Clinical characteristics, investigations, treatments and outcomes of patients with PCR-positive SARS-CoV-2 infection (N=403) according to country of origin
| Canada n=266 (%) | Costa Rica n=107 (%) | Iran n=30 (%) | Total N=403 (%) | |
| Clinical features | ||||
| Fever prior to or during admission* | 205 (82.3%) | 71 (78.0%) | 26 (92.8%) | 302 (82.1%) |
| Cough | 136 (51.1%) | 54 (50.5%) | 18 (60.0%) | 208 (51.6%) |
| Shortness of breath | 125 (47.0%) | 55 (51.4%) | 8 (26.7%) | 188 (46.6%) |
| Vomiting | 91 (34.2%) | 22 (20.6%) | 14 (46.7%) | 127 (31.5%) |
| Rhinitis | 66 (24.8%) | 49 (45.8%) | 10 (33.3%) | 125 (31.0%) |
| Diarrhoea | 70 (26.3%) | 31 (29.0%) | 14 (46.7%) | 115 (28.5%) |
| Abdominal pain | 67 (25.2%) | 26 (24.3%) | 15 (50.0%) | 108 (26.8%) |
| Headache | 47 (17.7%) | 19 (17.7%) | 6 (20.0%) | 72 (17.9%) |
| Rash | 42 (15.8%) | 24 (22.4%) | 3 (10.0%) | 69 (17.1%) |
| Conjunctivitis | 46 (17.3%) | 21 (19.6%) | 1 (3.3%) | 68 (16.9%) |
| Myalgia | 30 (11.3%) | 12 (11.2%) | 18 (60.0%) | 60 (14.9%) |
| Pharyngitis | 32 (12.0%) | 15 (14.0%) | 13 (43.3%) | 60 (14.9%) |
| Wheeze | 16 (6.0%) | 26 (24.3%) | 12 (40.0%) | 54 (13.4%) |
| Chest pain | 32 (12.0%) | 3 (2.8%) | 4 (13.3%) | 39 (9.7%) |
| Cracked lips | 22 (8.3%) | 16 (14.9%) | 0 | 38 (9.4%) |
| Oedema of hands and feet | 14 (5.3%) | 12 (11.2%) | 1 (3.3%) | 27 (6.7%) |
| Anosmia | 10 (3.7%) | 2 (1.9%) | 0 | 12 (3.0%) |
| Seizures | 6 (2.2%) | 3 (2.8%) | 2 (6.7%) | 11 (2.7%) |
| Coinfections | ||||
| Bacterial (positive cultures)† | 14 (5.3%) | 7 (6.5%) | 3 (10.0%) | 24 (5.9%) |
| Viral | 7 (2.6%) | 25 (23.4%) | 0 | 32 (7.9%) |
| Bacterial and/or viral | 21 (7.9%) | 30 (28.0%) | 3 (10.0%) | 54 (13.4%) |
| Investigations | ||||
| Chest imaging performed | 200 (75.2%) | 82 (76.6%) | 30 (100.0%) | 312 (77.4%) |
| CXR and/or CT chest normal or had findings unrelated to COVID-19 | 60 (22.5%) | 45 (42.0%) | 16 (53.3%) | 121 (30.0%) |
| CXR and/or CT chest abnormalities compatible with COVID-19 | 140 (52.6%) | 37 (34.6%) | 14 (46.7%) | 191 (47.4%) |
| Laboratory investigations | ||||
| Leucopenia (<4×109/L)‡ | 43 (17.1%) | 12 (11.5%) | 4 (13.3%) | 59 (15.3%) |
| Leucocytosis (>15×109/L)‡ | 20 (7.9%) | 21 (20.2%) | 6 (20.0%) | 47 (12.2%) |
| Neutropenia (<1.5×109/L)§ | 53 (21.4%) | 27 (26.0%) | 8 (26.7%) | 88 (23.0%) |
| Neutrophilia§ | 73 (29.4%) | 37 (35.6%) | 10 (33.3%) | 120 (31.4%) |
| Thrombocytopenia (<100×109/L)¶ | 27 (10.8%) | 12 (11.5%) | 5 (16.7%) | 44 (11.4%) |
| Thrombocytosis (>450×109/L)** | 47 (18.7%) | 29 (27.9%) | 10 (33.3%) | 86 (22.3%) |
| CRP >50 (mg/L)** | 87 (38.7%) | 22 (25.0%) | 10 (33.3%) | 119 (34.7%) |
| Ferritin >500 (mcg/L)†† | 37 (28.2%) | 12 (37.5%) | 6 (30.0%) | 55 (30.0%) |
| Albumin <29 (g/L)‡‡ | 34 (45.9%) | 10 (21.7%) | 2 (16.7%) | 46 (34.8%) |
| Treatments | ||||
| Intravenous immunoglobulin | 48 (18.0%) | 22 (20.6%) | 12 (40.0%) | 82 (20.3%) |
| Antiviral agent for influenza | 4 (1.5%) | 0 | 4 (13.3%) | 8 (2.0%) |
| Corticosteroids | 130 (48.9%) | 30 (28.0%) | 8 (26.7%) | 168 (41.7%) |
