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Correspondence: Celeste M. Schultz, PhD, RN-BC, CPNP-PC, Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave., MC 802, Chicago, Illinois 60612
COVID-19 symptom presentation among adults is mostly understood. However, understanding COVID-19 symptom presentation in children lags.
Method
A literature search was conducted in three electronic databases. Twenty-three initial publications addressing COVID-19 symptom presentation among hospitalized children in the United States met the criteria for review and meta-analysis.
Results
Fever, the most common symptom, was present in nearly all cases. Gastrointestinal, respiratory, oral symptoms, and rash occurred in over half of the cases. Disease severity assessment showed that comorbidities were present in one-third of patients; intensive care was needed for half of the patients, and supplemental oxygen and mechanical ventilation were needed by 13.3% and 7.1%, respectively.
Discussion
The magnitude and significance of COVID-19 symptoms in children compared with those in adults and three common childhood viral illnesses: influenza, respiratory syncytial virus, and gastroenteritis, are discussed. Important clinical differences were found that may help clinicians distinguish COVID-19 from other illnesses.
Much can still be learned from the COVID-19 pandemic. COVID-19 is a viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2;
). Although SARS-CoV-2 symptom presentation (COVID-19) in adults is fairly well understood, less remains known about symptom presentation in children. The objective of this manuscript is twofold: (1) to determine the most common COVID-19 symptoms in hospitalized children seen early in the pandemic and (2) to assess the frequency of COVID-related treatments and outcomes. Results from the meta-analysis are used to distinguish the magnitude and significance of COVID-19 symptom presentation in children compared with the symptoms seen in adults, as well as comparing COVID-19 to three other common childhood viral illnesses (influenza, respiratory syncytial virus [RSV], and gastroenteritis) in the United States. Such a distinction will aid in delivering appropriate care to children and result in more positive health outcomes.
COVID-19 is a contagious disease caused by SARS-CoV-2 (
). The risk of breathing these particles is highest when people are close (i.e., less than 3 ft apart). SARS-CoV-2 particles can also be inhaled over longer distances, particularly in confined spaces, such as indoors (
). Transmission can further occur if particles are splashed or sprayed via contaminated fluids during coughing or (more rarely) by contacting contaminated surfaces (
). People who are infected can transmit the virus to another person up to 2 days before they show symptoms, as can people who do not experience symptoms. People remain infectious for up to 10 days after the onset of symptoms in moderate cases and up to 20 days in severe cases (
Much of our knowledge regarding COVID-19 symptom presentation pertains to those seen in adults. Symptoms in adults may include fever, cough, headache, fatigue, breathing difficulties, and loss of smell and taste (
Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. 118. Proceedings of the National Academy of Sciences of the United States of America,
2021e2109229118
). Of those who develop symptoms noticeable enough to be considered ill, most (81%) develop mild to moderate symptoms, including mild pneumonia, whereas 14% develop severe symptoms (dyspnea, hypoxia, or > 50% lung involvement on imaging). Five percent suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction), with older individuals being at a higher risk (
Although COVID-19 outcomes in adults are fairly well understood, this knowledge may not be transferrable to children. For example, adults with comorbid conditions such as cardiovascular disease, diabetes, hypertension, and cancer are at increased risk for contracting and experiencing complications from COVID-19. However, these conditions are much less common in children. Moreover, adults from African American and Hispanic/Latinx populations are disproportionately impacted by COVID-19 (
). The effect of COVID-19 on children in these populations is unclear. To address this gap in knowledge, the purpose of this systematic review and meta-analysis is to summarize the initial literature regarding COVID-19 symptom presentation and outcomes among children in the United States.
