Predictors of COVID-19 Symptom Severity in NYC Children: A Prospective Cohort Study

Abstract

Rationale: There is an urgent need to better understand the factors associated with symptomatic COVID-19 illness in the general pediatric population, and specifically, children with asthma. Children can contract the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) but most are asymptomatic. Little is known, however, about the subset of children at risk for symptomatic illness. We sought to identify the sociodemographic and clinical characteristics associated with symptomatic COVID-19 disease in children, with and without asthma, exposed to SARS-CoV-2 during the pandemic in New York City (NYC). Methods: Data from an ongoing prospective observational cohort of 103 children, aged 2-20 years, enrolled from New York-Presbyterian/Weill Cornell Medicine outpatient clinics across the epicenter of the COVID-19 pandemic in NYC were included in this analysis. Participants had baseline determination of body mass index percentile. A comprehensive survey was administered. COVID-19 illness was ascertained by positive SARS-CoV-2-specific serologies and/or the presence of symptoms with known positive contact. Symptom severity was assessed using a novel COVID-19 symptom grading system. Descriptive analysis was used for comparisons across symptom severity categories. Results: Of 103 children enrolled to date, 24 (23.4%) had COVID-19 illness. Of these, 11 were asymptomatic, 8 mild, 4 moderate, and 1 had severe symptoms. Those with greater symptoms tended to be older. All children with moderate-severe symptoms were female. A higher percentage of Hispanic children were seen in all categories: no symptoms (64%), mild (62.5%), moderate (75%), severe (100%). SARS-CoV-2 household exposure was present in 100% of positive symptom categories (N=13) but in only 55% of the asymptomatic category (N=6). A higher percentage of obese children were seen in all symptom categories: no symptoms(73%), mild(62.5%), moderate(50%), severe(100%). Thirteen (54%) children with COVID-19 illness had asthma. There were no demonstrable COVID-19 symptom differences appreciated between asthma severity classifications. However, of those treated with inhaled corticosteroids (ICS) (N=6), 50% were asymptomatic. Other atopic conditions (food allergy, allergic rhinitis, eczema) were present in all symptom severity categories. Conclusion: Older age, female gender, and positive household exposure were higher in those with more symptomatic COVID-19 disease. The majority of children with COVID-19 illness were Hispanic and/or obese. At least half of our cohort had asthma;moderate-severe persistent asthmatics did not endorse greater COVID-19 symptoms but higher ICS use seemed to be protective against severe COVID-19 illness. Other atopy was prevalent among all symptom categories. A larger sample size is needed to further assess the significance of these initial trends.