How serious is COVID-19 in children?

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“1. HOW SERIOUS IS COVID-19 DISEASE IN CHILDREN?

By February 2022, the new coronavirus had evolved from the original alpha variant that human populations had no immunological experience with, to the more transmissible and severe Delta variant that emerged in the summer of 2021, to the Omicron variant that became dominant in late 2021.92

Omicron is highly contagious but causes fewer complications and hospitalizations than Delta,93 and there is speculation that the fact so many people have developed various degrees of natural immunity to SARS-CoV-2 is one reason why hospitalizations and deaths are coming down in the U.S.94,95

As of February 14, 2022, COVID-19 death rates reported by states in the previous seven days ranged from 0.26 to about 1.5 deaths per 100,000 people.96

To put the worst case 1.5 COVID-related deaths per 100,000 people rate into perspective, the annual death rate for some of the leading causes of death in the U.S. in 2014 were: 193 deaths per 100,000 for heart disease; 186 per 100,000 for cancer; 46 per 100,000 for chronic respiratory disease; 24 per 100,000 for diabetes; 15 per 100,000 for drug overdoses.97

Severe COVID Most Likely in Chronically Ill People Over 65

At the outset of the coronavirus pandemic, it became obvious that most of the serious complications of COVID-19 disease leading to hospitalizations and death do not occur in children or healthy young adults, but in people over age 65, especially if they have one or more chronic health problems.

In 2020, researchers projected that about 45 percent of the U.S. adult population was at increased risk for complications from SARS-CoV-2 infections because of underlying heart or respiratory disease, diabetes, hypertension and cancer.98

One big study sponsored by the CDC looked at the connection between underlying medical conditions and severe illness among more than 500,000 adults with COVID-19 admitted to 800 US hospitals in 2020 and 2021. Researchers found that 95 percent of adult COVID patients had at least one underlying poor health condition like high blood pressure and obesity.99 The strongest risk factors for death were obesity, anxiety and fear disorders, and diabetes with complications.

Children with chronic health problems are also at risk for COVID disease complications. The CDC states on its website that, “In the United States, more than 40% of school-aged children and adolescents have at least one chronic health condition, such as asthma, obesity, other physical conditions, and behavior/learning problems.”100

Most Serious COVID-19 Occurs in Chronically Ill Children

A large cross-sectional study funded by the CDC examined the health records of more than 43,000 patients under the age of 18 with a COVID diagnosis who visited the emergency room or were admitted to 900 US hospitals in 2020 or January 2021.101

The median age of child COVID patients was 12 years old. Researchers found that about 29 percent of the child COVID patients had underlying chronic conditions like asthma; obesity; and neurodevelopmental, depressive, anxiety and fear-related disorders.

The strongest risk factors for hospitalization were type 1 diabetes and obesity. The strongest risk factors for severe COVID illness were type 1 diabetes and congenital cardiac and circulatory problems. Prematurity was a risk factor for severe COVID illness in children under two years old.102 Those with a COVID diagnosis represented only about 1% of all children who visited an emergency room or were admitted to the hospital.

More than 81% of COVID related deaths in the U.S. have occurred in seniors over age 65 and deaths in that age group are 80 times higher than for people between 18 and 29.103 The COVID case fatality rate for children by February 2022 was measured at less than one percent in the U.S.104

Healthy Infants and Children Usually Have No or Mild Symptoms

Studies have shown that most healthy infants and children with COVID disease either have no symptoms or much milder symptoms than adults, which last about a week.105 COVID disease symptoms in the majority of healthy children are similar to a cold or flu-like illness and range from fever, sore throat, fatigue and body aches to runny nose and congestion, headache, cough, nausea and diarrhea.

