The proportion of US pediatric COVID-19 cases has risen substantially over time, with significant geographic variation, according to a study today in Pediatrics and a joint report from the American Academy of Pediatrics (AAP) and the Children's Hospital Association (CHA) also published today.
But although children represent a growing percentage of total cases, severe disease remains uncommon, the data show.
From 2% to 10.5% of cumulative cases
The studies examined trends in child COVID-19 cases using state health department website data for 49 states, 2 large, urban areas—New York City (NYC) and Washington, D.C.—and the territories of Puerto Rico and Guam. Researchers collected data weekly from Apr 16 to Sep 24 for case numbers, proportion of confirmed child cases, and testing, hospitalization, and mortality rates.
Pediatric cases have risen from 2.0% of cumulative reported cases in April to 10.5% last week, with children accounting for 12% to 15.9% of new weekly reported cases over the past 8 weeks. Twenty-nine states reported that 11% or more of cases involved children.
The Pediatrics study identified 549,432 cumulative child COVID-19 cases (729 cases per 100,000 children) as of Sep 10, with substantial regional variation. Early in the pandemic, most reported pediatric cases were in the Northeast, followed by surges in June in the South and West, and mid-July increases in the Midwest.
Since publication of the Pediatrics article, updated information in the AAP/CHA joint report shows children's cases have risen to 624,890—an overall rate of 829 cases per 100,000 children—representing a 14% increase in the 2 weeks from Sep 10 to Sep 24.
Hospitalization, death uncommon
"Although children are a growing percentage of total cases, hospitalization, and death due to COVID-19 is uncommon," the Pediatrics study authors wrote. As of Sep 10, children represented 1.7% of total hospitalizations, with 2% of children needing hospital care.
Rates of child death remained stable across the study period, with children representing 0.07% of overall deaths (a 0.01% rate of death in children). The share of all tests administered to children ages 0 to 17 years also remained stable at 5% to 7% since late April.
The AAP/CHA state-level study reports that pediatric cases represent 0.5% to 3.7% of total hospitalizations (25 states and NYC), and 0.2% to 7.9% of child cases have resulted in hospitalization. Child mortality (42 states and NYC) ranged from 0% to 0.26% of all COVID-19 deaths, and 0% to 0.16% of all children with COVID died.
AAP President Sally Goza, MD, said in an AAP press release, "These rising numbers concern us greatly, as the children's cases reflect the increasing virus spread in our communities. While children generally don't get as sick with the coronavirus as adults, they are not immune and there is much to learn about how easily they can transmit it to others.
"We must keep our children—and each other—healthy by following the recommended safety measures like washing hands, wearing cloth face coverings, and staying 6 feet apart from others."
Nationwide variations in data collection
In a commentary on the Pediatrics study in the same issue, Andrea Cruz, MD, MPH, with Baylor College of Medicine and Jeffrey Shaman, PhD, and Peter Dayan, MD, from Columbia University identified shortcomings in the use of state health department data containing substantial variation in definitions of children by age.
While most states define children as ages 0 through 19, Utah and Florida define children as ages 0 to 14, while Tennessee and South Carolina include individuals up to age 20, making comparisons across regions challenging. The commentators also highlighted state variation in the type of test used and reporting guidelines: "Texas only reports 'confirmed' cases, defined by PCR [polymerase chain reaction test] and does not report rapid antigen tests, which defined a 'probable' case, leading to an underestimation of the burden of disease."
The commentary authors advocate for standardized reporting and disaggregating data by pediatric age cohort to better understand epidemiologic trends like differences in transmission rates. They also warn of potential under-diagnosis of children because they often have milder symptoms and infrastructure barriers, as some testing sites opt not to test toddler- or preschool-aged children. The authors note, "While testing does not artificially increase case counts, the variation in access to and reporting of testing does have the consequence of artificially depressing case counts in children."
With case numbers increasing in children, it is increasingly important for caregivers to monitor children for COVID-19 symptoms and be proactive with preventive health measures. Goza says in the AAP press release, "We encourage parents to call their pediatricians and get their children into the office for well visits and vaccinations, especially now that some schools are reopening and flu season has arrived."