METHODS
A literature search was conducted in consultation with a health science librarian in August 2020 in three electronic databases: PubMed, CINAHL, and Web of Science. Terms used in these searches included: “coronavirus” or “corona virus” or “nCoV” or “2019 nCoV” or “novel coronavirus” or “novel corona virus” or “COVID-19” or “SARS-CoV-2” or “severe acute respiratory syndrome coronavirus 2” or “coronavirus disease 2019” or “corona virus disease 2019” or “new coronavirus” or “new corona virus” or “new coronaviruses” or “novel coronaviruses” or “severe acute respiratory syndrome coronavirus 2” or “2019 nCoV” or “nCoV 2019” or “SARS coronavirus 2”; “English”; “USA”; “youth” or “child” or “adolescent”; “all years”; “English”; “United States”; “pediatrics.” No filters or limitations were applied. Searches generated 342 publications: 85 articles from PubMed, 193 from CINAHL, and 64 from the Web of Science. Articles were included in the meta-analysis if they addressed COVID-19 cases among children in the United States, were published in peer-reviewed journals and were written in English. After the first and third authors simultaneously reviewed the publications, 241 were eliminated, including 21 duplicates, 187 ineligible, 30 outside the United States, and three unrelated topics (e.g., SARS, influenza, and bronchiolitis). One hundred and one publications were selected for further review. The same two authors reviewed the 101 publications and further excluded 25 publications (narrative discussions regarding COVID [n = 3]; systematic reviews [n = 5]; presented laboratory, genetic, or radiological findings [n = 17]); and two reports (Morbidity and Mortality Weekly reports; Figure). After an independent review of symptoms and disease severity by the second author, the final meta-analysis consisted of 23 publications.
FIGUREPreferred Reporting Items for Systematic Reviews and Meta-Analyses diagram of study selection.
Study characteristics, including sample size, description of the patient sample, research location, enrollment dates, age, and race of patients were assessed and summarized in Table 1. A dataset was created of the symptom characteristics and disease severity statistics of patients reported for each study (Tables 2 and 3). A wide range of symptoms was reported across studies, and the symptoms reported by each study differed. Fever, respiratory, or gastrointestinal symptoms could be determined for most studies. Other symptoms, such as cough, nausea, or fatigue, could only be determined in some studies. For disease severity measures, the number of patients with comorbid conditions could be determined for all studies. Other measures, such as supplemental oxygen use and intensive care, could only be determined for some of the studies. Symptom and disease severity measures were only included in the analysis if reported on by at least three studies. Summary statistics included the number of studies that reported on the symptom/measure and the total sample size for those studies. The proportion and percentages of patients with the symptom or other traits were also summarized across studies. Continuous outcomes were summarized by calculating the overall mean and standard deviation.
TABLE 1Description of included studies
Study
n
Sample description
Hospital
Region
Enroll dates
Age range
Age median
Male sex
White
Black
Hispanic
Asian
Other
Unknown
Bhumbra et al.
19
Hospitalized children with COVID
Riley Hospital for Children at Indiana University Health
Indianapolis
February 26 to May 4, 2020
< 2–18 years
5
14
4
7
7
1
0
0
Blumfield & Levin
19
Case series, hospitalized children with COVID
Montefiore Medical Center
Bronx, NY
February 25 to May 1, 2020
2 months to 18 years
8
10
19
Cheung et al.
17
Children/adolescents with MIS
Columbia University Irving Medical Center
New York City
April 18 to May 5, 2020
1.8–16 years
8
8
2
4
4
1
6
0
Craver et al.
1
Case report/autopsy
Children's Hospital of New Orleans
New Orleans
March 2020
17
1
0
1
0
0
0
0
Danley & Kent
1
Case report: 4-month-old male with muscular ventricular septal defect and atopic dermatitis and COVID
Rush University Medical Center
Chicago
March 26, 2020
0.33
1
1
Del Greco et al.
4
Four cases of MIS
New York-Presbyterian Queens
Queens, NY
May 8, 2020
4–16 years
11.5
1
4
Feld et al.
3
Case series three infants < 2 months with COVID
Cohen Children's Medical Center
New Hyde Park, NY
March 2020
28-43 days
0.12
2
3
Feldstein et al.
186
Children and adolescents with MIS
53 Pediatric Health Centers
United States
March 15 to May 20, 2020
< 1–20 years
8.3
115
35
46
57
0
9
41
Gefen et al.
1
Case report: 16-year-old boy with autism
Cohen Children's Medical Center of New York
New Hyde Park, NY
Before May 2020
16
1
1
Heinz et al.
