Severe COVID Illness Remains Uncommon in Children

By Reuters Staff

November 23, 2020

NEW YORK (Reuters Health) - In the spring and early fall across the United States, cases of COVID-19 in children rose in concert with the general population, with growth in cases shifting from the Northeast to the South and West and then to the Midwest, a new trends analysis shows.

However, in the latter half of the study period, the proportion of cases identified in children increased three- to four-fold from the start of the study period, although severe illness in children remains uncommon.

Researchers from the American Academy of Pediatrics and Children's Hospital Association, in Washington, D.C., used state and territory health department data to describe temporal and geographic trends in COVID-19 among U.S. children between April 16 and September 10, 2020.

As of September 10, there were more than 549,000 cumulative child COVID-19 cases, a rate of 729 cases per 100,000 children. Growth in pediatric cases varied considerably by region, in line with what was happening in adults. In April, a preponderance of child cases was in the Northeast. In June, cases surged in the South and West, followed by increases in the Midwest in mid-July.

The proportion of pediatric COVID-19 cases has risen substantially over time. In April, less than 3% of the reported cases were in children. In the last eight weeks of the study period, children represented between 12% and 15.9% of new weekly reported cases.

"Although children represent a growing percentage of total cases, hospitalization and death due to COVID-19 is uncommon," Dr. Blake Sisk and colleagues report in Pediatrics.

On September 10, children represented 1.7% of total hospitalizations, and about 2% of child cases led to hospital admission, they report. Children made up 0.07% of total deaths, and 0.01% of child cases led to death.

"These rates have remained stable across the study period," the study team says.

They caution that the data are limited by states' heterogeneous data reporting methods. It's also not known how many children have been infected with SARS-CoV-2 but not tested. And it is unclear how much of the increase in child cases is due to increased testing capacity, although the share of all tests in children has held stable at 5% to 7% since late April, they note.

"Going forward, states should continue to report cases, testing, hospitalizations, and mortality by age so that the effects of COVID-19 on children's health can be closely monitored," Dr. Sisk and colleagues conclude.

In a linked commentary, Dr. Andrea Cruz, associate editor for Pediatrics, and colleagues write, "We have opportunities to improve surveillance data by expanding the accessibility of tests to children; conducting active as well as passive surveillance; more fully integrating children into contact tracing; standardizing reporting criteria across states; and disaggregating pediatric data into more epidemiologically meaningful age brackets. These modifications would allow a more data-driven, phased approach to re-opening schools and other institutions based on local transmission patterns."

SOURCE: and Pediatrics, online November 20, 2020