Scientific Ambiguity in the Time of Coronavirus Disease 2019

To the Editor We read with interest the work by Tagarro et al¹ and we are concerned about several issues that we would like to discuss. The first case of severe acute respiratory illness coronavirus 2 (SARS-CoV2) infection in Madrid, Spain, was reported at La Paz University Hospital on February 25, 2020, two days earlier than what the authors state. Although a minor issue, this should be clarified.

The Spanish Ministry of Health recommended that patients who were going to be admitted into a hospital be tested for SARS-CoV2 infection. It is surprising that the need for admission was misjudged in 40% of the children. This may indicate that testing policies were not compliant with official recommendations, generating an excessive consumption of resources in a time of severe constraints and representing an unnecessary delay of care.

The World Health Organization defined coronavirus disease 2019 (COVID-19) as the disease produced by the virus severe acute respiratory illness coronavirus 2 (SARS-CoV2).² It is extremely important that the distinction between having COVID-19 and being an asymptomatic carrier is made to avoid confusion. The authors do not provide data on how many patients showed symptoms suggestive of COVID-19 on presentation, a fact that makes their conclusions hard to interpret. Thus, we find that concluding that 60% of confirmed infections in children required admission could be an overestimation.

The authors report a 10% pediatric intensive care unit admission rate. This is the highest rate reported to date³ and more than doubles the official rate published by the Spanish Ministry of Health,⁴ making the lack of discussion on this topic remarkable. It is particularly relevant that there are no details on the criteria used for pediatric intensive care unit admission or the degree of severity of COVID-19 in these patients. It could be that these patients were admitted for other reasons and then tested positive for SARS-CoV2. Providing clinical data such as standardized severity scores, the presence of respiratory distress, chest radiograph findings, or the oxygen saturation by pulse oximetry to fraction of pulse oximetry ratio could help the reader understand this excessive admission rate. Lastly, the authors fail to report any financial support for this project, especially regarding the acquisition of personal protective equipment and polymerase chain reaction tests, as it is required by JAMA Pediatrics’ instructions for authors.⁵

In summary, we consider that with the data presented, Tagarro et al¹ make unsound generalizations that could be a cause of concern for the general population. In a serious situation, such as this pandemic, rigor and accuracy should not pay the cost of immediacy.

Corresponding Author: Pedro de la Oliva, MD, PhD, Head of the Pediatric Intensive Care Department, Pediatric Intensive Care Department, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain (pedro.oliva@salud.madrid.org).

Published Online: October 19, 2020. doi:10.1001/jamapediatrics.2020.2925

Conflict of Interest Disclosures: None reported.