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In a cross-sectional study of 3,378 influenza-positive children across 7 U.S. pediatric hospitals, researchers found a substantial decline in antiviral prescribing in the emergency department during the COVID-19 pandemic, as published in JAMA Network Open. Among 2,514 children at higher risk of severe influenza, 32.2% received antivirals in the prepandemic era (December 1, 2016, to March 31, 2020), compared with 15.6% during late pandemic era (July 1, 2021, to June 30, 2023)—a 53% relative decrease. Despite unchanged treatment guidelines during the study period, prescribing dropped even as clinical influenza testing increased. During the late pandemic period, antiviral use was significantly associated with symptom duration under 2 days (adjusted odds ratio [aOR], 4.08; 95% confidence interval [CI], 2.49–6.71) and clinical testing (aOR, 17.20; 95% CI, 4.08–72.37). The authors attribute the pattern to diagnostic uncertainty, uncertainty about antiviral efficacy, and limited drug availability.
Testing increased: Prepandemic, 53.0% of the children (1,310) who were influenza positive and at increased risk of severe influenza were clinically tested for influenza. However, in the late pandemic era, this increased to 77.6% (697 of 898 children). The authors say: “This discrepancy between testing and treatment underscores the need to promote guideline-concordant antiviral prescribing, since timely initiation of treatment has been shown to reduce the severity and duration of influenza illness, thus lowering the risk of complications and hospitalization.”