COVID-19 Trends Among School-Aged Children — United States, March 1–September 19, 2020

Abstract

On September 28, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Approximately 56 million school-aged children (aged 5-17 years) resumed education in the United States in fall 2020.* Analysis of demographic characteristics, underlying conditions, clinical outcomes, and trends in weekly coronavirus disease 2019 (COVID-19) incidence during March 1-September 19, 2020 among 277,285 laboratory-confirmed cases in school-aged children in the United States might inform decisions about in-person learning and the timing and scaling of community mitigation measures. During May-September 2020, average weekly incidence (cases per 100,000 children) among adolescents aged 12-17 years (37.4) was approximately twice that of children aged 5-11 years (19.0). In addition, among school-aged children, COVID-19 indicators peaked during July 2020: weekly percentage of positive SARS-CoV-2 test results increased from 10% on May 31 to 14% on July 5; SARS-CoV-2 test volume increased from 100,081 tests on May 31 to 322,227 on July 12, and COVID-19 incidence increased from 13.8 per 100,000 on May 31 to 37.9 on July 19. During July and August, test volume and incidence decreased then plateaued; incidence decreased further during early September and might be increasing. Percentage of positive test results decreased during August and plateaued during September. Underlying conditions were more common among school-aged children with severe outcomes related to COVID-19: among school-aged children who were hospitalized, admitted to an intensive care unit (ICU), or who died, 16%, 27%, and 28%, respectively, had at least one underlying medical condition. Schools and communities can implement multiple, concurrent mitigation strategies and tailor communications to promote mitigation strategies to prevent COVID-19 spread. These results can provide a baseline for monitoring trends and evaluating mitigation strategies. School-aged children were stratified by age into two groups: children aged 5-11 years and adolescents aged 12-17 years. Confirmed COVID-19 cases were identified from individuallevel case reports submitted by state health departments for the weeks beginning March 1-September 13, 2020. † Confirmed cases had a positive real-time reverse transcription-polymerase chain reaction (RT-PCR) test result for SARS-CoV-2, the virus * https://nces.ed.gov/fastfacts/display.asp?id=372.

COVID-19 Trends in Florida K-12 Schools, August 10 – November 14, 2020

“…School data by grade level (e.g. elementary, middle, high) shows trends consistent with earlier findings by the CDC regarding case rates between younger and older adolescents 4 . Staff rates are higher than student rates in all school environments except high schools.…”

Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis

“…Nonetheless, 7 studies (Anand et al, 2020, Kainth et al, 2020, Meslin et al, 2020, Moreno-Galarraga et al, 2020, Riollano-Cruz et al, 2020, Schwartz et al, 2020, Tagarro et al, 2020 had a higher risk ratio of severe COVID-19 among pediatric patients without comorbidities than those with underlying conditions (Figure 2). Furthermore, studies such as the CDC Mortality and Morbidity Weekly Report (Leeb et al, 2020) had noticeably larger participant cohort populations than other reports. To examine the potential preferential bias of these studies towards the overall relative risk ratio of our analysis, we individually excluded each of the 37 studies to determine the overall effect of each singular study on the net relative risk ratio.…”

“…Across the 19 articles, of the 274,647 pediatric patients without comorbidities and COVID-19 infection, only 77 (0.03%) died across 8 studies (Bixler et al, 2020;Cai et al, 2020;Du et al, 2020;Götzinger et al, 2020;Leeb et al, 2020;Oualha et al, 2020;Riollano-Cruz et al, 2020;Yayla et al, 2020). In contrast, 134 (1.5%) of the 8960 children with pre-existing conditions died during the course of their SARS-CoV-2 infection across 15 studies (Bellino et al, 2020;Bixler et al, 2020;Blumfield and Levin, 2020;Chao et al, 2020, de Farias et al, 2020Derespina et al, 2020;Diorio et al, 2020;Eghbali et al, 2020;Götzinger et al, 2020;Kainth et al, 2020;Leeb et al, 2020;Moraleda et al, 2020;Otto et al, 2020, Oualha et al, 2020Swann et al, 2020) (Table 1). The random effects model used to determine the risk of mortality among children with comorbidities and COVID-19 relative to pediatric patients without comorbidities revealed a total risk ratio of 2.81 (95% CI 1.31 -6.02; 2 = 97.85 (P < 0.001); I 2 = 82%) ( Figure 4).…”

COVID-19—Lessons Learned and Questions Remaining

“…The mild course of COVID-19 is quite different from other respiratory illnesses in children, such as influenza and respiratory syncytial virus, which impact children more severely than adults and in which children are the major mediators of transmission. COVID-19 incidence in adolescents aged 12–17 years is approximately twice that in children aged 5–11 [ 74 ]. Children may transmit SARS-CoV-2 to other children and adults, but are not generally thought to play a major role in community spread.…”