key: cord-0896888-0kgykn3o
authors: Bhopal, Sunil S.; Bagaria, Jayshree; Olabi, Bayanne; Bhopal, Raj
title: COVID-19 deaths in children: comparison with all- and other causes and trends in incidence of mortality
date: 2020-09-06
journal: Public Health
DOI: 10.1016/j.puhe.2020.08.022
sha: b946456e01f17d5f74d5cff26be6f58b642d87a4
doc_id: 896888
cord_uid: 0kgykn3o

nan

Keywords: covid-19; child; mortality; epidemiology Our analysis of COVID-19 in children until the end of May 2020 indicated mortality was rare and lower than from influenza, for which children already have a vaccine. We feared and wrote that over time the severity of the virus in children might increase. We published this in May 2020 1 and now examine childhood mortality from COVID-19 over time and compared with other causes in seven countries: USA, United Kingdom, Italy, Germany, Spain, France and Republic of Korea.

As before, we extracted COVID-19 mortality data for 0-19 year olds (only 0-14 is group data were available in USA) from The National Institute of Demographic Studies (INED) 2 , which is collated from national statistical agency reports. This analysis was for five months between 1 March 2020 until 31 July 2020 (5 months). We extracted mortality data for other-and all-causes from the latest Global Burden of Disease estimates (2017 3 ) except for influenza deaths which we obtained for the last three years from national statistical agencies. We estimated deaths from these annual data for the five month period through simple division (5/12) of the annual numbers. BO, SB and JB cross-checked all data.

In an estimated population of 137,047,945, from March-July there were 78 deaths from COVID-19. For comparison, there were an estimated 21,966 deaths from all-causes (1,755 from unintentional injury, 510 from lower respiratory tract infection, 178 from influenza), with COVID-19 accounting for 0.355% of deaths (Table 1 & Figure 1 ). We examined mortality weekly, finding that the peak of cases and deaths in children mainly matched that of adults (USA continues to report child deaths from COVID-19 which is in-line with the continuation of that country's overall epidemic) ( Figure 2 ). The proportion of deaths attributable to COVID-19 in children was stable over May, June and July. We predict this proportion will decline assuming the continuation of public health control measures and improvements in treatments.

Five months of data show that in these countries, children are at much greater risk of death from other elements of normal life, than from COVID-19. Our fears of increased virulence in children, so far, are unfounded. Nonetheless, vigilance is necessary as the pandemic may unfold differently. Children were hit hard by the 1918-19 influenza pandemic, and were key to spread of that disease 4 ; this, fortunately, does not so far appear to be the case with COVID-19 5 . Close monitoring is essential following relaxation of 'lockdown' policies, particularly as there are genetic changes in the virus.

Children have sacrificed much to international efforts to contain COVID-19 6 . We know that negative experiences in childhood matter lifelong 7 . Cases, hospitalisations and deaths from COVID-19 may increase during the northern hemisphere winter. If this happens we must remember the minimal direct risk to children of COVID-19, and to act to minimise the harmful effects of future lockdown measures,-including school-closures,-on children especially those without good evidence of likely efficacy 8, 9 . Our data have implications for quantitatively demonstrating the safety and effectiveness of potential vaccines in children 10 and planning for vaccination should a safe and effective vaccine be invented. Week ending Number of deaths

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

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

Back to the Future: Lessons Learned From the 1918 Influenza Pandemic

Age-dependent effects in the transmission and control of COVID-19 epidemics

Children are being sidelined by covid-19 | The BMJ

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Finding a path to reopen schools during the COVID-19 pandemic. The Lancet Child & Adolescent Health 2020

Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: a modelling study

COVID-19 zugzwang: Potential public health moves towards population (herd) immunity