COVID-19 Cases In Children Steadily Increasing -- New CDC Guidelines

"The number and rate of cases in children in the United States have been steadily increasing from March to July 2020. The true incidence of SARS-CoV-2 infection in children is not known due to lack of widespread testing and the prioritization of testing for adults and those with severe illness.

“Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19, suggesting that children may have less severe illness from COVID-19 compared to adults."

– Centers for Disease Control and Prevention, Updated Guidelines

The CDC has issued new guidance to inform pediatric healthcare providers about the effects of COVID-19. The guidance said …

1. While it is unclear whether children are as susceptible to infection by SARS-CoV-2 compared with adults and whether they can transmit the virus as effectively as adults, recent evidence suggests that children likely have the same or higher viral loads compared with adults.
2. Children can spread the virus effectively in households and camp settings.
3. While children do have lower rates of mechanical ventilation and death than adults, one in three children who are hospitalized with COVID-19 complications in the United States were admitted to the intensive care unit -- the same rate for adults.
4. Children with certain underlying medical conditions and infants (age <1 year) might be at increased risk for severe illness from SARS-CoV-2 infection.
5. Hispanic and Black children in particular were much more likely to require hospitalization for COVID-19, with Hispanic children about eight times as likely as white children to be hospitalized, while Black children were five times as likely.

The new report also says …

"While children infected with SARS-CoV-2 are less likely to develop severe illness compared with adults, children are still at risk of developing severe illness and complications from COVID-19. Recent COVID-19 hospitalization surveillance data shows that the rate of hospitalization among children is low (8.0 per 100,000 population) compared with that in adults (164.5 per 100,000 population), but hospitalization rates in children are increasing.”

(Jon Haworth. “Coronavirus updates: CDC says rate of COVID cases in children 'steadily increasing.'” ABC News. August 16, 2020.)

The CDC said that transmission of the virus among kids may have been lower in the spring and summer due to strict stay-at-home orders, warning that trends are likely to change after the return to in-person learning and other activities.

The increase in children is also confirmed in a new report from the American Academy of Pediatrics noted a 90% increase in pediatric cases from July 9 to August 6. During the last two weeks of July alone, more than 97,000 children tested positive, according to the AAP. The increase represents a 40% surge in the nation's cumulative total of child cases.

(Children and COVID-19: State Data Report. “A joint report from the American Academy of Pediatrics and the Children’s Hospital Association.” Summary of publicly reported data from 49 states, NYC, DC, PR, and GU Version: August 06, 2020.)

Some government officials, including President Trump, have falsely claimed the virus poses a significantly reduced risk to children, urging states to return to full in-person learning. But the new CDC guidance says children can still develop severe illness and complications from the virus, even if their risk is lower compared to adults.

"I think it's showing that, yes, kids can get infected and can spread the infection," said Dr. Sean O'Leary, a pediatric infectious disease specialist at Children's Hospital Colorado and vice chair of the Committee on Infectious Diseases for the American Academy of Pediatrics.

If there is good news in such a report, it's that, in spite of the uptick in child infection rates, the data also show that most children do not get critically ill with the disease and that, among the states that reported hospitalization data, the current hospitalization rate for children remains low, at 2%. What's less clear is how effectively children would spread the virus in a classroom setting, not only to friends and classmates but to teachers and school staff.

(Corey Turner. “At Least 97,000 Children Tested Positive For Coronavirus In Last 2 Weeks Of July.” National Public Radio. August 11, 2020.)

Dr. Sean O'Leary, vice chair of the committee on infectious diseases for the American Academy of Pediatrics, says …

"We cannot simply assume that we don't have to worry about kids because they don't get infected. They absolutely do."

O'Leary noted that some of the rise seen in kids is likely reflective of more testing. But largely, the spike is related to a spike in overall infections. "In places where there are large increases in adult infections, there are also large increases in infections in children," he said.

(Erika Edwards. “Why are COVID-19 cases in kids rising? It's mostly the adults around them.” NBC News. August 12, 2020.)

Schools are reopening amid great concerns, and Dr. Roberta DeBiasi, chief of Infectious Diseases at Children's National Hospital in Washington, warns …

"You have to keep your eye on the ball when you reopen. We don't want parents to panic. But we also don't want people to be too cavalier and say, 'I don't need to wear a mask or worry about playgroups because my child can't get infected.'"

One report (August 11, 2020) by the Florida Department of Health certainly confirms parents' fears. In Florida, the total number of cases in children 17 and under rose from 16,797 on July 9 to 39,735 on August 9 -- an increase of 137%. At the same time, COVID-19 hospitalizations among children in Florida rose from 213 to 436 during that same period, a 105% increase. Deaths among children rose from four to seven in Florida during that period.

(“Florida's COVID-19 cases in children have increased 137% in past month.”

CNN. August 11, 2020.)

The American Federation of Teachers has said it considers in-person schooling to be safe only when fewer than 5% of coronavirus tests in an area are positive. The AFT's guidelines demand that areas reopening have "effective" COVID-19 tracing and isolation protocols in place. It is urging that officials at the state, city and community levels be given the authority to shut down schools again, if there's a spike in infection rates or if standards set by public health officials are not adhered to.

Increased testing, reopening schools, larger adult positives – children must be protected from the virus no matter the reasons for their infection. Understanding trends as they relate to outbreaks is essential to fighting the deadly disease. Serious illness in children with COVID-19 is possible, and parents should stay alert if their child is diagnosed with, or shows signs of, the disease.