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Children and COVID-19: The Evidence

The CDC has provided guidance about children and COVID-19.

Cases and Deaths Associated with COVID-19

by Age Group in California 

Source: California Department of Public Health

As children go back to school, one question is whether children themselves will spread infections.

"Recent evidence suggests that children likely have the same or higher viral loads in their nasopharynx compared with adults and that children can spread the virus effectively in households and camp settings."

Are children getting COVID-19?

"The number and rate of cases in children in the United States have been steadily increasing from March to July 2020."

California data reports that 9.7% of their cases were among children 0-17.

How severe are the child cases?

"Recent COVID-19 hospitalization surveillance data shows that the rate of hospitalization among children is low (8.0 per 100,000 population) compared with that in adults (164.5 per 100,000 population), but hospitalization rates in children are increasing.

"1 in 3 children hospitalized with COVID-19 in the United States were admitted to the intensive care unit, which is the same in adults."

"During March 21–July 25, weekly hospitalization rates steadily increased among children (from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000). " What should we expect when school opens?

One major reason that COVID-19 spreads so effectively is that those infected can spread it before any symptoms are visible. This study describes cases of infections caused by infected persons without symptoms:

The periods reported between exposure and the appearance of symptoms are 2-9 days, and 3-11 days. Either way, this poses a problem for groups of people. Schools are going to extraordinary lengths to clean school spaces, wear masks, and social distance as best they can. Protocols are in place for when students have symptoms which even might be COVID-19 - fever, cough, sore throat. But COVID-19 spreads while its victims still feel just fine, during the pre-symptomatic period. It's difficult to see how schools hosting hundreds or thousands of children daily will avoid having infections which spread before symptoms can be spotted. 

The numbers above allow for some rough predictions. Bearing in mind that the numbers observed above were during a period when children were not gathering in schools, we should expect that more infections will occur among children. The US is currently (August 15) at a plateau of about 55,000 new cases daily. If the percentage observed in California continues, then we would see 5,335 new cases daily among those under 18. The weekly hospitalization rates reported by the CDC are per 100,000, so that allows you to scale that prior result to your community. Houston Texas, for example, has about 7 million people. Weekly hospitalization at the rate of 0.4 per 100,000 would predict 28 child hospitalizations per week. If 1 in 3 of those go into the ICU, that would be about 9 children into intensive care in the Houston area each week. 

Scaled to the U.S.

In one study which tracked cases all the way through, 0.5% of children hospitalized with COVID-19 died. We can use current numbers to look at hospitalization and deaths to be expected among children.

The most recent week averaged 52,658 new cases daily.

Of those, about 4.5% are being hospitalized. 

If 9.7% of cases are among those under 18, that would be about 5100 new daily cases among children (remember: under conditions where children are not attending school). 

If 4.5% of those are hospitalized, that would be about 230 children hospitalized daily.

If 1 in 3 of those go into Intensive Care Units, that would be about 77 children placed in ICUs daily

At 0.5% of those hospitalized dying, this puts the death rate among children at 1.15 daily.  This at current rates of COVID-19 among children.

When children go back to school, how many additional cases will be seen? We don't have statistical data yet, only reports of individual schools experiencing outbreaks. Right now the US. is at a high plateau in cases. If we see that cases do not increase in September, then that will be consistent with our hope that schools can re-open safely. 

If cases go up as schools re-open, then we DO already have some statistical data about what to expect among children, per the reports above. 

All opinions expressed in this blog are solely those of the authors, and do not reflect those of University of Texas Rio Grande Valley, or any organizations of which either is a member.

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