COVID vs Flu in Kids: Can We Breathe a Little Easier?

F. Perry Wilson, MD, MSCE


September 09, 2020

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This transcript has been edited for clarity.

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson from the Yale School of Medicine.

"It's just the flu." We all heard that sentiment early on in the coronavirus crisis. But statements like that have died down as the death total went up. With nearly 200,000 Americans dead from COVID-19 compared with 50,000-60,000 dead from flu and pneumonia in a bad flu season, it's pretty clear that this ain't the flu.

At least for most of us.

But a new study in JAMA Network Open finds that, among kids, coronavirus is pretty darn flu-like.

Researchers from Children's National Hospital in Washington, DC, examined 315 kids with laboratory-confirmed COVID-19 and compared them with historical controls — kids with lab-confirmed influenza A and B.

The presenting symptoms were pretty similar across the groups, though fever and myalgia were a bit more common among kids with COVID-19. This is a problem, actually.


In kids, COVID-19 presents an awful lot like every other respiratory virus they come down with. Winter is coming, and with it not just flu but RSV, adenovirus, rhinovirus, and their ilk. The only way to tell whether a kid has the common cold (read: can still go to school) is robust, rapid testing for coronavirus — and right now, we don't have it. That means that a lot of kids will be sidelined because of non-COVID respiratory illness while they wait for test results.

But what about outcomes? Not many differences here, either.


Hospitalization rates, ICU rates, and vent rates were all pretty similar. Kids with COVID were hospitalized a bit longer, but that may have been out of an abundance of caution, given the novel nature of the disease.

Deaths? None in the COVID group and just two in the flu groups.

In contrast to flu, which affects younger kids more, the kids with COVID were older: fully 28% in the 15- to 20-year-old age group compared with just 5% in the flu groups.


Looking at all of these data, parents like me may breathe a bit easier. COVID — in kids, at least — acts a lot like the flu.

But there are a few gaps in the data to remember. Most kids recover fully after a bout of the flu. We don't yet know what the long-term consequences of COVID infection are. I would have liked a breakdown on how many of the kids in this study developed the multisystem inflammatory syndrome of children, for example, but we aren't given those data.

And there's one more, simpler concept to remember. This study looked at kids who were already infected. Even if the outcomes are similar between flu and COVID, more infections will mean more outcomes. And COVID is ongoing.

It's pretty hard to find reliable data on the infections per capita in various age groups, but the CDC does provide information about deaths per capita, stratified by age. I compared the 2017 flu season, the 2009 H1N1 swine flu pandemic, and COVID deaths per capita among younger ages. You can see the results here.


Overall, things look pretty similar, with COVID and the flu posing particularly high risks to those under age 1. COVID, of course, starts outstripping flu by a large margin when it comes to deaths in the older age groups. But keep in mind that COVID is ongoing. Those blue and green bars won't change anymore, but as more kids get infected with COVID and some die, the red bars keep growing.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of Yale's Program of Applied Translational Research. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He tweets @methodsmanmd and hosts a repository of his communication work at

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