Children Contract COVID-19 at the Same Rate as Adults

Jessica E. Justman, MD, sat down with Contagion to discuss the COVID-19 survey research she presented this week at the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI).

Justman has been conducting population-based HIV surveys for over a decade, and believes clinical data is best supplemented by a “snapshot” of the community. “We thought it would be particularly useful to measure the burden of COVID, the impact of COVID, at the community level,” she said.

Thus, Justman and her team conducted the COMPASS study, “SARS-CoV-2 Prevalence in Children and Adults in 15 US Communities.” Strategically located at 15 sites in the US, the researchers conducted a general population survey to gauge the prevalence of COVID-19 by age. After asking passersby to join the study and complete COVID-19 testing, the study included approximately 21000 American adults, adolescents, and children; Justman noted that just under 10% of the study cohort were children.

Across all testing sites, an average of 13% of participants were either PCR- or antibody-positive. The testing period ran from January-August 2021, before the highly infectious Omicron variant became responsible for the vast majority of new COVID-19 infections. “I’m sure if we did the survey again, right now, it would be much higher than 13%,” Justman said.

The PCR-positivity rate was just under 1%. Justman emphasized that this represented people the researchers approached on the street, the participants were not seeking out a COVID-19 test due to a recent exposure or symptoms.

Justman said the most surprising result was that PCR-positivity was not affected by age. At the time the team was designing the survey, Justman said, “We all thought…that children don’t get this virus, they don’t get infected, they seem to be protected.”

The study results show that children contract COVID-19 just as often as adults, which Justman said has major implications for debates surrounding school reopenings and mask mandates.

Justman emphasized that we must face the unwelcome truth that COVID-19 vaccination, while highly effective against severe disease and death, is not as protective against infection and transmission. “We really need to think about masking and vaccines as a package deal,” she said.

Jessica E. Justman, MD, is an associate professor of medicine in epidemiology at the Columbia Mailman School of Public Health. She is also ICAP's senior technical director. With the coronavirus outbreak, Justman applied her background in HIV preventative research to study COVID-19.

The study, “SARS-CoV-2 Prevalence in Children and Adults in 15 US Communities: The COMPASS Study,” was presented virtually during the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI).