CLINICAL CHARACTERISTICS, TREATMENT OUTCOMES AND DISEASE SEVERITY RELATED FACTORS AMONG PEDIATRIC COVID-19 PATIENTS IN RURAL THAILAND

Abstract

Coronavirus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome-Cororonavirus-2 (SARS-CoV-2) is a cause of morbidity among pediatric patients in rural Thailand. In this study we aimed to review cases of COVID-19 among pediatric patients in rural Thailand in order to determine the clinical characteristics, treatment outcomes and severity related-factors in this cohort to better understand the epidemiology of COVID-19 in this patient population. We retrospectively reviewed the medical records of pediatric (aged <15 years) COVID-19 patients confirmed to have COVID-19 by RT-PCR, treated at 22 regular and 33 field hospitals in Si Sa Ket Province, Thailand during April-August 2021. A total of 863 subjects were included in the study, 52.1% male. Three hundred seventy-seven (43.7%) were asymptomatic, 416 (48.2%) had a mild infection, defined as those without pneumonia, 66 (7.7%) had a moderate infection, defined as those with pneumonia but not requiring oxygen or critical care and 4 (0.5%) had a severe infection, defined as those needing oxygen and/or critical care. The median age of subjects with moderate/severe COVID-19 (4 years) was significantly (p=0.017) lower than subjects who had mild/asymptomatic COVID-19 (7 years). The median weight for height of subjects with moderate/severe COVID-19 (107%) was significantly (p=0.008) greater than subjects who had mild/symptomatic COVID-19 (103%). The percentage of subjects who had medical diseases with moderate/severe COVID-19 (7.1%) was not significantly different (p=0.075) from those who had mild/asymptomatic COVID-19 (4.0%). The most common underlying diseases among study subjects with COVID-19 were allergies and asthma. The percentage of subjects with mild/asymptomatic COVID-19 who had underlying allergies or asthma (4.3%) was not significantly different (p=0.174) than the percentage with moderate/severe COVID-19 (1.9%). The most common symptoms among those with mild/asymptomatic illness and moderate/severe illness were fever (33.3% and 38.6%, respectively; p=0.412) and cough (26.2 % and 35.7%, respectively; p=0.124). Sixty-seven subjects (7.8%) had pneumonia on radiography but 32.8% of these were asymptomatic. All 863 subjects had improved by discharge. On multivariable logistic regression analysis, subjects with rhinorrhea were significantly less likely to have moderate/severe COVID-19 than those without rhinorrhea (adjusted OR: 0.36; 95%CI: 0.15-0.88; p=0.024). In summary, only 0.5% of our subjects had severe COVID-19 and 8.2% developed pneumonia. Younger and higher weight for height subjects were more likely to have severe infection. Those with rhinorrhea were more likely to have mild infection. In conclusion, younger subjects and higher weight for height subjects need to be monitored more carefully than those with rhinorrhea. Further studies are needed to determine if these factors can be used to predict the course and outcome of other subjects.