Question: Now that so many adults are/are getting vaccinated, my attention is again focused on keeping my kids safe.  What’s the latest on COVID severity in children?

Answer: There’s so much to say on this topic, but I’m going to try to keep it brief: While severe COVID in children can occur, it is rare.  

1. The American Academy of Pediatrics keeps an updated weekly report that is very informative, Children and COVID-19: State-Level Data Report.  According to the latest report, between 0.1%-1.9% of all child COVID-19 cases resulted in hospitalization and in states reporting, 0.00%-0.03% of all child COVID-19 cases resulted in death.  As of April 8, over 3.54 million children have tested positive for COVID-19 since the pandemic began.  Recent weeks have seen slight increases in new reported cases among children (~73,000 new child cases during the week of April 8th), with such increases having been more pronounced in the midwest, mid-Atlantic and northeast (Figure 1).  
2. When it comes to understanding which children are at higher risk of severe disease, JAMA published an article on this topic just last week, Characteristics and Disease Severity of US Children and Adolescents Diagnosed With COVID-19.  Examining discharge data from 869 medical facilities, study authors found that children with COVID-19 who required treatment in an intensive care unit or step-down unit were more likely to have one or more chronic medical conditions, to be younger, and to be male (Table 1).  
3. And when it comes to the widely spreading B.1.1.7 variant, a study published in February in Lancet, found that while the variant is more contagious, “we have found no evidence of more severe disease having occurred in children and young people during the second wave, suggesting that infection with the B.1.1.7 variant does not result in an appreciably different clinical course to the original strain. These findings are in keeping with early national data.”

There is still much we are learning.  For example, the American Academy of Pediatrics report states, “there is an urgent need to collect more data on longer-term impacts of the pandemic on children, including ways the virus may harm the long-term physical health of infected children, as well as its emotional and mental health effects.”  Based on what we do know, I’ll state it again–  while severe COVID in children can occur, it is rare.  
Figure 1. Cumulative Child Cases and Percent Increase (from American Academy of Pediatrics)

Table 1. Adjusted Odds of Severe Disease (from JAMA)