1
Case report: 6-month-old liver transplant patient
New York-Presbyterian Hospital
New York, NY
March 17, 2020
0.5
0
1
Kainth et al.
65
Hospitalized COVID patients < 22 years
Steven and Alexandra Cohen Children's Medical Center at Northwell Health
New Hyde Park, NY
January 23 to April 18, 2020
< 60 days to 22 years
10.3
33
14
17
15
8
24
2
Kaushik et al.
33
Children with MIS-C in intensive care units
Three tertiary care children's hospitals
New York City
April 23 to May 23, 2020
IQR: 6-13
10
20
3
13
15
1
1
0
Kest et al.
3
Three critically ill children with MIS-C
St. Joseph's Children's Hospital
New Jersey
April 4 to May 10, 2020
6–10 years
9
1
0
1
2
0
0
0
Lara et al.
1
Case study: Pediatric patient with COVID and acute fulminant myocarditis
Ochsner Hospital for Children
New Orleans, LA
April 2020
12 years
12
0
0
0
0
1
0
0
McLaren et al.
7
Case series: seven febrile infants aged ≤ 60 days with SARS-CoV-2
Vagelos College of Physicians and Surgeons, Columbia University
New York City
March 1 to April 15, 2020
≤ 60 days
0.11
6
7
Mithal et al.
18
Case Series: 18 infants aged < 90 days tested positive for SARS-CoV-2 in ED (n = 15) and outpatient (n = 3)
Ann and Robert H. Lurie Children's Hospital
Chicago, IL
April 11 to May 12, 2020
10-88 days
55.5
7
0
0
14
0
0
4
Needleman & Hanson
1
Case study: 3-week-old male with mild hypoxic-ischemic encephalopathy and COVID-19 hospitalized twice
Indiana University School of Medicine
Indianapolis, IN
Before June 2020
25 day
0.07
1
1
Patel et al.
1
Case study: Severe pediatric COVID-19 patient presenting with respiratory failure and severe thrombocytopenia
Children's Healthcare of Atlanta and the School of Medicine
Atlanta, GA
Before April 2020
12
0
1
Perez et al.
2
Case series: two healthy adolescents with SARS-CoV-2 and cholestatic jaundice, and hepatitis
Cohen Children's Medical Center of New York
Bronx, NY
Before June 2020
16–17 years
16.5
1
2
Shekerdemian et al.
48
Children with COVID admitted to the ICU
14 U.S. hospitals
USA
March 14 to April 3, 2020
< 1 to 21 years
13
25
48
Spencer et al.
2
Case series: two children with COVID and clinical features suggestive of Kawasaki disease
New York-Presbyterian Morgan Stanley Children's Hospital
New York, NY
Before May 2020
7–11 years
9
1
2
Tsao et al.
1
Pediatric COVID patients with immune thrombocytopenia
Warren Alpert Medical School, Brown University
Providence, RI
Before May 2020
10 years
10
0
1
Zachariah et al.
50
Patients with COVID-19 hospitalized at a children's hospital
New York-Presbyterian Morgan Stanley Children's Hospital
New York, NY
March 1 to April 15, 2020
<1–21 years
9
27
27
0
25
0
0
0
Total
484
n/mean
10.5
275
85
89
139
12
40
138
%/SD
11.1
56.8
17.6
18.4
28.7
2.5
8.3
29.7
Note. ED, emergency department; ICU, intensive care unit; IQR, interquartile range; MIS, multisystem inflammatory syndrome; MIS-C, multisystem inflammatory syndrome in children; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Some participants are listed in multiple racial groups.
), and results are displayed in Table 4. The Metaprop Stata package was used to analyze proportional measures, and the meta-command was used to analyze continuous outcomes. Case studies with no effect size variation were excluded from continuous outcome models. Overall pooled effect sizes and 95% confidence intervals (CIs) are reported for each outcome. Heterogeneity statistics are also reported for each outcome, including the χ2 test of Q for whether study effects varied, Tau2 (the variance of true effect sizes), and I2 (percent of variance which reflects true differences in effect size vs. random error). Egger's tests of publication bias were run, though none were statistically significant. Metaregression analyses were conducted for each outcome to assess factors related to heterogeneity in the effect sizes of studies. Factors included study sample size, whether a study was a case report (≤ 10 patients), the median age of study patients, whether the study reported race, the percentage of patients with comorbidities, and percent of male patients. Postestimation publication bias and metaregression analyses were conducted with maximum likelihood estimation. No sensitivity analyses were done.
