn

It’s important for parents to do what they can to avoid these illnesses.

For flu, that means getting the flu shot. Until a COVID-19 vaccine is available, wear masks, wash hands, and practice social distancing, Rasmussen added.

But even after getting a vaccination, parents should remember that children may still end up with the flu this winter.

“While the flu shot decreases your chance of having influenza and decreases the complications and course if you do have influenza, it is not 100-percent effective at preventing influenza. So pediatricians will likely need to test for both [diseases] even in those who have had the flu shot,” Beers said.

The American Academy of Pediatrics (AAP) is also reminding parents that getting the flu vaccine could be critical this year.

“Make sure your child gets a flu shot, ideally by the end of October or sooner. This is more important than ever this flu season because of the COVID-19 pandemic,” the website states.

The website also says that children who have COVID-19 who were previously not vaccinated for the flu can still get a flu shot once COVID-19 symptoms go away.

COVID-19 numbers in kids

Shortly before the study was published, an AAP report noted a 16 percent increase in child cases over a 2-week span during the end of August and beginning of September.

There have been at least 549,000 pediatric cases of COVID-19 since the start of the pandemic in the United States.

“As we continue to see communities with significant COVID-19 numbers, we will continue to see cases in children,” Beers explained.

“The good news is that our testing capacity has increased in many areas so that children are actually getting tested so that we can learn more about the disease burden in children and the spread between children and others,” Beers added.

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