The risk of death or severe illness from COVID-19 in teenagers and children is extremely low, according to three new studies from the UK.
The studies provide the most detailed analysis to date on the impact of the CCP (Chinese Communist Party) virus on children and confirm earlier findings for those aged 18 and younger: that they’re at very low risk of becoming severely ill or dying from the disease.
Researchers from the University of Liverpool, the University College of London, the University of York, and the University of Bristol published their pre-print studies, which are in the process of being peer-reviewed, online on July 8. Two of the studies analyzed the risks of severe illness and death from COVID-19, while one focused only on deaths.
The preliminary findings will be submitted to the World Health Organization and the UK’s Joint Committee on Vaccination and Immunization, which is still considering whether to expand the use of Pfizer’s COVID-19 vaccine to children aged 12 to 17 in the country. All four COVID-19 vaccines authorized for use in the UK are only for people aged 18 and older.
Russel Viner, a senior author on two of the studies and a professor of adolescent health at the University College London’s Great Ormond Street Institute of Child Health, said the findings “will inform shielding guidance for young people as well as decisions about the vaccination of teenagers and children, not just in the UK, but internationally,” according to a statement.
While the studies didn’t include information specific to the effects of the Delta variant, there’s currently no evidence that it causes more severe disease or death in children.
“Although this data covers up to February 2021, this hasn’t changed recently with the Delta variant,” said Dr. Elizabeth Whittaker, senior clinical lecturer in pediatric infectious diseases and immunology at Imperial College London. “We hope this data will be reassuring for children and young people and their families.”
Deaths Rare, Mostly in Children with Underlying Health Conditions
In the study that focused only on deaths, researchers analyzed England’s national databases, including the mandatory National Child Mortality Database, to identify all children under the age of 18 who have died as a result of COVID-19 between March 2020 and February 2021.
During the first year of the pandemic in England, of the 3,105 children who had died from all causes, 61 were children who had tested positive for the CCP virus.
But after “differentiating between those who died of SARS-CoV-2 infection and those who died of an alternative cause but coincidentally tested positive,” the researchers determined that only 25 of the 61 children had died of COVID-19 in a population of more than 12 million children.
This equated to a mortality rate of about two in a million.
SARS-CoV-2 is the scientific name for the CCP virus that causes the disease COVID-19.
Of the 25 children who died with COVID-19, 15 had a life-limiting condition, 16 had multiple comorbidities, and 19 had an underlying chronic health condition.
The researchers found that the “comorbidity group at highest risk [for death] were those with complex neurodisability, who comprised 52 [percent] of all deaths” in children who died of COVID-19.
“Those young people at higher risk are those who are also at higher risk from any winter virus or other illness—that is, young people with multiple health conditions and complex disabilities,” Viner said. “COVID-19 does, however, increase the risks for people in these groups to a higher degree than for illnesses such as influenza (seasonal flu).”
Only six of the 25 COVID-19 deaths—24 percent—appeared to not have underlying health conditions.
In addition, the researchers found no deaths in children with an isolated diagnosis of a respiratory condition such as asthma, Type 1 diabetes, Down syndrome, or epilepsy.
However, the researchers noted that “during the same time period studied, there were 124 deaths from suicide and 268 deaths from trauma, emphasizing COVID-19 is rarely fatal” in children and teenagers.
Underlying Health Conditions Increase Risk of Severe Illness
A different study, this one examining “81 existing studies assessing risk factors for severe illness and death from COVID-19 among young people,” found that pre-existing health conditions and severe disabilities increased the risk of severe disease.
Children who had heart or neurological conditions, more than one medical condition, or were obese were at higher risk. However, the absolute risks were still small, even when compared to children without comorbidity.
“It’s important to remember that the risks are very low for all children and young people,” said Lorna Frasier, professor of epidemiology at the University of York and senior author of the study. “Even when we found higher risks for some groups with severe medical problems, these risks were still very small compared to risks seen in adults.”
Pediatric surgeon Dr. Rachel Harwood, lead author of the study, emphasized that obesity is linked to more severe cases of COVID-19 in children.
“Our meta-analysis found similar risk factors to the other studies, although we also found that obesity increased the risk of severe COVID-19 illness, something we’ve known for some time in adults but is only now becoming evident as an important risk in children and young people too,” she said.
Hospitalizations Remain Low Overall
In a third study (pdf), which examined risk factors for death and intensive care admission, researchers concluded that children and teenagers were at a “very low risk of severe disease and death from COVID-19 or PIMS-TS [pediatric inflammatory multisystem syndrome-temporarily associated with SARS-CoV-2].”
Researchers found that, of the 5,830 children admitted to the hospital with COVID-19, 251 were admitted to the intensive care unit (ICU) in England during the first year of the pandemic, up until the end of February. This equated to children “having a one in approximately 50,000 chance of being admitted to intensive care with COVID-19 during that time.”
Within the same period, more than 367,000 children were admitted to the hospital for other causes.
Of those 251 admitted to the ICU, 91 percent had an underlying health condition or comorbidity. Those at greatest risk were children with multiple medical conditions and neurological disorders.
“This pattern is described in previous work, and is consistent with our meta-analysis of the published data, where each increase in the number of pre-existing conditions was associated with increased odds of PICU [pediatric intensive care unit] admission and death for COVID-19,” the authors wrote.
The authors also found that 309 children were admitted to the ICU with PIMS-TS, a rare inflammatory condition in children due to COVID-19, “equating to an absolute risk of one in 39,000.”
“It is reassuring that these findings reflect our clinical experience in hospital—we see very few seriously unwell children,” Whittaker said.
CDC Still Recommends Masks for Unvaccinated Students
A day after the studies were published online, the U.S. Centers for Disease Control and Prevention (CDC) released updated guidance on how to prevent COVID-19 in K–12 schools, saying that cloth masks and physical distancing of three feet were still recommended for students who aren’t fully vaccinated when indoors.
Other preventative measures recommended by the CDC include the promotion of vaccines among students, screening tests to identify those who are infected, improving ventilation, contact tracing, and proper hand hygiene.
“Vaccination is currently the leading public health prevention strategy to end the COVID-19 pandemic,” the CDC stated, noting that the promotion of “vaccination can help schools safely return to in-person learning as well as extracurricular activities and sports.”
COVID-19 vaccines have been recommended for adolescents aged 12 to 15 years in the United States since May.
In June, the CDC continued its recommendation of emergency use-approved messenger RNA COVID-19 vaccines to everyone 12 years and older, despite higher than normal reports of heart inflammation in young men following an mRNA vaccine. The CDC cited that the benefits of the vaccine outweighing the risk of heart inflammation as its reason for doing so.
The one-size-fits-all approach, rushing to vaccinate healthy children and teenagers without adequate safety and efficacy data, has been concerning to some doctors and parents, as the risk of severe illness or death is extremely low for that age group. Young children haven’t been reported to be superspreaders of the CCP virus.
Viner, in an opinion piece published in The Guardian, said that public health officials should wait until there are enough safety data before vaccinating healthy teenagers.
“I believe it is reasonable to now offer to vaccinate teenagers with chronic diseases and medical conditions that make them more vulnerable. As for healthy teenagers, let’s first use our vaccine supplies to raise adult vaccination levels as high as possible, provide boosters for the elderly and fulfill our promises to provide vaccines for poorer countries. Then, we should vaccinate healthy teenagers once we have adequate safety data—but for this we must wait,” he wrote.
The CDC didn’t immediately respond to a request for comment on whether its recommendations also apply to children who have recovered from COVID-19 and have natural immunity.