New Delhi: A real-world 22-month study from the United Kingdom has found that Covid deaths in children are extremely rare and are usually associated with underlying conditions or comorbidities.
The study, which looked at all deaths that occurred in Covid-positive children from March 2020 to December 2021, is yet to be peer reviewed. The authors are affiliated with the UK’s Health Security Agency — a government public healthcare agency — the University of London, Public Health England, and the NHS Foundation Trust.
The researchers analysed data from the Active Prospective National Surveillance in England, from March 2020 to December 2021. Active prospective surveillance refers to the active monitoring after an event, in this case, an infection.
During this period, there were 185 deaths of children and young people (CYP) under 20 who had tested positive for Covid. Out of these, 81 deaths (43.8 per cent) were due to Covid, the study said.
Only deaths that occurred within 100 days of a positive report were counted, the study said.
“Compared to non-COVID-19 deaths in CYP (children and young people) with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age and underlying comorbidities, with a shorter interval between SARS-CoV-2 testing and death,” the authors wrote.
They added that half the deaths (41 out of 81, or 51 per cent) occurred within seven days of confirmation of SARS CoV infection, and 91 per cent (74 out of 81) within 30 days.
Of the COVID-19 deaths, 61 (75.3 per cent) had an underlying condition, especially severe neurodisability (27 people) and immunocompromising conditions (12 people), they wrote.
The study found that over the 22-month period, SARS-CoV-2 was responsible for 81 out 6,790, or 1.2 per cent of all CYP deaths (whether Covid-positive or not). It added that there was an infection fatality ratio (IFR) of 0.70 deaths out of 1,00,000 SARS-CoV-2 infections in CYP. This figure was arrived through nowcasting (a form of prediction) modelling and a mortality rate — deaths per 1 lakh population — of 0.61 out of 1,00,000.
According to the World Health Organization (WHO), an infection fatality ratio estimates the proportion of deaths among all infected people.
The authors concluded that Covid deaths are extremely rare in children and young people, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.
The study also found that the incidence of the disease in young people is in proportion to their share in the population. In England, one in four cases (24.3 per cent) have been in children and young people aged less than 20 years, the study said, adding that the group accounts for 23.6 per cent of the English population.
Most of these people have been asymptomatic and suffered a mild disease, sometimes a non-specific illness, the study said.
The authors pointed out that even when Covid is mentioned in the death certificate as the cause of death, it’s often difficult to assess the extent to which the infection contributed to the death.
Only 40% of deaths in infected young people caused by Covid
The authors said that there was limited information available on the extent to which Covid infection had contributed to a patient’s death.
“More recently, death registrations with mention of SARS-CoV-2/ COVID-19 are routinely reported by the UK Office for National Statistics (ONS) but, as we and others have previously reported, these too are limited by the information available on the death certificate, making it difficult to assess the contribution of SARS-CoV-2 infection to death,” the study said.
“During the first 12 months of the pandemic, for example, only 40 per cent of deaths in CYP with confirmed infection in England were due to COVID-19.”
They also wrote that one of the reasons for the limited data on Covid deaths in young people two years into the pandemic is because such deaths were an uncommon occurrence.
“Overall, our study confirms the very low risk of death due to SARS-CoV-2 in CYP, irrespective of variant,” the study said. IFR based on confirmed SARS-CoV-2 infections overestimates the risk because there was very limited testing for the virus until June 2020,” the authors wrote.
“Also, children with asymptomatic or mild, transient infection are less likely to be tested. We, therefore, used estimated infection rates using real-time modelling developed and updated regularly since the start of the pandemic to calculate age-specific and variant-specific IFR for CYP with confirmed SARS-CoV-2 infection.
“The estimated IFR of 0.7/100,000 was four-fold lower than the 2.8/100,000 calculated using confirmed infections (or CFR) in England,” the authors wrote.
Case Fatality Ratio (CFR) is another measure to calculate deaths caused by Covid. While IFR calculates the proportion of deaths among all infected people (including cases that haven’t haven’t been tested), CFR estimates the proportion of deaths among identified confirmed cases, according to the WHO.
(Edited by Uttara Ramaswamy)