It is well-known by now that the symptoms of COVID-19 are milder among children as compared to adults. A recent Morbidity and Mortality Weekly Report (MMWR) released by the US Centers for Disease Control and Prevention (CDC) found that for those aged less than 21, the burden of death is higher among Hispanic, Black and American Indian/Alaskan Native persons and those with underlying medical conditions.
What does the report tell us?
Among 121 SARS-CoV-2 deaths associated with individuals younger than 21 years of age that were reported to the CDC till July 31, 12 were among infants (10 per cent) and 85 were aged between 10-20 years (70 per cent). Hispanic, non-Hispanic Black and non-Hispanic American Indian/Alaskan Native persons accounted for 94 (78 per cent) of these deaths.
Further, in this cohort, 63 per cent of the deaths occurred in males, 10 per cent in those aged less than 1, 20 per cent among those aged between 1-9 years of age, 70 per cent among those aged between 10-20 years of age. Overall, 45 per cent of those that died were Hispanic, 29 per cent were non-Hispanic Black people and 4 per cent were non-Hispanic American Indian or Alaska Native (AI/AN) persons.
Significantly, 75 per cent (91) of those that died had underlying medical conditions, 45 per cent reported two or more underlying health conditions, 65 per cent died after admission to the hospital and 32 per cent died at home or in the emergency department.
What does this mean?
The authors of the report conclude that as per the data, nearly three-quarters of SARS-CoV-2 associated deaths among infants, children, adolescents and young adults have occurred in persons aged in 10-20 years, with a disproportionate percentage of the burden borne by young adults aged 18-20 years and by Hispanics, Blacks, AI/ANs and persons with underlying medical conditions.
Authors also report that the most frequently reported underlying health conditions in this cohort included chronic lung disease, including asthma (28 per cent), obesity (27 per cent), neurologic and developmental conditions (22 per cent) and cardiovascular conditions (18 per cent).
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What explains the higher proportion of death among racial and ethnic minorities?
One reason is that people from racial and ethnic minorities are over-represented among essential workers who are unable to work from home, resulting in higher exposure to the virus and subsequent transmission among their family members, which includes adolescents, children and infants. Further, the report notes that people from these minority groups may face food and housing insecurity, wealth and educational gaps, racial discrimination and live in crowded conditions, thereby increasing their representation in the number of COVID-19 cases.
Significantly, higher rates of adverse outcomes among racial and ethnic minorities may also be due to the challenges they face in seeking care for reasons including difficulty and delays in accessing health care services due to lack of insurance, child care, transportation and paid sick leaves.
What are the limitations of this study?
All deaths may not have been recognised or reported because of incomplete testing and failure to update vital status after death. Further, during the period in consideration for this report (February 12-July 31), schools and educational institutes in the US were closed and therefore, the gatherings between children were greatly reduced, which means the incidence of pediatric outcomes of SARS-CoV-2 associated deaths might change as schools open up in the US.
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