Covid-19 the disease has mostly spared children’s lives, but it is widely expected that the measures taken to slow its spread and the economic dislocation that has followed in its wake will have all sorts of negative consequences for them. A team of researchers from the Johns Hopkins Bloomberg School of Public Health projected in May that pandemic-induced disruptions to health care and food provision in developing countries will result in the deaths of hundreds of thousands of children — possibly causing the first annual increase in the global child mortality rate in at least 60 years. Another group of researchers from Johns Hopkins, the International Food Policy Research Institute and elsewhere forecast in July that Covid-related malnutrition would claim the lives of 128,605 children under 5 around the world — mostly in Africa — this year. Even in rich countries where malnutrition is unlikely to be a major issue, the pandemic’s mental health consequences for young people could be dire.
I do not wish to cast doubt on any of these forecasts or warnings, especially those focused on developing nations. But it does seem worth pointing out that, since the arrival of the pandemic, the Centers for Disease Control and Prevention data indicate that fewer children have died in the U.S. than would have been expected based on recent years’ experience.
Something similar has been happening in other affluent nations. Twenty-two of the 29 countries with weekly data for 2020 in the Human Mortality Database maintained by scholars at the Max Planck Institute for Demographic Research in Germany and the University of California at Berkeley have seen deaths in the 14-and-under age group decline this year. Here’s a selection:
What is causing this? “The overall picture that is emerging is that stay-at-home orders have provided stresses but also some protection,” replied Michel Guillot, a sociologist at the University of Pennsylvania and Institute for Demographic Studies in France who studies mortality, when I emailed him to ask about the phenomenon. “In the case of infants this might have meant less exposure to viruses, accidents, and perhaps more attentive child care, breastfeeding, etc. Also the fact that expectant mothers were forced to stay home prior to delivery may have provided some benefits.” There have been reports that premature births fell sharply in the early months of the pandemic. For infants in the U.S. the top cause of death year-in and year-out is “certain conditions originating in the perinatal period,” of which “extreme immaturity” is the most common, so fewer premature births should reduce that.
For kids ages 1 to 14 the top cause of death in the U.S. is accidents, and being stuck at home with parents likely reduces the chances of those. In reporting a marked drop in under-25 deaths in France in March and April, the French national statistics agency speculated that it was “probably due to containment measures that can act on other causes of death, particularly accidental.”
Lyman Stone, an economist and demographer who was the first person I know of to point out the children’s mortality decline in the U.S., cites school closures as the crucial containment measure. “Going to school may expose kids to mortality risk on the way,” he emailed. Also,
Kids get sick at school. 99.9% of the time they’re fine. Sometimes they aren’t. It turns out, school-age deaths of infectious disease are much more seasonal than adult deaths of infectious disease.
So taking kids out of school in March, near the tail end of infectious-disease season in the Northern Hemisphere, may have kept a few from getting fatally ill from diseases other than Covid-19. Stone cites the comparison between Denmark, which closed schools on March 12 and then reopened them on April 15 for children 11 and younger, and neighboring Sweden, where schools for children under 16 never closed this spring.
That’s interesting, and suggestive. But I wouldn’t make too much of it! These are small countries with extremely low child mortality, meaning that just a handful of deaths can meaningfully affect the percentages, and though I’ve compared 2020’s numbers to the 2017-2019 average here in case 2019’s numbers were anomalous (they weren’t), it seems like 2020 was anomalous for Denmark even before Covid came along. Also, all the weekly data for 2020 that I’m citing here are provisional and in some cases incomplete. We can be pretty confident that deaths aren’t up so far this year among children 14 and under in affluent countries, but some of the mortality declines depicted in my charts may evaporate.
They also may be in part a continuation of existing trends. In the U.S., for example, the mortality rate for children ages 1 through 14 declined almost 30% from 1999 through 2018, mainly because the number of accidental deaths went down.
