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COVID-19 Trends Among School-Aged Children – United States, March 1-September 19, 2020

Our take —

This study leveraged data reported by state health departments from March to mid-September 2020, to assess demographic characteristics, underlying conditions, clinical outcomes, and trends in weekly COVID-19 incidence among children 5 to 17 years old in the United States. Among the 277,285 laboratory-confirmed cases of COVID-19 among children ages 5-17 years old in the United States, 37% were children aged 5–11 years and 63% were adolescents aged 12–17 years. Among cases identified, 58% reported at least one symptom, 5% reported no symptoms and symptoms of others were unknown; 1.2% were hospitalized, including 0.1% requiring ICU admission; and 0.01% died of COVID-19. Among hospitalized children 5-17 years with complete information on race/ethnicity, 45% were Hispanic and 24% were Black. This study may underrepresent asymptomatic or mild cases. Incidence among cases 5-11 and 12-17 years old was similar. Although the data do not present extensive data from period when many schools were in session, the characterization of COVID-19 cases among children 5-17 may help to inform strategies for COVID-19 prevention and control efforts alongside school openings. However, the potential impact of children on family or household transmission is not answered by these data.

Study design

Other

Study population and setting

This study leveraged data reported by state health departments to assess demographic characteristics, underlying conditions, clinical outcomes, and trends in weekly COVID-19 incidence among children 5 to 17 years old in the US. Data included in this analysis were reported between March 1 to September 19, 2020, and consisted of 277,285 laboratory-confirmed cases of COVID-19 among children 5 to 17 years old. Confirmed cases were based on a positive real-time reverse transcription–polymerase chain reaction (RT-PCR) test result for SARS-CoV-2. Trends were analyzed using CDC report date to calculate a daily 7-day moving average, aggregated by week. Statistical comparisons were not performed.

Summary of Main Findings

Among the 277,285 laboratory-confirmed cases of COVID-19 among children ages 5-17 years old in the United States, 37% were children aged 5–11 years and 63% were adolescents aged 12–17 years. Among cases identified, 58% reported at least one symptom, 5% reported no symptoms, and information of symptom presentation was missing or unknown for 37% of the cases. Overall, 1.2% of children 5 to 17 years were hospitalized, including 0.1% requiring ICU admission. Among children 5-17 years represented in these data, 0.01% (N=51) died of COVID-19. Among hospitalized children 5-17 years with complete information on race/ethnicity, 45% were Hispanic and 24% were Black. Among children admitted to the ICU, 43% were Hispanic and 28% were Black. From March to September 2020, the weekly incidence among children 5 to 17 years peaked at 37.9 cases per 100,000 the week of July 19; plateaued at an average of 34 per 100,000 during July 26–August 23, decreased to 22.6 per 100,000 the week of September 6, and increased again to 26.3 per 100,000 the last week of available data. Trends in incidence were similar among both age groups.

Study Strengths

This study includes a large sample of cases across the United States, allowing for broad characterization of COVID-19 cases among children 5 to 17 years old identified through state health departments.

Limitations

Data from this study were reported from state health departments and may not represent all cases among children 5 to 17 years old in the United States. Incidence described in this study may be underestimated as testing may have been prioritized for individuals with symptom presentation and not including representation of asymptomatic cases. A large proportion of missing data describing race and ethnicity, symptom presentation, medical history, and outcomes were observed and therefore these values may be subject to bias. These analyses did not include any statistical comparisons to assess differences between age groups, or formal evaluation of changes over time. Furthermore, given the lag in detections of infections, conclusions related to the impact of school re-openings are likely limited given the mid-September cut-off for data included. The data also do not provide information on the role of children in household transmission.

Value added

The characterization of COVID-19 cases among children 5-17 years old may provide useful information to inform strategies for COVID-19 prevention and control efforts alongside school openings.

This review was posted on: 19 December 2020