The study indicates that pharmaceutical and public health interventions remain important to protect children and young people against COVID-19. Image credit: Shutterstock.

COVID-19 was the underlying cause of death for more than 940,000 people in the US, including over 1,300 deaths among children and young people aged 0–19 years. Until now, it had been unclear how the burden of deaths from COVID-19 compared with other leading causes of deaths in this age group.

The researchers investigated this using data from US Centers for Disease Control and Prevention databases for the period 1 August 2021 to 31 July 2022.

Key findings:

• Among children and young people aged 0 – 19 years in the US, COVID-19 ranked eighth among all causes of death; fifth among all disease-related causes of death; and first in deaths caused by infectious or respiratory diseases.

• By age group, COVID-19 ranked seventh (infants), seventh (1–4 year olds), sixth (5–9 year olds), sixth (10–14 year olds), and fifth (15–19 year olds).

• COVID-19 was the underlying cause for 2% of deaths in children and young people (800 out of 43,000), with an overall death rate of 1.0 per 100,000 of the population aged 0–19. The leading cause of death (perinatal conditions) had an overall death rate of 12.7 per 100,000; COVID-19 ranked ahead of influenza and pneumonia, which together had a death rate of 0.6 per 100,000.

• Like many diseases, COVID-19 death rates followed a U-shaped pattern across this age-range. COVID-19 death rates were highest in infants aged less than one year (4.3 per 100,000), second highest in those aged 15–19 years (1.8 per 100,000), and lowest in children aged 5 –9 years (0.4 per 100,000).

• Overall, deaths in children and young people were higher during the Delta and Omicron waves compared to previous waves (pre-July 2021), likely reflecting the higher numbers infected during these periods. Nevertheless, in the pre-Delta period of the pandemic, COVID-19 still ranked as the ninth leading cause of death overall.

• The month with the highest number of COVID-19 related deaths in 0 – 19 year-olds was January 2022 at 160.

Many of the 82 million American children and young people were infected during the big Delta and Omicron waves, and as a result more than 1,300 children and young people have died from COVID-19 during the pandemic, most in the last two years.

Associate Professor Seth Flaxman, Department of Computer Science, University of Oxford.

Although COVID-19 amplifies the impacts of other diseases (such as pneumonia and influenza), this study focuses on deaths that were directly caused by COVID-19, rather than those where COVID-19 was a contributing cause. Therefore, it is likely that these results understate the true burden of COVID-19 related deaths in this age-group.

Compared with other age-groups, the overall risk of death from COVID-19 was substantially lower in children and young people. For instance, between 1 August 2021 and 31 July 2022, the COVID-19 death rate among all ages in the US was 109 per 100,000. However, because deaths among children and young people in the US are rare, the mortality burden of COVID-19 is best understood in the context of all other causes of death in this age-group.

According to the researchers, these results suggest that, with variants of COVID-19 continuing to circulate, public health measures such as vaccinations, staying at home when sick, and ventilation still have an important role to play in limiting transmission of the virus and mitigating severe disease in children and young people.

Associate Professor Seth Flaxman (Department of Computer Science, University of Oxford), lead author of the study, said: ‘These results demonstrate that while it’s rare for kids and teens to die in the US, COVID-19 is now the leading underlying cause of death from infectious disease for this age group. Fortunately, we now have an array of effective tools to minimize risk, from building ventilation to air purifiers to safe vaccines. Working together, communities can significantly limit the extent of infection and severe disease.’

The study also involved researchers from Imperial College London, Queen Mary University of London, Columbia University, the National University of Singapore and the University of Copenhagen.

The full paper ‘Assessment of COVID-19 as the underlying cause of death among children and young people aged 0 to 19 years in the US’ can be read in the journal JAMA Network Open.