Covid deaths extremely rare in children, usually linked to comorbidities, says 2-year UK study

New Delhi: A real-world 22-month study from the UK has found that Covid deaths in children are extremely rare and usually associated with underlying conditions or co-morbidities.

The study, which looked at all deaths in Covid-positive children from March 2020 to December 2021, has yet to be peer reviewed. The authors are affiliated with the UK’s Health Security Agency – a government agency for public health – the University of London, Public Health England and the NHS Foundation Trust.

The researchers analyzed data from the Active Prospective National Surveillance in England, from March 2020 to December 2021. AActive prospective surveillance refers to the active monitoring after an event, in this case an infection.

During this period, there were 185 deaths of children and adolescents (CYP) under 20 who tested positive for Covid. Of these, 81 deaths (43.8 percent) were attributable to Covid, the study said.

Only deaths that occurred within 100 days of a positive report were counted, the study said.

“Compared to non-COVID-19 deaths in CYP (children and adolescents) with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age and underlying co-morbidities, with a shorter interval between SARS – CoV-2 testing and death,” the authors wrote.

They added that half of the deaths (41 out of 81, or 51 percent) occurred within seven days of confirming SARS CoV infection and 91 percent (74 out of 81) within 30 days.

Of the COVID-19 deaths, 61 (75.3 percent) had an underlying condition, most notably severe neurodisability (27 people) and immunocompromising conditions (12 people), they wrote.

The study found that SARS-CoV-2 over a 22-month period was responsible for 81 out of 6,790, or 1.2 percent, of all CYP deaths (covid-positive or not). It added that there was an infection death rate (IFR) of 0.70 deaths out of 100,000 SARS-CoV-2 infections in CYP. This figure has come about through nowcasting (a form of prediction) modeling and has a death rate – deaths per 1 lakh population – of 0.61 out of 100,000.

According to the World Health Organization (WHO), a death rate from infections estimates the percentage of deaths among all infected people.

The authors concluded that Covid deaths are extremely rare in children and young people, with most fatalities occurring within 30 days of infection, and in children with specific underlying conditions.

The study also found that the incidence of the disease among young people is proportional to their proportion in the population. In England, one in four cases (24.3 percent) was in children and young people under the age of 20, the study said, adding that the group makes up 23.6 percent of the English population.

Most of these people were asymptomatic and suffered from mild illness, sometimes nonspecific illness, the study said.

The authors pointed out that even when Covid is listed in the death certificate as the cause of death, it is often difficult to estimate how much the infection contributed to the death.

Also read: Lesson learned from Covid, ICMR is developing Phase I clinical trial sites at government agencies

Only 40% of deaths among infected young people caused by Covid

The authors said limited information was available on the extent to which Covid infection contributed to a patient’s death.

“More recently, death records indicating SARS-CoV-2/COVID-19 are routinely reported by the UK Office for National Statistics (ONS), but, as we and others have previously reported, these too are limited by the information available on the death certificate, making it difficult to assess the contribution of SARS-CoV-2 infection to death,” the study said.

“For example, during the first 12 months of the pandemic, only 40 percent of deaths in CYP with confirmed infection in England were due to COVID-19.”

They also wrote that one reason for the limited data on Covid deaths among young people two years after the pandemic is that such deaths were an uncommon phenomenon.

“Overall, our study confirms the very low risk of death from SARS-CoV-2 in CYP, regardless of variant,” the study said. IFR based on confirmed SARS-CoV-2 infections overestimates the risk because testing for the virus was very limited until June 2020,” the authors wrote.

“Also, children with an asymptomatic or mild transient infection are less likely to be tested. Therefore, we used estimated infection rates using real-time modeling that has been regularly developed and updated since the onset of the pandemic to calculate age-specific and variant-specific IFR for CYP with confirmed SARS-CoV-2 infection.

“The estimated IFR of 0.7/100,000 was four times lower than the 2.8/100,000 calculated using confirmed infections (or CFR) in England,” the authors wrote.

Case Fatality Ratio (CFR) is another measure to calculate the number of deaths from Covid. While IFR calculates the percentage of deaths among all infected people (including cases that have not been tested), CFR estimates the number of deaths among identified confirmed cases, according to the WHO.

(Edited by Uttara Ramaswamy)

Also read: Covaxin safe for children, generates higher antibody response in them than adults, says Lancet paper

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