‘Extremely low’ risk of hospitalisation and death from Covid in children, large study shows

Some 5,830 children have been admitted to hospital with the disease, out of an estimated four million infections

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The risks of severe illness, hospitalisation and death from Covid-19 in children are “extremely low”, according to the largest study of its kind yet.

Analysis of public health data in England, presented in three different, non-peer reviewed papers, has found that just 25 children died as a result of Covid-19 up to February 2021. The absolute risk of death from the virus equates to one in 481,000, the researchers said.

Some 5,830 children and young people have also been admitted to hospital since the beginning of the pandemic, out of an estimated four million infections among this age group, said Dr Joseph Ward, a lead author of one of the papers and training fellow at UCL Great Ormond Street Institute of Child Health.

Dr Ward said this could be an overestimate “as it's hard to distinguish between children who had a positive test incidentally or required admission because of the positive test.”

The preliminary findings, put together by researchers from UCL and the universities of Bristol, York and Liverpool, have been submitted to the UK’s Joint Committee on Vaccination and Immunisation (JCVI), which is debating whether to roll out the Covid vaccines to those aged between 12 and 17.

One of the group’s studies found that 251 young people aged under 18 in England were admitted to intensive care with Covid-19 during the first year of the pandemic — up until the end of February 2021. 

The researchers, seeking to determine absolute risk, said this equated to young people of that age group having a one in approximately 50,000 chance of being admitted to intensive care with Covid-19.

Looking separately at PIMS-TS, a rare inflammatory syndrome in children caused by Covid, the researchers found that 309 young people were admitted to intensive care with this condition— equating to an absolute risk of one in 38,911.

Professor Russell Viner, of the UCL Great Ormond Street Institute of Child Health, said: “These new studies show that the risks of severe illness or death from Sars-CoV-2 are extremely low in children and young people.”

The analysis suggested the risk was marginally higher in the most vulnerable young people, such as those with compromised or suppressed immune systems and severe disabilities. Nonetheless, even for these groups the risks remain low overall, the researchers added.

“Those young people at higher risk are those who are also at higher risk from any winter virus or other illness — that is, young people with multiple health conditions and complex disabilities,” said Prof Viner.

“Covid-19 does however increase the risks for people in these groups to a higher degree than for illnesses such as influenza (seasonal flu).”

Dr Ward said: “Factors linked to a higher risk of severe Covid-19 appear to be broadly consistent for both children and adults.

“Our study found a higher risk of admission to intensive care among young people of Black ethnicity compared to white, as well as among young people with health conditions such as diabetes, asthma and cardiovascular disease. Young people with multiple conditions had the highest risk.”

In one of the pre-print papers, researchers looked at data from the National Child Mortality Database (NCMD), a mandatory reporting system in England, to identify all children and young people who died following Sars-CoV-2 infection until the end of February 2021.

Sixty-one children died following a positive diagnosis, but the researchers reviewed clinical records to determine that only 25 of these children died as a result of Covid-19.

Prof Russell said the findings of the analysis suggested “there’s probably few children who need to shield” as a result of their underlying health conditions, such as cystic fibrosis, severe asthma, those receiving cancer treatment and those with suppressed immune systems.

He said that there’s a “general feeling” among paediatricians that too many children were placed into the vulnerable, shielding category throughout the pandemic.

No children with active asthma have died from Covid-19, Prof Russell added.

Dr Liz Whittaker, a lecturer in paediatric infectious diseases and immunology at Imperial College London, who was involved in the research, said the “vast majority of children, even those who have a slight increase in absolute risk, are still going to have much greater benefits from being in society, going to school, getting exercise” compared to the advantages of shielding.

She added: “For those with neurodisability, going to school and having occupational therapy and having speech and language therapy - those benefits much far outweigh any potential, tiny risk of becoming severely unwell with Covid. So the detriment of shielding to those families far outweigh the benefit of shielding in my opinion.”