Question: Saw this on Politico Nightly: There are 317,711 reported Covid-19 cases in children and teenagers across the U.S., according to the COVKID Project, led by a team of epidemiologists who track cases in children and teens. There have been 77 reported deaths, and 805 intensive care hospitalizations in children 17 and under. How do these numbers compare in deaths and hospitalizations to other childhood illnesses like flu, infections, and RSV?

Answer: Thanks for asking! We talked some about childhood COVID/influenza comparisons in our Q&A of 5/23. Two months have since passed (both shockingly quickly and slowly because time is increasingly difficult to track these days) and we have more information.

1. First, data show that children are still far less likely to have complications/severe COVID as compared with adults. Indeed, there seems to be a linear relationship between COVID severity and age — each year of age is associated with increased risk of severe COVID outcomes, including death (Figures 1 and 2).
2. Second, data show that children are not impervious to the virus, as illustrated by the COVKID Project data you shared in your question. While rare, death and other severe outcomes are coming to the fore, including multisystem inflammatory syndrome (described in Q&A of 5/15).
3. Third, the latest evidence we have is from a comprehensive contact tracing study out of South Korea (published earlier this month in Emerging Infectious Diseases), which shows that households with index cases among children ages 0–9 have the fewest transmission events while households with index cases among children ages 10–19 have the highest level of transmission events, transmitting just as much as adults. Young children seem less likely to infect others while older children seem at least as likely as adults to infect others (Table 1).

Now to get more directly into your question. Table 2 shows the 10 leading causes of death among adolescents and children in the United States in 2016 (from this paper published by New England Journal of Medicine). As you can see, 20,360 children (defined in this study as people ages 1–19 years) died in 2016. Of these deaths, 60% were due to injury-related causes. Cancer and congenital abnormalities were the next leading causes of non-injury related deaths (~9% and 5% of all deaths, respectively).

Turning specifically to influenza, we can use CDC reporting to see that a total of 185 pediatric deaths (ages 0–18) were reported for the 2019–20 flu season (Figure 3). You can find flu hospitalization rates by age here and covid hospitalization rates by age here. The 77 COVID-related deaths reported in children and adolescents in the US since March are deaths over a 4 month period. If the numbers remained constant over a 12-month period, we would see more pediatric deaths due to COVID (231) than influenza deaths (185), but fewer deaths than an ailment like heart disease (599 deaths in 2016).

Figure 1. Case Fatality Rates by Age (from ourworldindata)

Figure 2. Case Fatality Rates by Older Age over Time in Maryland (from Dr. YJ Choi)

Table 1. Children ages 0–9 appear to be the least likely to pass coronavirus on to other household members. (from “Contact tracing during coronavirus disease outbreak, South Korea”)

Table 2. Ten Leading Cases of Child and Adolescent Death in the United States, 2016 (from this 2018 article in NEJM)

Figure 3. Influenza Deaths among Children (from CDC)