Children at risk of severe coronavirus infection as 1 out of 3 American kids require ICU admission, says CDC

The rates of hospitalization among Hispanic and Black children is nearly eight times and five times more respectively as compared to the rate among White children


                            Children at risk of severe coronavirus infection as 1 out of 3 American kids require ICU admission, says CDC
(Getty Images)

One in three children in the US hospitalized with Covid-19 is admitted to an intensive care unit which shows that children with coronavirus infection can have severe illness, according to the Centers for Disease Control and Prevention (CDC). The report comes as parents and policymakers across states in the US grapple with the challenges of reopening schools and resuming classroom learning. 

"Children are at risk for severe Covid-19. Public health authorities and clinicians should continue to track pediatric SARS-CoV-2 (the virus that causes Covid-19) infections. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools," recommends the agency. 

Most reported cases of Covid-19 in children aged below 18 years appear to be asymptomatic or mild, but less is known about severe coronavirus illness requiring hospitalization in children, say experts. Accordingly, the CDC analyzed pediatric coronavirus hospitalization data from 14 states. From March 1 to July 25, 576 pediatric Covid-19 cases were reported to the Covid-19-associated hospitalization surveillance network (Covid-NET), a population-based surveillance system.

The median patient age was eight years (range between nine months to 15 years), and 292 (50.7%) were males. Among 526 (91.3%) children for whom race and ethnicity information was reported, 241 (45.8%) were Hispanic, 156 (29.7%) were Black, 74 (14.1%) were White, 24 (4.6%) were non-Hispanic Asian or Pacific Islander and four (0.8%) were non-Hispanic American Indian/Alaska Native.

The analysis reveals that the cumulative Covid-19-associated hospitalization rate among children below 18 years during the surveillance period was 8.0 per 100,000 and it was highest among children below 2 years (24.8). The rates were substantially lower in children aged 2-4 years (4.2) and 5-17 years (6.4). Overall weekly hospitalization rates among children increased steadily during the surveillance period — from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000. 

A medical chart review was completed for 208 (36.1%) children and it shows that the median duration of hospitalization was 2.5 days. A total of 69 children (33.2%) were admitted to the ICU for a median of two days. Invasive mechanical ventilation was required by 12 (5.8%) of 207 children and one patient died during hospitalization. “This report found that children with SARS-CoV-2 infection can have severe illness requiring hospitalization and intensive care.

During the surveillance period, one in three children were admitted to the ICU. Although the cumulative Covid-19-linked hospitalization rate among children is low compared with that among adults (164.5 per 100,000 population), weekly hospitalization rates in children increased during the surveillance period,” says the report. It adds, “The percentage of ICU admission was similar among children (33.2%) and adults (32.0%) reported to Covid-NET. However, invasive mechanical ventilation was required less frequently in children (5.8%) than in adults (18.6%).”

Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools, recommends the CDC (Getty Images)

The researchers also found that Hispanic and Black children were disproportionately impacted and had the highest rates of hospitalization. The rates among Hispanic and Black children were nearly eight times and five times, respectively, the rate in White children. According to the authors, Hispanic children were hospitalized for coronavirus at the highest rate, 16.4 per 100,000 people, followed by Black children at 10.5 per 100,000. In contrast, White children were hospitalized at a rate of 2.1 per 100,000. 

Health experts emphasize that the reasons for disparities in Covid-19-associated hospitalization rates by race and ethnicity are not fully understood. “This report found the highest rates of Covid-19-associated hospitalization among Hispanic children. It has been hypothesized that Hispanic adults might be at increased risk for SARS-CoV-2 infection because they are overrepresented in frontline (for example, essential and direct-service) occupations with decreased opportunities for social distancing, which might also affect children living in those households. During the 2009 influenza A H1N1 pandemic, pediatric mortality rates also were higher among underrepresented ethnic groups in a study from England,” the team explains.

Cumulative Covid-19-linked hospitalization rates among US children by age group and race/ethnicity, from March 1 to July 25 (CDC)

 

Forty-two percent of children in this analysis had one or more underlying medical conditions, with higher prevalence among Hispanic and Black children. "Among 222 (38.5%) of 576 children with information on underlying medical conditions, 94 (42.3%) had one or more underlying conditions," reveals the study.

The most prevalent conditions included obesity (37.8%), chronic lung disease  (18%), and prematurity (15.4%). Hispanic and Black children had higher prevalence of underlying conditions (45.7% and 29.8%, respectively) compared with white children (14.9%). "This suggests that the presence of underlying conditions place children at higher risk for Covid-19-associated hospitalizations and that observed disparities might in part be related to the higher prevalence of underlying conditions among hospitalized Hispanic and Black children compared with those among White children," the findings state.

Based on their findings, the CDC recommends continued surveillance. Improved understanding of the social determinants of health is needed to inform and reduce disparities as found in this report, they explain. Similar to the general population, experts suggest that children should be encouraged to wash their hands often and continue social distancing. "Children aged 2 years and above should wear a mask when around persons outside of their families to reduce the risk for SARS-CoV-2 infection and transmission to others. Ongoing monitoring of hospitalization rates, clinical characteristics, ICU admission, and outcomes in the pediatric population is important to further characterize the morbidity and mortality of coronavirus in children," the authors write. 

Over 97,000 kids test positive in last 2 weeks of July

An estimated 97,078 children in the US have tested positive for Covid-19 in the last two weeks of July alone, reveals data from July 16 to July 30. This is a 40% increase in child cases, according to a joint report from the American Academy of Pediatrics and the Children’s Hospital Association. 

The study, which summarizes the data that was available on July 30, says that at least 338,000 children have been infected since the Covid-19 pandemic began and children represent 8.8% (338,982 out 3,835,573) of all cases in the US. "From July 16-July 30, there were 97,078 new child cases reported (241,904 to 338,982, a 40% increase), with over 7 out of 10 new child cases reported from states in the South and West," the researchers write.

The overall rate of coronavirus infections was 447 cases per 100,000 children in the population. Seventeen states and DC reported more than 500 cases per 100,000 children. Information from 44 states and the New York City suggests that children represent 0%-0.8% of all Covid-19 deaths, and 20 states have reported zero child deaths. In states reporting data on mortality, 0%-0.3% of all child Covid-19 cases resulted in death. "Six states have over 15,000 cumulative child cases. Half of the states reported over 5,000 child cases, and 10 states reported fewer than 1,000 child cases," the findings state.

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