Clinical Outcomes of Children With COVID-19 by SARS-CoV-2 Strain

Abstract

Objective We sought to investigate the disease outcomes and predictors of severe outcomes among children infected with the Delta variant of SARS-CoV-2 compared with pre-Delta strains. Methods Single-center retrospective cohort study in an emergency department located within an urban academic children's hospital. Patients included children (0–18 years) who tested positive for SARS-CoV-2. Main outcomes measured include need for hospital admission or COVID-directed therapies. Results There was a trend toward decreased hospital admission and no significant difference in the severity of outcomes in the Delta cohort relative to the pre-Delta cohort. The Delta cohort had lower odds of hospital admission (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.51–1.23), but the result was not statistically significant. Logistic regression analyses showed that overall, age 1 to 4 years (OR, 2.35; 95% CI, 1.23–4.57) and public insurance (OR, 1.80, 95% CI, 1.08–3.01) were predictors of hospital admission. Within the Delta cohort, the presence of any comorbidity increased the odds of admission (OR, 2.52; 95% CI, 1.09–6.04). Black children had lower odds of admission than white children (overall OR, 0.53; 95% CI, 0.31–0.90; pre-Delta OR, 0.50; 95% CI, 0.26–0.95). Conclusions The severity of measured disease outcomes was similar in pediatric patients when comparing children infected with the pre-Delta and Delta variants of SARS-CoV-2, even among children with comorbidities once adjusting for acuity. Ongoing research is essential to determine disease severity and risk for children with comorbidities because SARS-CoV-2 continues to mutate, including with Omicron subvariants.