| Lopinavir-ritonavir | 0 | 0 | 8 (26.7%) | 8 (2.0%) |
| Remdesivir | 35 (13.1%) | 0 | 6 (20.0%) | 41 (10.2%) |
| Azithromycin | 0 | 0 | 13 (43.3%) | 13 (3.2%) |
| Hydroxychloroquine | 1 (0.4%) | 0 | 23 (76.7%) | 24 (5.9%) |
| Highest level of care required | ||||
| No supplemental oxygen or ICU admission | 137 (51.5%) | 38 (35.5%) | 18 (60.0%) | 193 (47.9%) |
| Supplemental oxygen but no ICU admission§§ | 47 (17.7%) | 46 (43.0%) | 2 (6.7%) | 95 (23.6%) |
| ICU admission | 82 (30.8%) | 23 (21.5%) | 10 (33.3%) | 115 (28.5%) |
| ICU care without CPAP/BiPAP/MV | 45 (16.9%) | 11 (10.3%) | 6 (20.0%) | 62 (15.4%) |
| ICU with CPAP/BiPAP | 18 (6.8%) | 2 (1.9%) | 0 | 20 (5.0%) |
| ICU with MV | 19 (7.1%) | 10 (9.3%) | 4 (13.3%) | 33 (8.2%) |
| Extracorporeal life support | 0 | 0 | 0 | 0 |
| Complications | ||||
| MIS-C diagnosis | 59 (22.2) | 19 (17.7) | 3 (10.0) | 81 (20.1%) |
| Outcomes | ||||
| Mean length of hospitalisation in days (SD)¶¶ | 5.9 (6.0) | 6.5 (8.1) | 9.3 (6.6) | 6.3 (6.7) |
| Median length of hospitalisation in days (IQR) | 4.0 (2.0–7.0) | 4.0 (3.0–7.0) | 7.0 (6.0–9.0) | 4.0 (2.0–7.0) |
| Death | 2 (0.7%) | 3 (2.8%) | 1 (3.3%) | 6 (1.5%) |
| Severe disease according to WHO clinical scale score ≥6 | 71 (26.7%) | 27 (25.2%) | 4 (13.3%) | 102 (25.3%) |
*A total of 35 children were missing data on fever prior to or during admission (17 from Canada, 16 from Costa Rica and 2 from Iran) resulting in a total N of 368.
†Children with one of the following are included: blood culture thought to be truly positive and/or positive endotracheal tube cultures treated with antibiotics for presumptive bacterial pneumonia and/or positive bacterial culture from another site treated with antibiotics.
‡A total of 17 children were missing leucocyte values (14 from Canada and 3 from Costa Rica) resulting in a total N of 386.
§A total of 21 children were missing neutrophil values (18 from Canada and 3 from Costa Rica) resulting in a total N of 382. Cut-off values for neutrophilia are age dependent.
¶A total of 18 children were missing platelet values (15 from Canada and 3 from Costa Rica) resulting in a total N of 385.
**A total of 60 children were missing a CRP value (41 from Canada and 19 from Costa Rica) resulting in a total N of 343.
††The variable assessing highest ferritin value used and a total of 220 children were missing a value (135 from Canada, 75 from Costa Rica and 10 from Iran) resulting in a total N of 183.
‡‡A total of 271 children were missing albumin values (192 from Canada, 61 from Costa Rica and 18 from Iran) resulting in a total N of 132.
§§Supplemental oxygen but no ICU admission includes those on oxygen, high flow nasal cannula, CPAP/BiPAP on regular or COVID-19 wards.
¶¶A total of 4 children were missing date of discharge from hospital (2 from Canada and 2 from Iran).
BiPAP, bilevel positive airway pressure; CPAP, continuous positive airway pressure; CRP, C-reactive protein; CXR, chest X-ray; ICU, intensive care unit; MIS-C, multisystem inflammatory syndrome in children; MV, mechanical ventilation.