Predicting SARS-CoV-2 infections for children and youth with single symptom screening

  1. Richard J. Webster
  2. Deepti Reddy
  3. Mary-Ann Harrison
  4. Ken J. Farion
  5. Jacqueline Wilmore
  6. Michelle Foote
  7. Nisha Thampi

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Abstract

Symptom-based SARS-CoV-2 screening and testing decisions in children have important implications on daycare and school exclusion policies. Single symptoms account for a substantial volume of testing and disruption to in-person learning and childcare, yet their predictive value is unclear, given the clinical overlap with other circulating respiratory viruses and non-infectious etiologies. We aimed to determine the relative frequency and predictive value of single symptoms for paediatric SARS-CoV-2 infections from an Ottawa COVID-19 assessment centre from October 2020 through April 2021.

Overall, 46.3% (n=10,688) of pediatric encounters were for single symptoms, and 2.7% of these tested positive. The most common presenting single symptoms were rhinorrhea (31.8%), cough (17.4%) and fever (14.0%). Among children with high-risk exposures children in each age group, the following single symptoms had a higher proportion of positive SARS-CoV-2 cases compared to no symptoms; fever and fatigue (0-4 years); fever, cough, headache, and rhinorrhea (5-12 years); fever, loss of taste or smell, headache, rhinorrhea, sore throat, and cough (13-17 years). There was no evidence that the single symptom of either rhinorrhea or cough predicted SARS-CoV-2 infections among 0-4 year olds, despite accounting for a large volume (61.1%) of single symptom presentations in the absence of high-risk exposures.

Symptom-based screening needs to be responsive to changes in evidence and local factors, including the expected resurgence of other respiratory viruses following relaxation of social distancing/masking, to reduce infection-related risks in schools and daycare settings.

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  1. ScreenIT

    SciScore for 10.1101/2021.08.19.21262310: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Data were captured in an electronic health record, and the pediatric hospital’s Research Ethics Board approved this secondary use of health administrative data.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot 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:
    This study has several notable limitations. It was undertaken during a period of reduced co-circulation of respiratory viruses due to masking, distancing and stay-at-home orders. As the frequency of non-COVID-19 respiratory viruses and their associated symptoms increase, the our results may overestimate the utility of single symptom screening when masking and social distancing measures diminish. Another feature of importance is the low prevalence of variants of concern during most of our study period. If emerging variants shift their symptom profiles, the generalisability of these findings to new variants should be revisited. 9, 23 Symptoms and HRE status were self-reported, therefore children/parents may not report symptoms that are mild or incur misreporting. Some parents may have experienced a greater financial burden of isolation for a pending or positive result,24, 25 which may produce an inherent socioeconomic bias to the under-reporting. As well, from Oct 1-Feb 21, non-HRE people with mild single symptoms were not directed for testing unless the symptom persisted >24hrs and/or new symptoms emerged. However, earlier return to school, daycare, or the workplace (for the affected adults in the household who needed to isolate pending the result of their child’s test) was possible with a negative test and symptom resolution. As such, there was no change in the time to get tested between periods when schools were open or closed to in-person learning. The number needed to test...

    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.

    Results from scite Reference Check: We found no unreliable references.

    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 10.1101/2021.08.19.21262310 on medRxiv