Effect is different from zero or heterogeneity χ2 test is significant. Only significant predictors for metaregression are shown.
0.8 (3)
0.0
0.0
Death
23
482
0.0 (0.0–0.0)
13.3 (22)
0
0
Notes. Hospital admission was only assessed for studies that included nonhospitalized patients. Case studies with no effect size variation were excluded from continuous outcome models.
a Different from zero.
b Effect is different from zero or heterogeneity χ2 test is significant. Only significant predictors for metaregression are shown.
Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (mis-c): A multi-institutional study from New York City.
International COVID-19 PICU Collaborative Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units.
Columbia Pediatric COVID-19 Management Group Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a Children's Hospital in New York City, New York.
). Patient enrollment in all studies occurred in the early stages of the pandemic between February and June 2020. Studies primarily included hospitalized children and adolescents with COVID-19, though three included patients not admitted for hospitalization but seeking care at hospital facilities. Studies were conducted in Georgia (n = 1), Illinois (n = 2), Indiana (n = 2), Louisiana (n = 2), New Jersey (n = 1), New York (n = 12), Rhode Island (n = 1), and at multiple sites (n = 2). The age range was from < 1 to 21 years, and the average median age across studies was 10.5 years old. Over half of the patients (56.8%; n = 275) were male children. Race of patients was reported in 10 studies (
Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (mis-c): A multi-institutional study from New York City.
Columbia Pediatric COVID-19 Management Group Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a Children's Hospital in New York City, New York.
). The race of children across studies was 17.6% White, 18.4% Black, 28.7% Hispanic, 2.5% Asian, 8.3% other, and 29.7% unknown. Some participants were listed in multiple racial groups.
Meta-analysis revealed fever to be the most common symptom, estimated to occur in 95% of children seeking medical care (Table 4). Fever was also the symptom that could be the most reliably estimated, as evidenced by the comparatively small CIs. Respiratory and gastrointestinal symptoms were also relatively common, occurring in 52.0% and 61.5% of children. Other symptoms estimated to occur in 50% or more of children were oral/mucosal changes (66.0%), abdominal pain (56.1%), rash (52.0%), and nausea/vomiting (49.6%). Dysgeusia and anosmia (loss of taste and smell), commonly reported in adults, were reported in only three studies in this meta-analysis. Almost no children experienced these symptoms. The symptom duration was about six days, and the fever was three days.
Comorbid conditions were estimated to be present in 33% of children seeking medical care. Of patients presenting to a hospital seeking medical care, 62.8% were admitted (assessed in three studies). The average length of hospital stay was about 5 days. Intensive care was needed in about half of the cases, and the average length was about 5 days. In 13.3% of cases, supplemental oxygen was needed, and intubation or mechanical ventilation was needed in 7.1%. Thirteen deaths (2.68%) in total were reported across studies.
Symptom and disease severity estimates were generally heterogeneous across studies; therefore, factors related to differences in the estimates were assessed with metaregression. A larger sample size was associated with longer symptom and fever duration and a lower frequency of reporting abdominal pain or supplemental oxygen use. Case studies were associated with a greater length of hospital stay, and patients had a higher median age. A higher percentage of patients with comorbidities were associated with less gastrointestinal or neurological symptoms reporting. Studies that did not report race had a higher percentage of patients with comorbid conditions. No publication bias was found.
DISCUSSION
This meta-analysis aimed to summarize the initial literature regarding COVID-19 symptom presentation and outcomes among children receiving hospital care in the United States. As reported by pediatric health care providers, common symptoms included fever and gastrointestinal and respiratory distress. Less than 3% of the 484 children included in the review and meta-analysis died of COVID-19.
