COVID-19 death risk extremely low in kids, studies confirm
The findings come from some of the most comprehensive research on the risks of the coronavirus for those 18 years and younger
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Children are at extremely slim risk of dying from COVID-19, according to some of the most comprehensive studies to date, which indicate the threat might be even lower than previously thought.
Some 99.995% of the 469,982 children in England who were infected during the year examined by researchers survived, one study found.
In fact, there were fewer deaths among children due to the virus than initially suspected. Among the 61 child deaths linked to a positive COVID-19 test in England, 25 were actually caused by the illness, the study found.
The three studies, by researchers in the U.K. reviewing its national health system's medical records or pulling together data from other countries, were published on preprint servers Thursday. The studies haven't yet been reviewed by independent experts and are preliminary.
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The studies provide some of the most detailed analysis yet of severe illness and death from COVID-19 in children, a closely watched subject as schools prepare for a new academic year and parents weigh whether to have their children vaccinated if shots are cleared for younger ages. One of the studies focused only on deaths, while the other two examined the risks of severe illness and death.
Researchers had previously found the risk of severe illness and death from COVID-19 among children under 18 years was relatively low. The new studies confirm the findings, adding to the weight of evidence as policy makers and school officials make decisions about mask-wearing and physical distancing.
"Having a larger and larger database...adds a lot to our ability to make important decisions," said Dr. Rick Malley, an infectious-diseases specialist at Boston Children's Hospital and Harvard Medical School, who wasn't involved in the studies. The study examining the risk of death is "certainly one of the largest studies I've seen."
Some vaccines are in late-stage testing in younger children, while in use in adolescents 12 years and older.
One thorny area for policy makers is whether to recommend the shots if health agencies authorize the vaccines for children of younger ages. The decision would involve balancing the risks and benefits of vaccination with the low risk of serious illness and death from COVID-19.
Some parents have been concerned about giving messenger RNA vaccines from Pfizer or Moderna to adolescents because of the risk of a rare inflammatory heart condition. Advisers to the U.S. Centers for Disease Control and Prevention have urged vaccination, saying the benefits outweigh the risks.
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Several countries, including the U.S., are offering the Pfizer shot to children 12 years and older. The U.K. has so far held back from offering vaccines to older children under 18, unless they have certain serious illnesses.
For the three new studies, researchers looked at various medical and study data for children of different ages for periods since the pandemic started.
Researchers conducting the death study analyzed several national databases to identify children under 18 across England who had died from COVID-19 in the first year of the pandemic, from March 1, 2020, to Feb. 28, 2021.
"England is a large enough country and it's had enough COVID sadly, that we have better data than almost anywhere else in the world on the risks," said Russell Viner, a professor of adolescent health at the University College London Great Ormond Street Institute of Child Health, and senior author on the death study and another looking at English hospital and intensive-care admissions.
Researchers from the University of Bristol, University of York and University of Liverpool were also key contributors to the three papers. Two of the studies were published on the medRxiv preprint server and one on the Research Square preprint server.
Underlying health conditions, especially serious brain or nerve-related disabilities, increased the risk of dying of COVID-19, according to the study looking at child deaths.
Fifteen of the 25 children in England who died because of COVID-19 during the period examined had underlying serious illnesses, the researchers said, while four had chronic underlying conditions. The researchers didn't specify the serious illnesses or chronic conditions, but said that children with a combination of neurological and respiratory-linked conditions were at the greatest risk of death.
Three of the deaths were due to multisystem inflammatory syndrome, a serious complication of infection where different body parts can become inflamed. Six of the children who died due to COVID-19 didn't appear to have an underlying health condition, researchers said.
No child with a stand-alone diagnosis of asthma, diabetes, epilepsy or Down's Syndrome died from COVID-19, the researchers said.
The risk of death was higher among children from Black and Asian backgrounds and in older children above 10 years, the researchers said. Even among these higher-risk groups, however, children's absolute risk of dying from COVID-19 is very small.
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"Twice a tiny risk is still a very, very tiny risk," said Professor Viner. "Even 10 times a very, very tiny risk is still a very, very tiny risk."
Underlying health conditions also raised the risk of severe illness, the two other papers said.
"Factors linked to a higher risk of severe Covid-19 appear to be broadly consistent for both children and adults," said Joseph Ward, of UCL Great Ormond Street Institute of Child Health, who led one of the studies.
That study found a higher risk of admission to intensive care among children with health conditions such as diabetes, asthma and cardiovascular disease. Those with multiple conditions had the highest risk. Even so, the absolute risk was very small, the researchers said.
The studies all related to time periods that predated the emergence of the Delta variant that is now dominant in both the U.K. and the U.S., but the authors said there was as yet no evidence that the variant causes more severe illness or death among children.