It is well-documented that COVID-19-related mortality and morbidity has disproportionately affected elderly populations. However, despite being less studied, COVID-19 in young people can lead to severe symptoms or long-term effects.
A recent report showed that children accounted for approximately 19 percent of confirmed COVID-19 infections, although this number is likely an underestimate due to asymptomatic and unreported infections (i.e., those confirmed using an at-home COVID test).1 Following implementation of mask mandates and social distancing in public spaces, a 2020 study by the CDC Covid Response team showed that children are most likely to be infected with COVID-19 through a household exposure; i.e., sharing space with an infected parent.2 However, there have also been school-related or healthcare-related outbreaks in which children have been infected, indicating the need for continued caution in public spaces. Children are also able to easily transmit COVID-19 when infected, as their nasopharyngeal viral load is comparable to or more than that reported in adults.3 For this reason, children should still exercise precautions when interacting with more vulnerable populations in particular.
The overall incidence of hospitalization due to COVID-19 in young people (age 18 or younger) is estimated at 48.2 per 100,000 children.4 Interestingly, hospitalization rates vary by age within this demographic. For children under four years old, the rate is 66.8 per 100,000; ages 5-11 is 25 per 100,000, and ages 12-17 is 59.9 per 100,000.4 The decreased hospitalization rate observed in the 5–11 demographic may indicate increased pre-puberty resilience to COVID-19 infection, although further research is needed to confirm this hypothesis.
In young people with pre-existing conditions, likelihood of hospitalization due to COVID-19 infection is increased. Studies have documented increased susceptibility to severe infection in children with genetic, neurological, metabolic, cardiovascular, and pulmonary diseases, as well as in children receiving immunosuppressive therapy.5 In cases where a pre-existing condition is known, more rigorous preventative measures may need to be taken to avoid infection.
Studies have indicated that a large number of children may display laboratory abnormalities as a result of COVID-19 infection. A meta-analysis compiled these findings and showed that perturbations in C-reactive protein, serum ferritin, lactate dehydrogenase, D-dimers, and procalcitonin were all frequently elevated in children diagnosed with COVID-19 infection.6 All of these biomarkers are indicative of heightened inflammation or infection-related inflammation in particular, which is consistent with COVID-19 pathology.
Children infected with COVID-19 experience similar symptoms to their adult counterparts, although typically less severe. Commonly reported symptoms include fever, cough, myalgia, shortness of breath, rhinorrhea, sore throat, headache, nausea/vomiting, abdominal pain, diarrhea, and, in some cases, loss of taste/smell, which can lead to refusal of food and eventual weight loss.6 Many of these symptoms are common to other mild upper respiratory tract infections that are commonly contracted by children, including the flu.
Overall, children experience lower risk of hospitalization due to COVID-19; however, they are still vulnerable to infection, can experience a variety of infection-related adverse symptoms, and are able to transmit the virus to other, vulnerable populations. For this reason it is highly recommended that children still take reasonable safety precautions, such as vaccination and mask wearing when possible.
1 American Academy of Pediatrics (2022). Children and covid-19: State-level data report. American Academy of Pediatrics. Retrieved from https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/
2 CDC COVID-19 Response Team (2020). Coronavirus Disease 2019 in Children – United States, February 12-April 2, 2020. MMWR. Morbidity and mortality weekly report, 69(14), 422–426. https://doi.org/10.15585/mmwr.mm6914e4
3 Chung, E., Chow, E. J., Wilcox, N. C., Burstein, R., Brandstetter, E., Han, P. D., Fay, K., Pfau, B., Adler, A., Lacombe, K., Lockwood, C. M., Uyeki, T. M., Shendure, J., Duchin, J. S., Rieder, M. J., Nickerson, D. A., Boeckh, M., Famulare, M., Hughes, J. P., Starita, L. M., … Chu, H. Y. (2021). Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting. JAMA pediatrics, 175(10), e212025. https://doi.org/10.1001/jamapediatrics.2021.2025
4 Delahoy, M. J., Ujamaa, D., Taylor, C. A., Cummings, C., Anglin, O., Holstein, R., Milucky, J., O’Halloran, A., Patel, K., Pham, H., Whitaker, M., Reingold, A., Chai, S. J., Alden, N. B., Kawasaki, B., Meek, J., Yousey-Hindes, K., Anderson, E. J., Openo, K. P., Weigel, A., … Garg, S. (2022). Comparison of influenza and COVID-19-associated hospitalizations among children < 18 years old in the United States-FluSurv-NET (October-April 2017-2021) and COVID-NET (October 2020-September 2021). Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, ciac388. Advance online publication. https://doi.org/10.1093/cid/ciac388
5 Woodruff RC;Campbell AP;Taylor CA;Chai SJ;Kawasaki B;Meek J;Anderson EJ;Weigel A;Monroe ML;Reeg L;Bye E;Sosin DM;Muse A;Bennett NM;Billing LM;Sutton M;Talbot HK;McCaffrey K;Pham H;Patel K;Whitaker M;McMorrow M;Havers F; ; (n.d.). Risk factors for severe COVID-19 in children. Pediatrics. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34686570/
6 Irfan O;Muttalib F;Tang K;Jiang L;Lassi ZS;Bhutta Z; (2021). Clinical characteristics, treatment and outcomes of paediatric covid-19: A systematic review and meta-analysis. Archives of disease in childhood. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33593743/