While everyone is at risk of infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), children are at less risk of severe infection than older adults. But children are not immune to the virus and may become infected because of household contact or high community transmission.
Led by Sarita Shah of Emory University, a new study shows low COVID-19 testing in children, suggesting the results are an underestimation of the true burden of disease.
“While it has been thought children are less susceptible to COVID-19 than adults, our data on testing rates and test positivity indicate the true burden of COVID-19 among those aged 18 years and younger may have been underestimated prior to the Delta variant,” concluded the research team.
The study “A Retrospective Cohort Study of COVID-19 among Children in Fulton County, Georgia, March 2020 – June 2021” was recently published on the medRxiv* preprint server.
How they did it
The researchers collected data on confirmed COVID-19 cases in children ages 0 to 18 years along with adults 19 years and older using the State Electronic Notifiable Disease Surveillance System. COVID-19 cases in Fulton County were from March 30, 2020, to June 6, 2021. Other information collected for the study included a positive SARS-CoV-2 test sample, age, gender, race, ethnicity, hospitalization, ICU admission, death, symptoms, and potential exposure.
Using Georgia’s Online Analytical Statistical Information System, the research team collected the number of children and adults living in Fulton County. For the study, children were categorized into different age groups — 0-4, 5-10, 11-13, and 14-18 years — to make inferences on age-based differences in COVID-19 infection.
What they found
A total of 10,437 pediatric COVID-19 cases were reported in Fulton County, Georgia. This translated to about 431.4 cases per 10,000 children.
About half of COVID-19 cases were children aged 14-18 (48.3%). The 5-10 age group had the second-highest number of cases (21.7%), followed by the 11-13 age group (16.9%), and the 0-4 year age group (13.1%).
Proportion of COVID-19 Cases Attributed to Children Aged 0-18 Years in Fulton County, Georgia by 14-day Periods, March 2020 – June 2021
There was no difference between boys and girls in all age groups. Additionally, non-Hispanic Blacks (35%) and non-Hispanic whites (33.5%) were the most common race/ethnicities among pediatric cases.
Children aged 0-4 were the age group most likely to require hospitalization during infection. However, less than 0.5% of COVID-19 cases required intubation.
One child in the 14 to 18 age group died.
Common features in pediatric COVID-19 cases
Less than half (43.2%) of children exhibited COVID-19 symptoms before the diagnosis. The most common symptoms across all ages were cough (17.2%) and fever (16.1%).
In older children, approximately 25.4% of the 14-18 age group reported headaches. However, only 3.8% of children aged 0-4 years experienced headaches.
Younger children were more likely to contract SARS-CoV-2 through household contact compared to older children.
All age groups showed a similar risk through community contact.
Rising number of COVID-19 cases in children
Throughout the study period, the number of pediatric cases rose to an unprecedented rate in the Fulton County population.
From early April 2020, children comprised 15.4% of all county cases. By September 2020, children made up 15.4% of all cases in the county. In April 2021, children made up 21.6% of cases.
Fortunately, recent data in the beginning of June demonstrated a decline in pediatric cases. By this time, they covered 11.8% of all cases.
COVID-19 cases were highest among adults and children aged 14-18 years.
When it came to COVID-19 testing rates, adults were more likely to get tested. Amongst children, the 14-18-year age group had the highest testing rates. For example, from December 7-20, 2020, children aged 14-18 years had 2.5 more tests than children aged 0-4 years.
“Despite these marked differences in testing rates, test positivity was similar across pediatric age groups and percent positivity among pediatric cases was higher than adults at almost every time period observed after July, 2020,” explained the researchers.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.