While everyone is at risk of infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), children are less at risk of serious infection than older adults. But children are not immune to the virus and can become infected through household contact or high community transmission.
Led by Sarita Shah of Emory University, a new study shows low COVID-19 testing in children, suggesting the results are an underestimation of the true burden of disease.
“While children were thought to be less susceptible to COVID-19 than adults, our data on test rates and test positivity indicate that the true burden of COVID-19 among individuals 18 years and younger may have been underestimated prior to the Delta variant,” , the research team concludes.
The study “A Retrospective Cohort Study of COVID-19 Among Children in Fulton County, Georgia, March 2020 – June 2021” was recently published on the medRxiv* preprint server.
How they did it
The researchers collected data on confirmed COVID-19 cases in children ages 0 to 18, along with adults ages 19 and older, using the State Electronic Notifiable Disease Surveillance System. COVID-19 cases in Fulton County were from March 30, 2020 to June 6, 2021. Other information collected for the study included a positive SARS-CoV-2 test sample, age, gender, race, ethnicity, hospitalization, admission to the IC, death, symptoms and possible exposure.
Using Georgia’s online analytical statistical information system, the research team collected the number of children and adults living in Fulton County. For the study, children were divided into different age groups – 0-4, 5-10, 11-13 and 14-18 years – to draw conclusions about age-based differences in COVID-19 infection.
What did they find?
A total of 10,437 pediatric COVID-19 cases were reported in Fulton County, Georgia. This translated to about 431.4 cases per 10,000 children.
About half of the COVID-19 cases were children aged 14-18 (48.3%). The age group 5-10 had the second highest number of cases (21.7%), followed by the age group 11-13 (16.9%) and the age group 0-4 years (13.1%).
Share of COVID-19 Cases Attributed to Children 0-18 Years in Fulton County, Georgia by 14 Day Period, March 2020 – June 2021
There was no difference between boys and girls in all age groups. In addition, non-Hispanic blacks (35%) and non-Hispanic whites (33.5%) were the most common race/ethnicity among pediatric cases.
Children aged 0-4 years were the age group most likely to require hospitalization during infection. However, less than 0.5% of COVID-19 cases required intubation.
A child in the age group of 14 to 18 years died.
Common features in pediatric COVID-19 cases
Less than half (43.2%) of the children showed symptoms of COVID-19 before diagnosis. The most common symptoms at all ages were cough (17.2%) and fever (16.1%).
In older children, about 25.4% of the 14-18 age group reported headaches. However, only 3.8% of children aged 0-4 years suffered from headaches.
Younger children were more likely to contract SARS-CoV-2 through household contact compared to older children.
All age groups showed a similar risk from community contact.
Rising number of cases of COVID-19 in children
Throughout the study period, the number of pediatric cases rose to an unprecedented number in the Fulton County population.
As of early April 2020, children made up 15.4% of all provincial affairs. In September 2020, children made up 15.4% of all cases in the province. In April 2021, children accounted for 21.6% of cases.
Fortunately, recent data showed a decline in pediatric cases in early June. By this time, they had covered 11.8% of all cases.
The number of COVID-19 cases was highest among adults and children aged 14-18.
When it came to COVID-19 testing rates, adults were more likely to get tested. Of the children, the 14-18 age group had the highest testing rates. For example, from December 7-20, 2020, children aged 14-18 had 2.5 more tests than children aged 0-4.
“Despite these clear differences in test rates, test positivity was similar in pediatric age groups and the percentage of positivity among pediatric cases was higher than among adults in nearly every period observed after July 2020,” the researchers explained.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, should guide clinical practice/health-related behavior or be treated as established information.