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Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 – COVID-NET, 14 States, March 1-July 25, 2020

Our take —

In this study of children hospitalized with COVID-19 from 14 US states, Hispanic and Black children were far more likely to be hospitalized than white children, and they were more likely to have underlying conditions that are associated with disease severity. Although hospitalized children were as likely to be admitted to the ICU as hospitalized adults, a smaller proportion required mechanical ventilation, and only one of 576 children died. We have known for some time that children can have severe COVID-19, and this study highlights the ethnic and racial disparities in the risks faced by US children.

Study design

Case Series

Study population and setting

This study reported on 576 pediatric (<18 years: median age 8 years, 51% male) cases of COVID-19 requiring hospitalization in 14 U.S. states participating in a surveillance network (COVID-NET) from March 1 to July 25, 2020. Cases required a positive test for SARS-CoV-2. Patient data were abstracted from medical records by surveillance personnel. Denominators for hospitalization rates were calculated using post-census population estimates in the surveillance catchment areas from the National Center for Health Statistics.

Summary of Main Findings

Hospitalization rates increased in all age groups during the study period. Among cases with available data on race and ethnicity, 46% were Hispanic, 30% were Black, 14% were white, 5% were Asian/Pacific Islander, and 1% were American Indian/Alaskan Native. Compared to white children, hospitalization rates were 8 times higher among Hispanic children and 5 times higher among Black children. Nineteen percent of cases were infants below the age of 3 months. The highest rate of hospitalization was observed among children aged <2 years (24.8 per 100,000), followed by children aged 5-17 years (6.4) and children aged 2-4 years (4.8); the overall rate among all children <18 years was 8.0 per 100,000. Among the 222 (39%) children with available data, 42% had one or more underlying comorbidity: 38% were obese (defined as a BMI at the 95th percentile or greater for age and sex), 18% had chronic lung disease, and 15% of children <2 years of age had a gestational age <37 weeks at birth. Prevalence of underlying conditions was higher among Hispanic (46%) and Black (30%) children relative to white (15%) children. The most common symptom upon admission was fever and chills (54%); 42% of children had gastrointestinal symptoms. Nine of 83 children (11%) with enough data to support assessment for multisystem inflammatory syndrome in children (MIS-C) received an MIS-C diagnosis. Of 67 children with a chest radiograph, 44 (68%) showed an infiltrate or consolidation. Among the 208 (36%) children with complete chart review, the median duration of hospitalization was 2.5 days. Sixty-nine children were admitted to the ICU (median stay 2 days). Twelve (6%) children required mechanical ventilation, and one child died.

Study Strengths

This study reported data from a population-based surveillance network from 14 US states, and so data are likely to be broadly representative of the pediatric population in these areas.


Case counts and rates are likely to be underestimates, since they depend upon laboratory confirmation of SARS-CoV-2 infection. Missing data meant that analysis of outcomes and comorbidities were based on smaller subsets of patients, which may not have been representative of the full population of hospitalized children. In particular, it is possible that the proportion of hospitalizations with ICU admission were overestimated if these records were more likely to be complete, and thus included in the analysis. Hospitalization rates for infants likely reflect increased testing and surveillance of neonates born to mothers with COVID-19, rather than increased disease severity in the <2 age group. Characterization of MIS-C was limited by 1) the requirement for laboratory-confirmed SARS-CoV-2 infection, and 2) the lack of systematic surveillance for MIS-C until late during the study period.

Value added

This study provides a broad, population-based picture of children in the United States hospitalized with COVID-19.

This review was posted on: 20 August 2020