How COVID-19 in kids compares to the flu, other viruses in children

COVID-19 isn’t the only viral disease children are catching this year. Influenza, which sends thousands of children to the hospital each season, is predicted to ramp up in the coming months.

USA TODAY analyzed data and spoke to pediatric specialists around the country to understand the risks of COVID-19 in children relative to other common viral diseases.

At the peak of the 2014-15 season, the flu sent twice as many children to the hospital as COVID-19 did from October 2020 through February 2021, according to data published by the Centers for Disease Control and Prevention.

But unlike the flu, COVID-19 is around all year, and the appearance of the more transmissible delta variant has swept in or sickened more children this past year than the average flu season does, says Dr. Jeremy Faust, an attending physician at Brigham and Women’s Hospital in Boston.

“Keep in mind that this summer’s delta spike occurred during a time of year when there is typically far less serious respiratory disease in children,” Faust says. “July and August delta being worse than some January-February flu seasons should be pretty alarming.”

Dr. David Buchholz, a professor of pediatrics at Columbia University’s Irving Medical Center, says the flu, which is dormant through the summer, is not a simple comparison to COVID-19, which infects year-round. What's clear, he says, is that the risk of COVID-19 outweighs that of the flu during a typical season. “Flu kills 37 to 199 children per year, which is far less than COVID. So if you look at the worst-case scenario of death, COVID is worse than flu.”

Buchholz points to another virus that parents contend with every year: respiratory syncytial virus, or RSV, which he says can kill 100 to 500 children a year. “If you have an infant or toddler you should be a lot more worried about RSV than COVID. A lot more children die of RSV than COVID, particularly children under 2.”

This summer, RSV sent more younger children to the hospital than COVID-19, according to doctors who spoke with USA TODAY.

RSV is driving pediatric hospitalizations. What is it?

RSV is always a primary concern for pediatricians. "RSV year after year has been the single No. 1 cause of pediatric hospitalizations," says Dr. Daniel Rauch, chief of pediatric hospital medicine at Tufts Children’s Hospital in Boston.

Typically striking in the winter, RSV can cause severe complications in the very young and the very old, Rauch says. Every year, 58,000 children under 5 are hospitalized with RSV, according to estimates from the CDC. In comparison, 64,000 children under 18 have been hospitalized with COVID-19 since Aug. 1, 2020, according to the CDC.

"Fortunately, overwhelmingly the kids do well,” Rauch says, referring to children infected with RSV. “It's the preterm infants, the infants with underlying heart or lung disease who are more at risk for problems.”

This year, RSV started infecting children a lot earlier than normal – in the summer months instead of winter – likely because of the relaxing of restrictions and more social contact between kids, doctors say. And many infants born just before or during lockdown weren't exposed to viruses and therefore didn't develop natural immunity.

“We’re seeing probably two to three times more positive tests for RSV than we are for COVID,” says Dr. Craig Shapiro, an attending physician in the division of pediatric infectious diseases at Nemours Children’s Hospital in Wilmington, Delaware.

Similarly, Oklahoma saw “a very severe RSV surge” over the summer, says Dr. Donna Tyungu, a pediatric infectious disease physician at OU Health in Oklahoma City. “Our RSV cases this summer were even more than what we'd typically see during a regular winter season.”

Because of staffing shortages and the RSV surge coupled with COVID-19 infections, Tyungu says, children at times have had to wait two or three days for a hospital bed.

“Our children's hospitals were very full of severe RSV cases," Tyungu says. "With the steady trickle of kids needing to be hospitalized, our hospital became capped very quickly.”

Uncertainties surrounding this fall and winter

Influenza cases haven’t picked up yet this season, experts tell USA TODAY – and last season there were virtually no influenza cases because of distancing, hand-washing and masking protocols.

Though this season may be worse, the medical experts USA TODAY spoke with say it’s hard to predict to what extent different viruses will surge this fall and winter in children. What’s clear, Shapiro says, is that adults should protect the vulnerable children not yet eligible for the COVID-19 vaccine and that those older children who are eligible should get the shot to protect themselves.

Kids' COVID-19 vaccination rates vs. hospitalization rates by state

One big difference between COVID-19 and influenza? Flu vaccines are available for children as young as 6 months. The CDC recommends the vaccines annually.

Shapiro said hundreds of kids a year die from influenza. "We need to be aware that we have the ability to prevent kids from getting sick from some of these viruses," he says. "Shortly we’ll be able to do the same for COVID.”

In Delaware, only a little more than 50% of children 12 and older have received the COVID-19 vaccine.

“If we don’t get that number up," Shapiro says, "we could see a lot more COVID cases on top of influenza.”

There’s also a great deal of uncertainty surrounding COVID-19's lasting effects on children. So-called long-haul COVID-19, in which puzzling symptoms persist for weeks and months after an infection, seems to be rare in children. According to CDC Director Rochelle Walensky, up to 3% of children infected with COVID-19 are believed to be long-haulers. And a condition known as multisystem inflammatory syndrome in children, or MIS-C, has been reported in more than 5,000 cases of children with COVID-19, according to the CDC.

“Then there's the unknowns of the long haul kids,” Rauch says. “We don't know much about MIS-C. We don’t know what happens to these kids one year, two years down the line. There's simply no question that you're better off not getting COVID.”

Children ages 12 and up are eligible to be vaccinated against COVID-19, and children 6 months and older are able to get a flu vaccine. Both types of vaccines are available at many local pharmacies and doctors’ offices and can be administered at the same time.

To find COVID-19 shots near you, visit Vaccines.gov or text your ZIP code to 438829.

This article originally appeared on USA TODAY: Data: Comparing COVID-19 hospitalizations with flu and RSV in kids