Symptoms suggestive of COVID-19 in households with and without children: a descriptive survey

  1. Grace Grove
  2. Nida Ziauddeen
  3. Nisreen A Alwan

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Abstract

Background

Exploring transmission and symptoms of COVID-19 in children is vital, given that schools have recently fully reopened.

Objectives

This study aimed to characterise the nature and duration of symptoms suggestive of COVID-19 in UK households, and examine whether the symptoms varied between households with and without children and between adults and children from March to May 2020 in the UK.

Methods

An online questionnaire posted on social media (Mumsnet, Twitter, Facebook) was used to gather demographic and symptom information within UK households.

Results

Results from 508 households (1057 adults and 398 children) were available for analysis. 64.1% of respondent households with children and 59.1% of households without children had adults with symptoms suggestive of COVID-19. The proportion of adults that reported being symptomatic was 46.1% in households with children (and 36.7% in households without children. In 37.8% of households with at least one adult and one child with symptoms, the child’s onset of symptoms started before the adult. Of all children, 35.7% experienced symptoms, with almost a quarter experiencing fluctuating symptoms for more than 2 weeks compared to almost half of symptomatic adults. In general, children had a shorter (median 5 days) and milder illness course than adults (median 10 days). Fatigue was the most common symptom in adults (79.7%) and cough was the most common symptom in children (53.5%). Chest tightness, shortness of breath, fatigue, muscle ache and diarrhoea were more common in adults than children, while cough and fever were equally common.

Conclusion

Children had shorter and milder illness than adults, but in almost a quarter of children symptoms lasted more than 2 weeks. In over a third of both adult-child symptomatic households, the child was the first to become ill. Child to adult transmission and clinical presentation in children need to be further characterised.

Synopsis

  • Study question.

    What is the nature and duration of symptoms suggestive of COVID-19 in UK households with and without children during March and May 2020? Do the symptoms vary between adults and children?

  • What’s already known.

    There has been uncertainty about the extent to which children get and transmit SARS-CoV-2 within households. Symptoms associated with SARS-CoV-2 infection are well described in adults but symptoms and their duration are less well-characterised in children.

  • What this study adds

    On average, children had shorter and milder illness than adults, but still symptoms lasted more than 2 weeks in a significant proportion of children. In over a third of both adult and child symptomatic households, the child was the first to become ill.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.11.09.20228205: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Survey responses were anonymous but participants were asked to give consent to be re-contacted in the future regarding COVID-19 testing status and result.
    IRB: Ethical approval was granted by the University of Southampton, Faculty of Medicine Ethics Committee (Reference 56462).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation of the household approach was that asking one member of the household to complete the survey for all household members may have resulted in some inaccuracies in responses, if the survey completer relied on their memory rather than asking other household members directly. Additionally, the survey asked for symptom data for those unwell on 16th March or later. However, whilst some participants only gave data for the requested timeframe, many participants provided data for early March (70% in households without children and 75% in households with children reported symptoms on or after 16th March). The decision was made to include these responses in our analysis, but this means that some respondents who were unwell in early March and did not provide data on their symptoms will have been included in the asymptomatic group for the analysis of the data. It was not possible to confirm COVID-19 infection status in most respondents, due to very limited community testing at the time that the survey was undertaken. However, a large number of respondents report both classic COVID-19 symptoms9,25,29, and a prolonged, fluctuating course, which is unusual in other infectious illnesses, especially in children. A fluctuating course of respiratory illness in children could be due to co-infection or successive infections. However, this is unlikely to explain the fluctuating course of illness observed in this sample as households were asked to isolate for 14 days and this was follo...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.11.09.20228205v1 on medRxiv