Comparison to Adult Cases
Symptomatology associated with COVID-19 is reported to increase with age (
). However, our results do not support this notion. The lack of support may be due to the frequency with which children report these symptoms or the lack of documentation in the medical record (
). More specifically, because children may lack the vocabulary to express sensory experiences, we speculate that the loss of smell and taste may be exhibited in behavior and not verbalized to clinicians. As such, the loss of smell and taste may contribute to poor feeding and/or anorexia.
Age has also been shown to be the strongest indicator for severe COVID-19 outcomes (
). However, younger children are clinically more likely to be affected by fluid loss and seem to be those who would be at the most risk for morbidity and mortality. Our study found that children who died were aged > 5 years. Studies also showed that risk severity increases as preconditions increase (
). Comorbidities in children, such as HIV, disabilities, neurological disorders, sickle cell disease, and being overweight and obese, are shown to be linked to more severe symptoms and slower recovery, specifically from COVID-19 (
). The associations between comorbid states and specific outcomes (e.g., death) were not described in detail within the 23 articles. However, our study did find that children with comorbidities presented with neurological symptoms.
Studies have also shown that populations are not affected equally by COVID-19. Based on the Centers for Disease Control and Prevention's National Vital Statistics System mortality data, an estimated 700,000 excess deaths occurred in the United States from February 1, 2020 to September 30, 2021 (
). The mortality rate among children in our analysis was < 3% (n = 13; N = 484). The race and ethnicity of these children could not be determined because of variations in the reporting of that data among the 23 publications.
Compared with Three Common Childhood Viral Illnesses
Compared with three other common childhood viral illnesses seen in the United States, COVID-19 symptom presentation appears like those seen with influenza, RSV, and gastroenteritis, as well as other viral illnesses caused by adenovirus and rhinovirus.
Symptoms associated with influenza are cough and fever lasting 5 days. In the 2018–2019 season, between 54,381 (10%;
) specimens tested positive for influenza. Moreover, 88.2% of the data (n = 10,766) included age information, further showing that the prevalence of influenza among children aged 0–4 years was (1,627 [15.7%] to 4,844 [12.6%]) as compared with children aged 5–24 years (3,493 [32.4%] to 12,508 [32.4%]). The cumulative hospitalization rate per 100,000 was 72 for children aged 0–4 years and 20.4 for children and adolescents aged 5–15 years (
). Results from a retrospective cohort study from the Programme de Médicalisation des Systèmes d'Information database found that influenza affected more children (n = 8,942; 19.2%) than did COVID-19 (n = 1,227; 1.4%); however, significantly more children aged < 5 years with COVID-19 (2.3%) required treatment in the intensive care unit than those with influenza (0.9%;
Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: A nationwide, population-based retrospective cohort study.
). No significant difference was found in children with COVID-19 and influenza mortality rates. Children aged 11–17 years with COVID-19 were 10 times more likely to die in the hospital than those with influenza (
Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: A nationwide, population-based retrospective cohort study.
In contrast, RSV primarily affects children aged < 5 years; however, adults may also contract the virus. The most common symptoms include cough (98%), fever (75%), and labored respirations (73%). RSV accounts for > 58,000 hospitalizations in children aged < 5 years (
). In a prospective, population-based surveillance study between 2000 and 2004, 18% of 5,067 specimens from children tested positive and were associated with 20% of annual hospitalizations. RSV-associated hospitalization was three per 1,000 children aged < 5 years and 17 per 1,000 children aged < 6 months. Significantly more inpatients were non-Hispanic white children under the age of 6 months and had private insurance (
). In another prospective population-based surveillance conducted in seven U.S. pediatric hospitals from November 2015 to June 2016, 35% of hospitalized children (n = 1,043) tested positive, 87% were aged < 2 years, and 50% were aged < 6 months. The hospitalization rate was higher among males (3.3 [95% CI, 3.0–3.6]) than females (2.6 [95% CI, 2.3–2.9];
Comparing gastrointestinal symptoms associated with SARS-CoV-2 to gastroenteritis (vomiting, diarrhea) in children in the United States, gastroenteritis in the United States accounts for 200,000 hospitalizations and 300 deaths each year (
). More specifically, 6.1% to 29.4% of children with gastroenteritis test positive for rotavirus, whereas Norovirus accounts for 11.9% of positive tests (
No evidence of an increase in the incidence of Norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel.
