Deaths in children and young people in England after SARS-CoV-2 infection during the first pandemic year.

Clare Smith,Elizabeth Whittaker,Rachel Harwood,Dougal Hargreaves,Joseph Ward,Matthew Clark,Elizabeth Draper,Simon E Kenny,Karen Luyt,Mike Linney,Lorna K Fraser,Russell Viner,David Odd,Peter J Davis,Shamez N Ladhani

doi:10.1038/s41591-021-01578-1

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rarely fatal in children and young people (CYP, <18 years old), but quantifying the risk of death is challenging because CYP are often infected with SARS-CoV-2 exhibiting no or minimal symptoms. To distinguish between CYP who died as a result of SARS-CoV-2 infection and those who died of another cause but were coincidentally infected with the virus, we undertook a clinical review of all CYP deaths with a positive SARS-CoV-2 test from March 2020 to February 2021. The predominant SARS-CoV-2 variants were wild-type and Alpha. Here we show that, of 12,023,568 CYP living in England, 3,105 died, including 61 who were positive for SARS-CoV-2. Of these deaths, 25 were due to SARS-CoV-2 infection (mortality rate, two per million), including 22 due to coronavirus disease 2019-the clinical disease associated with SARS-CoV-2 infection-and 3 were due to pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. In total, 99.995% of CYP with a positive SARS-CoV-2 test survived. CYP older than 10 years, Asian and Black ethnic backgrounds and comorbidities were over-represented in SARS-CoV-2-related deaths compared with other CYP deaths. These results are important for guiding decisions on shielding and vaccinating children. New variants might have different mortality risks and should be evaluated in a similar way.

Highlights

Identifying CYP at risk of severe illness and death after SARS-CoV-2 infection is essential to guide families, clinicians and policymakers about future shielding policies, school attendance, novel therapeutic agents and vaccine prioritization
Severe illness and death associated with SARS-CoV-2 in CYP is rare and can be due to either acute COVID-19 or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS)[2,5]
Clinical records of the 61 CYP who died with a positive SARS-CoV-2 test were reviewed to identify if SARS-CoV-2 contributed to death

Summary

Introduction

Identifying CYP at risk of severe illness and death after SARS-CoV-2 infection is essential to guide families, clinicians and policymakers about future shielding policies, school attendance, novel therapeutic agents and vaccine prioritization. It remains unclear to what extent these rare deaths relate directly to the pathological processes of COVID-19 or whether CYP who died from alternative causes were coincidentally positive for SARS-CoV-2 around the time of death. This issue is made more difficult by the very high prevalence of asymptomatic infection at times of high prevalence, with reported prevalence up to 4–6% of United Kingdom CYP during December 2020 The distinction between those who died of SARS-CoV-2 infection and those who died of an alternative cause with a coincidental positive SARS-CoV-2 test is important for understanding which CYP are truly at higher risk for severe disease or death. Unable to classify national dataset of deaths of individuals younger than 18 years of age, to review the contribution of SARS-CoV-2 to death

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Conclusion