COVID-19 in children: analysis of the first pandemic peak in England

Abstract

ObjectivesTo assess disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared with adults during the first pandemic peak in England.SettingEngland.ParticipantsChildren with COVID-19 between January and May 2020.Main outcome measuresTrends in confirmed COVID-19 cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity rates in children compared with adults; community prevalence of SARS-CoV-2 in children with acute respiratory infection (ARI) compared with adults, case-fatality rate in children with confirmed COVID-19 and excess childhood deaths compared with the previous 5 years.ResultsChildren represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%–34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%–45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children.ConclusionsChildren accounted for a very small proportion of confirmed cases despite the large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2.

Sharing a household with children and risk of COVID-19: a study of over 300,000 adults living in healthcare worker households in Scotland

“…To support decision making concerning the closure of schools during the COVID-19 pandemic, several studies have examined the transmission of COVID-19 from children to adults. A community surveillance study in England and Wales conducted by Public Health England found that children rarely tested positive for SARS-CoV-2, even when they had symptoms of acute respiratory infection; this was particularly true for younger children 19 Studies examining contacts of younger children with SARS-CoV-2 have also shown low rates of secondary cases, particularly in non-household settings, consistent with minimal or no transmission from children to adults. 20 Although we were mainly concerned with testing the hypothesis that contact with children might exert a protective effect in a high-risk population (healthcare workers), our study is also consistent with the findings that children do not pose a substantial risk of infection to adults with whom they share a household.…”

“…Children are relatively protected from Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). When exposed, children are less likely to develop symptomatic infection (COVID- 19), and when infected they are less like to become seriously ill. 1 This difference is large; in the UK over the peak 9 weeks of the epidemic, the mortality in the UK population for SARS-CoV-2 was 0.0005% among children aged 0 to 14, compared to 0.003% for adults aged 25-44 and 0.11% for adults aged 65 to 74. 2 The reasons why COVID-19 is milder in childhood are not well understood, and differences in both the innate and acquired immune systems have been implicated.…”

Should children be vaccinated against COVID-19 now?

“…Children account for 1%-3% of diagnosed COVID-19 cases and have less severe disease and better prognosis than adults, with deaths being extremely rare and mainly affecting adolescents and those with significant underlying comorbidities. 1 Early epidemiological studies suggest that children do not contribute much to the spread of SARS-CoV-2 and that younger children may be less likely to get infected or transmit the virus compared with older children or adults. 2 Most children with SARS-CoV-2 infection are either asymptomatic or develop mild and non-specific respiratory symptoms.…”

“…Specific paediatric risk groups may benefit from immunisation during the early vaccine deployment stage. Given the limited data on safety and effectiveness of SARS-CoV-2 vaccines in children at present, however, it may be prudent to initially recommend any vaccination for older children (eg, ≥12 years old) who appear to be more at risk of severe and fatal disease than younger children 1 and then extend recommendation to children of all ages as more data become available. Since severe COVID-19 is rare in children, however, there are limited data on relative risks of hospitalisation, paediatric intensive care unit (PICU) admission or death in children with specific comorbidities unlike adults.…”

“…4 During the first wave of the pandemic in England, there were eight deaths in SARS-CoV-2 positive children, including four that were attributed to COVID-19, of which three were in children aged 10-15 years with severe underlying neurodisabilities. 1 A large prospective UK study reported neurological conditions (11%; 65/614) as the most prevalent underlying condition in children hospitalised with COVID-19. 5 In a small cross-sectional study of 46 North American PICUs, 24 of 48 (50%) children aged ≤21 years had at least one comorbidity, including 19 (40)%) with complex medical problems, defined as children with long-term dependence on technological support (including tracheostomy) associated with developmental delay and/or genetic anomalies.…”