The coronavirus affects more children than we think

The virulence of the coronavirus is less harmful to children. The severity and mortality of COVID-19 is much lower amongst children. However, a study recently published in the Journal of Public Health Management and Practice suggests that the number of infected children could be much higher than the statistics show. According to the research, for every 74 children who are admitted into the intensive care unit (ICU) because of the new coronavirus, there are 176,190 who have been infected, that is, for every child admitted to the ICU, there are 2,381 infected with SARS-Cov-2 that mostly goes unnoticed by health authorities.

These calculations have been made by analysing data from a report prepared by the Chinese Centre for Disease Control and Prevention based on a clinical study of more than 2,100 children with the disease in China during the period January to February 2020.

Estimates of the total number of children infected with SARS-Cov-2 in the United States by 6 April 2020 were calculated using the United States Pediatric ICU cases and the adjusted ratio of paediatric criticality. The paediatric criticality ratio is the number of severely ill children with COVID-19 divided by the total number of children infected with SARS-Cov-2 (including asymptomatic children).

The projected numbers of severely and critically ill children with COVID-19 were derived by applying adjusted severity and criticality ratios to United States population data under various scenarios of cumulative paediatric infection ratio (CPIR).

If as of 6 April there were 74 children in the United States ICU, it is estimated that 176,190 children would be infected throughout the country. Of these, 52,381 were babies and children under two years of age, 42,857 were children between two and 11 years of age and 80,952 were children between 12 and 17 years of age. If CPIR were 5%, there would be 3.7 million children infected, 9,907 would need hospitalization and 1,086 would have to enter the paediatric ICU. In a 50% CPIR scenario, 10,865 children would require admission to the ICU, 99,073 would need hospitalization for severe pneumonia, and 37 million would be infected with SARS-Cov-2.

There are an estimated 74 million children in the United States between the ages of zero and 17, so the projected numbers of serious cases could exceed the resources available for paediatric hospital care in several moderate CPIR scenarios by 2020. According to the study, there are only 5,100 paediatric ICU beds in the United States, 94% of them in the main metropolitan areas. The investigators advise hospitals to plan, according to their circumstances and geographical location, the amount of paediatric equipment and supplies that will be required, as well as the health professionals that will be required in view of an increase in child patients requiring intensive care.

The researchers also refer in their study to the children most vulnerable to the new coronavirus infection, who belong to low-income families and whose parents have to go to work in person and not from home, living in densely populated areas, as well as small people with developmental disabilities, those with congenital birth defects, those with underlying medical conditions such as type I diabetes and cancer, and those with lung disease have a proven paediatric criticality ratio in China. This is because we excluded all paediatric Covid-19 cases that were clinically diagnosed but not confirmed by laboratory tests in the Dong study. To the extent that any of these suspicious cases were true cases, the critical ratio estimates used in our study are understatements, "it can be read in the publication.

Chronic diseases such as asthma, which impair lung function.

Limitations of the study

The researchers claim that the limitations of this study could inaccurate estimates – meaning that the statistics are not depicting how grave the situation really is.

"It is possible that the conservative criticality ratios we obtained from Chinese empirical data are an understatement of the true paediatric criticality ratio experienced in China. This is because we excluded all paediatric Covid-19 cases that were clinically diagnosed but not confirmed by laboratory tests in the Dong study. To the extent that any of these suspicious cases were true cases, the critical ratio estimates used in our study are understatements,” is stated in the report.

Reference: APA Pathak, Elizabeth Barnett PhD, MSPH; Salemi, Jason L. PhD, MPH; Sobers, Natasha PhD, MBBS, MPH, FRSPH; Menard, Janelle PhD, MPH; Hambleton, Ian R. PhD COVID-19 in Children in the United States, Journal of Public Health Management and Practice: April 16, 2020 - Volume Publish Ahead of Print - Issue – doi: 10.1097/PHH.0000000000001190