SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020

Abstract

, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2-associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2-associated deaths reported to CDC among persons aged <21 years in the United States during February 12-July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1-9 years, 70% were aged 10-20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED). † These data show that nearly three quarters of SARS-CoV-2-associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10-20 years, with a disproportionate percentage among young adults aged 18-20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 * https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/peoplewith-medical-conditions.html. † Location of death for all cases (121): hospital (79 [65.3%]), home (16 [13.2%]), ED (23 [19.0%]), hospice (one [0.8%]), and unknown (2 [1.7%]).

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

“…† † † Acute COVID-19 and † † † https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/otherat-risk-populations.html. multisystem inflammatory syndrome in children (MIS-C) have been reported to disproportionately affect Hispanic and Black children (3,4). Implementing multiple, concurrent mitigation strategies and tailored communications about the importance of promoting and reinforcing behaviors that reduce spread of COVID-19 (e.g., wearing masks, maintaining a social distance of ≥6 feet, and frequent handwashing) can reduce COVID-19 spread in schools and communities.…”

Relationships between Demographic, Geographic, and Environmental Statistics and the Spread of Novel Coronavirus Disease (COVID-19) in Italy

“…In particular, the results of the present study suggest that SARS-CoV-2 has been circulating in Italy since early January, probably mistaken for flu or the common cold. In fact, having ascertained that those suffering from COVID-19 were largely asymptomatic [12], symptoms associated with COVID-19 are milder in children compared with adults [13], the incubation period ranges from two to 14 days with an average of 5-6 days [14], 80% of people with COVID-19 have mild symptoms [15], average mortality is about 1% [16,17], and the fatality rate is proportional to age and extremely high for patients over 65 years [18], the most likely hypothesis is that the virus had been present in Italy before their arrival. All these factors drastically increase the time needed to identify and isolate a person infected with COVID-19 since: a) the asymptomatic individuals infected without their knowledge and the people with whom they have been in contact, b) children (besides the problem of asymptomaticity) showed milder symptoms than adults, inducing parents and relatives to associate them with normal colds or flu, c) the symptoms were identified up to 14 days after contagion, allowing infected subjects to infect other people unknowingly, d) in the overwhelming majority of cases, symptomatic patients showed mild symptoms not causing concern in work colleagues and relatives, and e) the fact that the death risk was extremely concentrated in the high age groups prevented an easy assessment of the extent of the epidemic since these groups were naturally more exposed to fatal phenomena, that is, until high numbers have been reached, the collective psychological impact was low.…”

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

“…Among these 86 articles, only 42 had pediatric case-control participants without comorbidities with either severe COVID-19 and/or COVID-19-associated mortality. Five studies (Bellino et al, 2020;Bixler et al, 2020;Blumfield et al, 2020;Moraleda et al, 2020;Otto et al, 2020) only examined children who died from COVID-19 and were therefore only included in the mortality analysis. These 42 studies were therefore the basis for our analysis examining the effects of comorbidities on severe and potentially fatal manifestations of pediatric SARS-CoV-2 infection.…”

“…Employing a random-effects model to examine the relative risk of severe COVID-19 and/or PICU admission among children with comorbidities, we obtained a total relative risk ratio of 1.79 (95% CI 1.27 -2.51; 2 = 602.31 (P < 0.001); I 2 = 94%) ( Figure 2). It is important to note that only 37 studies were included in this analysis as 5 studies only examined COVID-19associated deaths (Bellino et al, 2020;Bixler et al, 2020;Blumfield et al, 2020;Moraleda et al, 2020;Otto et al, 2020). 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).…”

“…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).…”