Human Vaccines & Immunotherapy.2019; 15: 1284-1293
Comparing these three illnesses, COVID-19 symptom presentation may begin 1–14 days after exposure. The frequency of positive laboratory tests is 3.9% in children aged 0–4 years and 6.3% in children aged 5–17 years. These rates are compared with an overall positivity rate of 14.4% (
Columbia Pediatric COVID-19 Management Group Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a Children's Hospital in New York City, New York.
). Higher hospitalization rates among children with COVID-19 may be attributed to an overabundance of caution when caring for patients with a novel illness. Furthermore, a comparison of mortality among children with COVID-19, influenza, RSV, and gastroenteritis shows that children with gastroenteritis are more likely to die than those with other viral illnesses. More specifically, of the 73 million children diagnosed with COVID-19, < 700 (0.001%) have died of the virus (
In light of the current uptick in RSV and influenza, the presentation of COVID-19 symptoms is not to be taken lightly but put into perspective in relation to these common childhood viral illnesses. Because of the similarity among symptoms of SARS-CoV-2 and other common childhood viral illnesses, diagnosing COVID-19 empirically is challenging. Therefore, testing is warranted to identify the causative agent of the illness. Regardless of test results, treatment for most viral illnesses is supportive unless a bacterial origin is identified.
Strengths
Our article provides a systematic review and meta-analysis of initial publications identifying key clinical symptom presentations that help clinicians recognize this disease process and intervene early to reduce poor outcomes rather than relying solely on laboratory results. Strengths of our work include the assessment of factors related to heterogeneity in reporting COVID-19 symptoms and disease severity for hospitalized children, as well as the lack of publication bias. Our meta-analysis also identifies inconsistencies in demographics reporting, disease prevalence, symptoms, hospitalizations, morbidity, and mortality. These inconsistencies create challenges for the clinician when making clinical decisions about significant symptoms that distinguish one disease from another. Therefore, reporting demographic information along with symptomology, hospitalization, morbidity, and mortality is warranted to advance health equity.
Limitations
Comparison of COVID-19 symptom presentation from evidence in the literature was challenging. Symptom presentation, ethnicity, race, and age group were inconsistently reported across publications, limiting the depth of detailed analysis. Comparison of the incidence of COVID-19 and the three common childhood illnesses was also challenging because COVID-19 data are reported cumulatively, whereas symptoms of common viral illnesses are reported seasonally. Comparison of the outcomes from these diseases was also challenging because reporting the incidence of RSV and death resulting from RSV is not required. Finally, all publications did not include ethnicity and/or race data. As a result, we could not determine whether symptom presentation in children differed between ethnic and/or racial groups.
Conclusions
SARS-CoV-2 is a viral vector with variable symptom presentation. As we continue to study COVID-19 symptom presentation in children and compare it to other viral illnesses and their outcomes, we hope to better understand the clustering of symptoms and the relationship between symptom clusters and health outcomes. This knowledge will allow for the early identification of those at greatest risk for rapid clinical decline and possible death.
The authors would like to recognize Annie Nickum, BSN, MLIS, AHIP, Assistant Professor Information Services and Liaison Librarian, for her assistance with the literature search. The authors acknowledge Kevin Grandfield, publications manager, Department of Biobehavioral Health Science, College of Nursing, University of Illinois Chicago.
References
Alcendor D.J.
Racial disparities-associated COVID-19 mortality among minority populations in the us.
Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (mis-c): A multi-institutional study from New York City.
No evidence of an increase in the incidence of Norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel.
Human Vaccines & Immunotherapy.2019; 15: 1284-1293
Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: A nationwide, population-based retrospective cohort study.
Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. 118. Proceedings of the National Academy of Sciences of the United States of America,
2021e2109229118
Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units.
Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a Children's Hospital in New York City, New York.
Celeste M. Schultz, Clinical Assistant Professor, Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL.
Larisa A. Burke, Visiting Research Specialist, Office of Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, IL.
Denise A. Kent, Clinical Assistant Professor, Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL.
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