SARS-CoV-2 in Children

The more you look for something, the more you tend to find it. Those of us who work with child and school health have listened in disbelief over the past few months to public discourse dismissing the role of children in transmission of SARS-CoV-2. Children are major vectors of influenza and almost every other respiratory virus. As focus has now turned more toward children, in anticipation of the start of the school year, we find that they are not immune from this pandemic.

Summary data for COVID-19 cases have been assembled in a joint report from the American Academy of Pediatrics and the Children’s Hospital Association and provide a picture of the childhood contribution to the national toll. This compilation of data from states, territories, and Washington, DC, provides the following key findings:

• 380,174 COVID-19 cases in children have been reported as of August 6, 2020.

  • This represents 9.1% of all cases.

  • This is a rate of 501 cases per 100,000 children.

  • In other words, 1 of every 199 children has tested positive.

• Children comprise 3% to 12% of individuals tested, depending upon the state.

• Children represented 0.5% to 5.3% of COVID hospitalizations, depending on the state.

  • 3% to 8.9% of positive cases resulted in hospitalization.

• Children represented up to 0.5% of COVID-19 deaths, depending on the state.

  • Up to 0.5% of positive cases have resulted in death.

Young people (aged 0 to 18 years) represent about 25% of the US population. We have not tested children as frequently as older individuals because they tend to have fewer severe symptoms. Such a mindset, however, has likely contributed to an under-ascertainment of cases and hindered the identification of asymptomatic and low symptomatic individuals who contribute to spread of SARS-CoV-2.

As additional testing has occurred in children, their relative contribution to the overall case burden has steadily increased (see graphic based on data from the report). Keep in mind that this has occurred during the time that most of our 50 million US schoolchildren have been at home. As schools reopen, and increased contact and mixing occurs, I anticipate significant increases in cases, hospitalizations, and deaths.