While the ongoing pandemic is sometimes equated with the 1918 Spanish flu, the 1918 pandemic was notable for its tragically substantial impact on children when compared to the highly age-stratified nature of COVID-19 mortality.

An analysis of SARS-CoV-2 mortality published in Public Health earlier in the pandemic indicated that deaths in the child population were not just rare, but were actually lower than that of influenza for the group despite the availability of influenza vaccines.

Authors of that analysis expressed concern, however, that severity of the virus within the 0-19 years age group may increase over time.

But thankfully, a new article by the same team of investigators highlights that that has not been the case.

In fact, the authors place matters in proportion by demonstrating that children are at much greater risk of death from other elements of normal life than from COVID-19.

The recent analysis tracks childhood mortality from COVID-19 over time and compares it with other causes in the United States, the United Kingdom, Italy, Germany, Spain, France and the Republic of Korea.

COVID-19 mortality data for patients 0-19 years of age was taken from The National Institute of Demographic Studies. For the US, only data from ages 0-14 were available.

The team’s mortality data were derived from the most recent (2017) Global Burden of Disease estimates, with the exception of influenza deaths which were acquired from national public health agencies.

Between March and July there were 78 deaths from COVID-19 among a population estimated to be about 137,047,945.

“For comparison, there were an estimated 21,966 deaths from all-causes (1,755 from unintentional injury, 510 from lower respiratory tract infection, 178 from influenza), with COVID-19 accounting for 0.355% of deaths,” the authors showed.

According to the analysis, the proportion of deaths caused by COVID-19 in children was stable across May, June and July. The feared increase in virulence did not occur.

Despite this, the investigators do caution that close monitoring is key in the aftermath of relaxation of ‘lockdown’ policies.

Particularly important is the task of monitoring genetic changes in the virus. But the authors also remind that “negative experiences in childhood matter lifelong” and that children have made immense sacrifices since the international response led to deployment of universal COVID-19 mitigation strategies.

If cases, hospitalizations, and deaths from COVID-19 rise again in the winter, they argue, society “must remember the minimal direct risk to children of COVID-19, and act to minimize the harmful effects of future lockdown measures, including school-closures, on children especially those without good evidence of likely efficacy.”

Q&A With Study Author Dr. Sunil Bhopal,

Academic Clinical Lecturer in Population Health Paediatrics

• Could you provide comment on how to reassure parents that the increase in cases among children will not worsen the pandemic situation overall?

SB: It is so important for children — who are the future of our societies and countries – to be socializing, developing and learning. Keeping them at home for extended periods without this will lead to long-term sequelae which we know will hurt all children in some ways, and those already most deprived & at-risk, the most.

The pandemic is not over. It is a sad fact that there are going to be more cases, hospitalisations, and indeed deaths from COVID-19 before we can put this period behind us. But there is very minimal evidence pointing at children as the cause of this. It seems much more likely that keeping adults apart is the crucial thing to keeping spread under control.

Nothing about controlling COVID-19 is easy, but we say that since a limited amount of interaction is possible, we should put children’s needs & rights first and prioritise them over us.

• What was the motive for the study and why were the other causes of mortality highlighted?

SB: We wanted to put information on COVID-19 mortality for children into a context that children, parents, teachers and other caregivers could understand. Every death of a child is shocking, especially to a parent (I speak as a dad of two myself), so we needed to remind people that sadly children do die of things that we accept as part of the risks of ‘normal life’ including chest infection (pneumonia), influenza and road traffic injury. I’m passionate about reducing all of those as well, for what it’s worth!

• Also curious your thoughts on ways of preventing child -> elderly transmission as well as (generally speaking)how schools should orient toward the pandemic. Should older teachers be given the option of remote, for example?

SB: I personally think that all workers who are at high-risk should be protected by their employer. What does this mean practically? That I would leave to education colleagues, home and office-based working, would seem reasonable, as long as those teachers stayed away from other adults from whom they seem to be much more at risk than children.