key: cord-0916101-olymwmgj
authors: Bhopal, Sunil S; Bagaria, Jayshree; Olabi, Bayanne; Bhopal, Raj
title: Children and young people remain at low risk of COVID-19 mortality
date: 2021-03-11
journal: Lancet Child Adolesc Health
DOI: 10.1016/s2352-4642(21)00066-3
sha: 87f5f5bccabf6281b2f09fb3ffec40a6765a960e
doc_id: 916101
cord_uid: olymwmgj

nan

Since early reports from China stated that severe COVID-19 disease was rare in children, 1 we have analysed child COVID-19 mortality in seven countries. To put the deaths into a context that would help the understanding of parents, clinicians, and policy makers, we previously made comparisons of COVID-19 deaths with modelled mortality from all causes and other causes. Our first publication in April, 2020, 2 was followed by a trend analysis up to August, 2020. 3 We also update a data table online. Here, we update this analysis to February, 2021, in light of increases in adult mortality through the 2020-21 winter, and concerns about variant B.1.1.7, first identified in the UK in December, 2020 (probably circulating since September). 4 In the USA, UK, Italy, Germany, Spain, France, and South Korea, deaths from COVID-19 in children remained rare up to February, 2021, at 0·19 per 100 000 population, comprising 0·54% of the estimated total mortality from all causes in a normal year (table, appendix p 2). Deaths from COVID-19 were relatively more frequent in older children compared with younger age groups. The differences between countries need careful interpretation because of small numbers, possible differences in case definition and death reporting mechanisms, and the related condition paediatric inflammatory multisystem syndrome temporally associated with COVID-19, which might not always be captured in these data. The highest rate of deaths per 100 000 children was in Spain (0·64 for children aged 0-9 years; 0·53 for children aged 10-19 years) and the lowest in South Korea (0 deaths for children aged 0-9 years and 10-19 years). Overall, there was no clear evidence of a trend of increasing mortality throughout the period up to February, 2021, but additional deaths have clearly occurred in children and young people during periods of high community transmission, particularly in Spain, Germany, and Italy (appendix p 3).

Although COVID-19 mortality data are contemporary and likely to accurately represent the reality in these countries, it is not possible to access such data for other causes of death. We therefore used estimates from the Global Burden of Disease 2017 database, which does not account for seasonality or changes in mortality patterns in this pandemic year. Nevertheless, the very low mortality we describe from COVID-19 compared with all-causes is likely to be of the correct magnitude. With the caveat that some children at high risk might be using extreme socalled shielding measures, children are overall not becoming seriously unwell with COVID-19, 5 and data from England show that children are also not requiring intensive care in large numbers. 6 Some of the measures to counteract the devastating impact of the virus on adults are having unintended negative consequences for children. 7 The possible benefit to wider society of these measures should be constantly scrutinised to ensure proportionality in line with outcomes for all. Our evidence indicates that children continue to be mostly, but not completely, spared the worst outcome of the pandemic, particularly compared with older adults who have been much harder hit. 8 

Epidemiology of COVID-19 among children in China

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