As with most respiratory diseases, pneumonia is always a risk and, clearly, risks for COVID complications are higher for children with certain types of underlying chronic disease.106

Severe complications of COVID-19 disease in some individuals appear to involve a hyper-inflammatory response by the immune system to infection with SARS-CoV-2. This can lead to cytokine storm involving elevated levels of circulating cytokines and immune-cell hyperactivation that can lead to severe respiratory distress and death if the inflammation does not resolve.107

There is a condition called Multisystem Inflammatory Syndrome in Children (MIS-C) that has been reported rarely, and obese children are most at risk. Symptoms include a prolonged fever, unusual fatigue, vomiting and diarrhea, red skin rash, abdominal pain, red lips and eyes and swollen hands or feet.108

Children With COVID at Very Low Risk of Hospitalization, Death

While the majority of people diagnosed with COVID disease have mild to moderate symptoms, about 10 to 15% become severely ill and five percent become critically ill. Most recover in two to three weeks, but researchers estimate about one in five may have symptoms for five or more weeks and one in 10 people will have symptoms that last for 12 weeks or longer.109

Symptoms of “long Covid,” can include fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell and taste, diarrhea, difficulty thinking clearly, memory loss, anxiety and sleep disorders. About four percent of children may experience “long Covid” symptoms like fatigue, headache and loss of smell and the majority recover within eight weeks.110

If infected with the SARS-CoV-2 virus, healthy children have a very low risk of being hospitalized or dying. A U.S. state data report published by the American Academy of Pediatrics on February 3, 2022 found that out of about 1.2 million COVID-related hospitalizations, only 3% were children. Out of 821,369 reported COVID deaths in the U.S., 828 of those deaths or .01% were in children.111

References

92 Sawyer S, Barbachano-Guerrero A, Warren C. Alpha then delta and now omicron – 6 questions answered as COVID-19 cases once again surge across the globe. The Conversation Jan. 21, 2022.

93 Goodman B. New Studies Suggest Omicron Infections Are Less Severe Than Delta Ones. WebMD Dec. 22, 2021.

94 Altarwneh HN, Hasan MR, Ayoub HH et al. Protection against the Omicron Variant from Previous SARS-CoV-2 Infection. N Engl J Med Feb. 9, 2022.

95 Bean M. US COVID-19 deaths down 5.9% this week: 9 CDC findings. Becker’s Hospital Review Feb 11, 2022.

96 Becker’s Hospital Review. States ranked by COVID-19 death rates. Feb. 14, 2022.

97 Geggel L. The Odds of Dying. Live Science Feb. 9, 2016.

98 Adams ML, Katz DL, Grandpre J. Population-Based Estimates for Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States. Emerg Infect Dis 2020; 26(8): 1831-1833.

99 Kompaniyets L, Pennington AF, Goodman AB et al. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized with COVID-19, March 2020-March 2021. Prev Chronic Dis 2021; 18:E66.

100 CDC. Managing Chronic Health Conditions. Oct. 20, 2021.

101 Kompaniyets L, Agathis N, Nelson JM et al. Underlying Medical Conditions Associated with Severe COVID-19 Illness Among Children. JAMA Netw Open 2021; 4(6).

102 Ibid.

103 CDC. COVID-19: People with Certain Medical Conditions. Feb. 25, 2022.

104 American Academy of Pediatrics and Children’s Hospital Association. Children and COVID-19: State Data Report. (Summary of State-Level Data; Appendix Table 1; Appendix Table 2B and Appendix Table 2C). Feb. 3, 2022.

105 Dawood FS, Porucznik CA, Veguilla V et al. Incidence Rates, Household Infection Risk, and Clinical Characteristics of SARS-CoV-2 Infection Among Children and Adults in Utah and New York City, New York. JAMA Pediatr 2022 176(1): 59-67.

106 Milstone A. COVID in Babies and Kids: Symptoms and Prevention. Johns Hopkins Medicine Dec. 8, 2021.

107 Olbei M, Hautefort E, Modos D et al. SARS-COV-2 Causes a Different Cytokine Response Compared to Other Cytokine Storm-Causing Respiratory Viruses in Severely Ill Patients. Front Immunol Mar. 1, 2021.

108 Ibid.

109 Aiyegbusi OL, Hughes SE, Turner G et al. Symptoms, complications and management of long COVID: a review. J R Soc Med 2021; 114(9): 428-442.

110 Molteni E, Sudre CH, FCanas LS et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. The Lancet 2022; 5(1): 708-718.

111 American Academy of Pediatrics and Children’s Hospital Association. Children and COVID-19: State Data Report. (Summary of State-Level Data; Appendix Table 1; Appendix Table 2B and Appendix Table 2C). Feb. 3, 2022.

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