Health Disparities in Children with Covid-19 Early in the Pandemic: Socioeconomic Disadvantages Contributing to Severe Disease

Purpose of Study: Ethnic disparities are associated with increased risk for severe disease in pediatric patients with COVID-19. Identifying the underlying social determinants of health are necessary to lead to improved health care utilization and mitigation strategies. Methods Used: This is an observational cohort study of children with COVID-19 in Colorado (the CCC study) from March 15 2020-October 31 2020. Pediatric patients between 2-20 years of age with positive SARS-CoV-2 PCR were included. Multivariable logistical regression models were fitted to identify demographic, socioeconomic, and comorbid health conditions as predictors of severe COVID-19 disease, as defined by hospital admission and need for respiratory support. Summary of Results: We identified 1572 pediatric patients with COVID-19 (45% Hispanic, 54% Medicaid or uninsured, 16% non-English language, and 20% obese). In univariable analyses, Hispanic ethnicity was associated with severe outcomes, including hospital admission (OR 2.4, CI: 1.57, 3.80, p<0.01) and respiratory support (OR 2.4, CI: 1.38, 4.14, p<0.01). Patients who identified as Hispanic or Latino had significantly increased rates of obesity (28% vs. 14%, p<0.01), preferred non-English language (31% vs. 3%, p<0.01), and had Medicaid or no insurance (79% vs. 33%, p<0.01) when compared to non-Hispanic or Latino children. After adjusting for covariables, ethnicity was no longer associated with hospital admission (OR 0.9, CI: 0.53, 1.63, p=0.79) or respiratory support (OR 0.6, CI: 0.29, 1.21, p=0.15). Obesity (OR 1.9, CI: 1.15, 3.08, p=0.01), non-English language (OR 2.4, CI: 1.35, 4.23, p<0.01), and Medicaid insurance (OR 2.0, CI: 1.10, 3.71, p=0.02) were identified as independent risk factors for severe disease. Conclusion(s): Severe COVID-19 disease observed in Hispanic or Latino patients early in the pandemic appears to be secondary to underlying comorbid conditions, such as obesity, and socioeconomic disadvantages that may have influenced access to care, such as language and insurance status. Pediatric healthcare providers and public health officials should use this knowledge to tailor resource allocation to better target this underserved patient population.

Olfactory testing to improve COVID-19 screening in school children

Introduction: We analyze olfactory changes in the pediatric SARS-CoV-2 population and compare with results in adults to determine if chemosensory screening may uniquely identify early infection;establish a screening tool for objective evaluation of olfaction in pediatric COVID-19 patients;and recognize the discrepancy between objective and patient-reported olfactory function in pediatric patients. This project includes significant new data since the initial submission date that strengthened our research amid the evolving COVID-19 pandemic. Our study analyzes smell disturbances in children during the COVID-19 pandemic in a largely asymptomatic cohort, which makes it unique compared with some recent studies. This project positively contributes to the olfactory research for pediatric COVID infections and demonstrates both COVID-19-related olfactory changes (ie, good smells are noxious) and children's discrepancies in self-reported vs objective sense of smell. Methods: Children aged 5 to 21 years undergoing SARSCoV2 polymerase chain reaction testing for preoperative screening for nonrespiratory illnesses at a tertiary pediatric hospital were enrolled from June 2020 to April 2021 and were administered subjective questionnaires and a 40-question Smell Identification Test (SIT) within 2 weeks of COVID testing. Patients with prior history of olfactory dysfunction were excluded. Data were summarized with descriptive statistics. Results: In total, 47 patients completed SIT testing (19 positive [40%] and 28 negative [60%] for COVID;mean age = 12.0 years;63% female). There was no significant difference in overall SIT score or individual question responses between positive and negative patients, but 44% reported that certain foods smelled noxious. Overall, 26 patients (55%) were normosmic yet 44 (94%) denied subjective change in their sense of smell or taste. Conclusion: There was no statistical difference in olfactory function between otherwise asymptomatic COVID-positive and negative children. Our findings suggest a discrepancy between objective and patient-reported olfactory function in pediatric patients.