How Dangerous is COVID for Children?

October 28, 2021

To what extent are our children endangered by COVID infection?

Many parents understandably approached this school year with trepidation at the thought of their children returning to in-person learning during a pandemic and the rise of viral variants. A survey of the data we have thus far should provide some comfort to worried parents about the risks faced by children.

First, deaths from COVID among children are very rare. According to the CDC, there have been 63 deaths from COVID in kids aged 1-4 and 172 deaths in kids aged 5-15. For all ages, there have been 723,880 deaths from COVID. This means that kids aged 1-4 make up 0.008703 percent of COVID deaths, and kids 5-15 make up 0.0238 percent of total COVID deaths.

Hospitalization rates are also much lower for younger age groups. According to the CDC, there were 87.8 hospitalizations per 100,000 people for those aged 0-4, and 52.5 hospitalizations per 100,000 people for those aged 5-15. For comparison, there were 2,000 hospitalizations per 100,000 for those 65 and older, and 1,033 hospitalizations per 100,000 for those aged 50-64. Kids aged 0-4 make up 0.7 percent of total hospitalizations, and kids aged 5-17 make up 1.1 percent of total hospitalizations.

Even these low number of hospitalizations for kids may be overstated. The CDC requires that every child admitted to the hospital be tested for COVID-19. According to one study, 45% of the time, a child who tested positive for the coronavirus at a hospital was not actually sick with COVID-19. In those cases, hospitalization was due to a completely unrelated diagnosis.

These data have been confirmed in other parts of the world. Studies in England found that COVID-19 carries a lower risk of death or intensive care among children and young people than previously thought. Researchers found that COVID caused 25 deaths in England among those 18 and younger and that half of these were in individuals with an underlying complex disability requiring high health-care needs, such as tube feeding or breathing assistance. One study looked at data from 19 countries and found that conditions such as obesity and cardiac or neurological problems were associated with a higher risk of death or intensive care treatment, but the absolute increase in risk was very small.

The data also seem to suggest that many children get infected with the virus but are asymptomatic or have mild illness. In testimony before the FDA, Dr. Peter Doshi noted that CDC data showed that 23 percent of 0-4 year olds and 42 percent of 5-17 year olds had already had COVID. The CDC estimates that anywhere between 16 percent and half of pediatric infections are asymptomatic.

Although most children infected with COVID-19 experience mild symptoms, there have been reports of a rare condition known as multisystem inflammatory syndrome in children (MIS-C). Estimates are that 0.03 percent of COVID infections in young children lead to MIS-C; incidence was higher among Black, Hispanic or Latino, and Asian or Pacific Islanders compared with white patients. In cases of MIS-C, different parts of the body become inflamed. It can be deadly, but most children who are diagnosed with the condition get better with medical care.

It also seems to be the case that it is less common for children to spread the virus to each other. Experts say that predominantly it is adult-to-child transmission; for reasons that are not yet understood, transmission from children to adults and from children to children are less common. This was substantiated by an Australian study which found that children infected with COVID-19 were more likely to have caught it from their parents than at school.

In the words of one doctor, “Of the number of children across the globe [infected with COVID-19], very few are requiring hospitalization, even fewer are requiring ICU, and very, very few die,” she said.

There is a concern that, although risk of death or serious illness is low in kids, they can still acquire “long COVID.” But as reported by our friends at ANH-International, a new review published in The Pediatric Infectious Disease Journal has cast doubt on previous estimates of the prevalence of long COVID in children and adolescents. The review is backed up by a new report from the Murdoch Children’s Research Institute (MCRI) in Australia, which found major limitations in the data used in existing studies on long COVID in children.

Given these data, there is also a question as to whether the benefits of vaccination for young children outweigh the risks. Currently there is conflicting data on this question. One study, which has not yet been peer-reviewed, found that healthy boys aged 12-15 are four to six times more likely to be diagnosed with vaccine-related myocarditis than end up in the hospital with COVID. On the other hand, another study found that the risk of myocarditis and other serious adverse events was substantially higher with COVID infection as opposed to COVID vaccination.

An FDA advisory panel recently endorsed the Pfizer COVID shot for 5-11 year olds by a vote of 17-0 with one abstention. Note, though, that if the panel did not vote to approve the shots, they would not be available for high-risk kids; the vote was to approve it for all kids in the age group or none. We don’t know what the vote would have looked like if panel members had the option to approve the shots just for high-risk kids with serious medical conditions, while excluding healthy kids for whom the risk/benefit analysis is quite different. For example, information presented during meeting shows that if infection rates fall, the risks of vaccinating kids may outweigh diminishing benefits in terms of prevented deaths and hospital stays.  

Hopefully these numbers paint a reassuring picture for parents and kids.

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