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Best Indicators of COVID-19 Fever and Cough in Children and Adolescents

Today, in most parts of the world, testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is initially based on common symptoms. Testing symptomatic individuals and tracking, testing, and isolating their positive contacts is assumed to be the most efficient way to use limited test resources.

In the United Kingdom, the criteria for testing an individual for SARS-CoV-2 are the presence of fever, a new persistent cough, and loss or alteration of the sense of smell. Similar symptom-based case definitions work in other countries.

A recent survey published on a preprint server medRxiv * In October 2020, we will investigate the types of symptoms that need to promote such tests.

Case definition

Most tests are caused by fever, a recent persistent cough, and an abnormal odor. Such symptoms are thought to indicate continued SARS-CoV-2 infection and require quarantine of all such individuals until the virus test is negative. This approach is justified in adults, as fever and cough from other causes are rare in healthy adults.

On the other hand, these are insensitive indicators of children and adolescents (CYPs), who are susceptible to upper respiratory tract infections (URIs) as many as 10 times a year, and more commonly in the colder months.

Increase in symptom testing continues to resume

Face-to-face education in the UK began in September 2020, after which the number of individuals under the age of 18 suspected of having COVID-19 symptoms has increased tenfold. Many of these are probably due to seasonal viral infections, but the frequency of CYP testing and quarantine recommendations has increased significantly.

COVID-19’s most common fever and cough in CYP

The current study aims to provide evidence of which symptoms are most likely to be associated with a positive COVID-19 test, and perhaps not. The researchers conducted a systematic review of 18 studies, primarily CYP, in COVID-19 inpatients.

They found that about 15% to 42% of CYPs with COVID-19 were asymptomatic. The most common symptoms continued to be fever and cough, which were present in up to two-thirds and more than half of all patients, respectively. All other symptoms and signs were found in less than one-fifth of patients.

Fatigue and myalgia were found in 8% and 14% in one review, while gastrointestinal symptoms were found in about 7% to about 18% in various studies.

Fever was seen in more than two-thirds of older children, compared to less than half of babies. A contrasting age profile was found for bowel symptoms. One study reported that 20% of CYPs were asymptomatic, compared to 5% in adults.

Researchers have concluded that fever and cough are the most frequently reported symptoms of this condition in CYPs, accounting for 40% to 60% of all COVID-19-positive individuals. Both fever and cough were combined and far more prevalent than either alone.

Do not mistake the URI for COVID-19

As commonly seen in URIs, with COVID-19, runny nose and sore throat are relatively rare, along with headache, malaise, malaise, diarrhea, and vomiting. Curiously, the change in odor sensation was not shown in any of the papers. Reviewers were unable to identify clear differences in symptom profiles between age groups of CYPs.

These findings are consistent with recent studies in the United Kingdom and other parts of Europe showing that two-thirds of children admitted with COVID-19 have fever. A UK study of more than 650 hospitalized CYPs also found a low prevalence of symptoms except fever and cough.


This study was limited by the fact that most researchers used data from in-hospital CYPs. It may cover a wide range of clinical severities. Many countries have practiced universal hospitalization of children once diagnosed, but by including only this group, regardless of clinical severity, the findings are only in children with symptoms and more serious illness. Greatly more likely to be applied.

Taking this into account, the actual prevalence of symptoms of COVID-19-positive CYPs can be much lower. Other studies have shown that only 20% to 50% of this group is symptomatological. This is consistent with the high rate of asymptomatic infections.

There is likely to be duplication of research, which has hindered the meta-analysis of these studies. Again, there was a lot of variation not only in the duration of data collection, but also in quality and potential bias. The review was dominated by Chinese data and severe cases of CYP.

Impact and future direction

Based on this limited data, researchers say that the most common symptoms of COVID-19 in CYPs are fever and cough, which can be used to define potential cases that need to be tested. I conclude. If other symptoms are included, their anomalous properties can lead to loss of specificity.

In addition, symptoms such as sore throat and runny nose are common in young children, but are rare symptoms of COVID-19, indicating that they are not associated with potential COVID-19 features. .. In fact, their use can misclassify infants as potentially infected with SARS-CoV-2 and require unnecessary testing and quarantine.

The researcher said,Symptoms of community samples, including schools, inform practical identification and testing programs of CYPs and reduce misclassification of CYPs as potential COVID-19 cases requiring isolation of peers and family members. Urgently needed... “

*Important Notices

medRxiv Publish preliminary scientific reports that should not be considered definitive as they are not peer-reviewed, guide clinical / health-related behaviors, and should not be treated as established information.

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