key: cord-0722306-1pty32l1
authors: Bhopal, Sunil; Bagaria, Jay; Bhopal, Raj
title: Children's mortality from COVID-19 compared with all-deaths and other relevant causes of death: epidemiological information for decision-making by parents, teachers, clinicians and policymakers
date: 2020-05-30
journal: Public Health
DOI: 10.1016/j.puhe.2020.05.047
sha: 48777bc9f33a408d97c17539880d6ea0f08c5307
doc_id: 722306
cord_uid: 1pty32l1

nan

Governments are grappling with the challenge of returning societies to quasi-normal following "lockdowns" to control the COVID-19 pandemic. Policymakers, the public, and especially parents are understandably anxious about the implications of re-opening nurseries and schools. In Europe, Norway, Denmark, France and Germany have already re-opened schools. The UK government signalled its intention to do so from 1 June 2020 to vast unease and controversy amongst the public, not least from teachers' unions whose arguments against premature reopening have polarised opinion. Others have described "collateral damage" to children through social distancing measures 1 and questioned compatibility with the UN convention on the rights of the child.

While decisions about allowing children to exit their homes, and to restart schooling, are ultimately value judgements, we think that understanding current risks to children from COVID-19 can be aided through epidemiology and that this understanding should underpin decision-makers' and parents' views 2 . We accept that there is much to learn about this new disease, and that the virus is likely to change during the pandemic and add new complexities.

We synthesised information on COVID-19 in relation to other causes of death in line with a previous call for increased focus on age-specific mortality 3 . We examined mortality as an important outcome providing accurate data, while recognising that reports about a multisystem hyper-inflammatory state in children need investigation and may modify our conclusions in due course 4 . Fortunately, the number of hospitalisations and ICU admissions in children remains low 5 .

We examined age-specific data on COVID-19 deaths which had been collated from official government sources for seven countries up to 8-19 May 2020 6 . These countries were chosen due to data availability and high burden of adult COVID-19 death. The data were first extracted by SB and then cross-checked by SB and JB together to ensure accuracy. We obtained estimated numbers of deaths from other causes from Global Burden of Disease estimates 7 except for influenza for which we examined official government statistical websites and extracted age-specific death counts for up to the last five years (2015-2019). To help to compare like-with-like we adjusted mortality counts to reflect a three-month time period (table 1) .

For this time period, in these seven countries combined, 44 COVID-19 deaths were reported in 42,846 confirmed cases (this latter number is likely to be a massive underestimate; data were not available for France) in those aged 0-19 years (0-14 in USA). This compares with 13,200 estimated deaths from all-causes, including 1,056 from unintentional injury, and 308 from lower respiratory tract infection (107 from influenza). The situation in each country was almost identical, and in accordance with early data from China 8 i.e. COVID rarely kills children, even compared with influenza, against which many children are already vaccinated. Our data show that for mortality COVID-19 is like flu, or less severe, in children whilst being the opposite in adults.

Our analysis should help parents, teachers and policymakers to make important decisions and possibly feel reassured about the direct impact of COVID-19 upon children. Political leaders, communities, clinicians and parents should appreciate that the main reason we are keeping children at home and socially isolated is to protect adults. The ethics of this choice needs public debate. Adults,-especially those at increased risk, including those with comorbidities or the elderly, who are -in close contact with children, need shielding. In children, at least in this wave of the pandemic and hopefully in the future, COVID-19 is a comparatively rare cause of death. We need to maintain close surveillance of COVID-19 in children in case this conclusion changes as the pandemic unfolds and the virus (SARS-CoV-2), evolves. 

Wider collateral damage to children in the UK because of the social distancing measures designed to reduce the impact of COVID-19 in adults

Risks to children during the pandemic: some essential epidemiology for parents, clinicians and policymakers

Covid-19 worldwide: we need precise data by age group and sex urgently

Royal College of Paediatrics & Child Health. Guidance -Paediatric multisystem inflammatory syndrome temporally associated with COVID-19

Coronavirus Disease 2019 and Children: What Pediatric Health Care Clinicians Need to Know

National Institute for Demographic Studies (INED) (distributor). The demography of deaths by COVID-19

Global Burden of Disease Study 2017 (GBD 2017) Data Resources | GHDx

SARS-CoV-2 Infection in Children

United Kingdom from Public Health England

Italy from: Istituto Superiore di Sanità

For USA: from Centers for Disease Control up to 8