One possible takeaway is that the rise in so-called helicopter parenting, brought on by smaller families, older parents and other factors, may be — whatever other damage it is doing — saving some youngsters’ lives. Improvements in and increased use of baby seats and booster seats in cars have been a big factor too, but that’s not exactly at odds with helicopter parenting. The school shutdowns and work-from-arrangements brought on by the pandemic would seem to have brought the helicoptering to a new if (one hopes) temporary level of intensity.
Happily, not many children ages 1 through 14 in the U.S. die in any case. If you slice things by five-year age groups (with a carve-out for infants), Americans ages 5 through 9 have the lowest mortality rate of any age group, those 10 through 14 the second lowest, and those 1 through 4 the third lowest. This has been the case for decades. Further declines in these mortality rates would be great, but surely not great enough to merit keeping schools closed and parents stuck at home with their kids indefinitely.
Infants, on the other hand, have a quite high mortality rate — higher in the U.S. than any other age group under 55. If something can be learned from the experience of the past six months that would reduce infant deaths in the U.S. significantly, that could be a really big deal. What might that something be? This year’s mortality statistics from England and Wales offer a clue.
In the U.K., all mothers get 39 weeks of paid maternity leave and “antenatal” care is a major focus of the National Health Service. That’s quite different from how things work in the U.S., which may help explain why the England and Wales infant mortality rate was about two-thirds that of the U.S. in 2018 and why pandemic-induced behavioral changes didn’t bring such a big drop in infant mortality there. Which implies that the U.S. could better its bottom-of-the-pack-among-developed-countries infant mortality rate without telling everybody to stay home.
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Then again, there’s also Spain, which has paid maternity leave and an infant mortality rate two-thirds that of the U.K. (and thus less than half that of the U.S.), and where deaths among those 4 and under (I couldn’t find numbers just for infants) are up 26% so far this year.
Covid-19 itself wasn’t the culprit here; as elsewhere in the world, hardly any children have died from the disease in Spain. The country did have the one of the world’s worst coronavirus epidemics this spring and the strictest lockdown in Europe, with children not even allowed out to play. Also, 65% of Spaniards live in apartments, meaning that hanging out in the backyard generally wasn’t an option. Maybe all that forced indoor family togetherness led to violence and accidents, or maybe newborns and pregnant mothers didn’t get adequate care because the country’s hospitals were overwhelmed. Then again, maybe it’s that a lot of small kids caught the flu in Spain early this year. Or maybe it’s misleading to read too much into a small number of provisionally reported deaths.
Still, the notion that lockdowns and other measures taken to halt the spread of Covid-19 have been a cure worse than the disease retains enough currency in the U.S. and elsewhere that it’s worth pausing a moment over the evidence. In Spain, a perhaps overly strict lockdown may have contributed to a rise in deaths among small children, but there has been no such increase for older children, teenagers or even those in their early 20s. In the U.S., where Covid-19 countermeasures were more relaxed and more varied, deaths are down among children but up by more than 2,000 among those in the 15-to-24 age bracket — far more than can be explained by Covid-19 deaths even if the CDC’s current tally of 333 for the age group is a significant undercount. The pandemic and efforts to thwart it have clearly caused some collateral damage, and more will become apparent over time as missed medical checkups, economic setbacks and other dislocations take their toll.
Still, with people avoiding their doctors in the U.S. even though physicians’ offices are open, it’s a stretch to blame all of that collateral damage on last spring’s lockdowns and other government-imposed restrictions. The child mortality data also indicate that those restrictions saved some people from non-Covid-related deaths, thus canceling out some or all of the collateral damage — at least so far, in some affluent countries. In several European countries that took action against Covid-19 early and effectively enough to avoid major epidemics (Bulgaria, Denmark, Germany, Hungary and Poland are the ones I ran the numbers for) overall deaths from all causes so far this year are below the 2017-2019 average. In the U.S., they’re about than 245,000 above average, according to the CDC, well above the 196,436 deaths attributed so far to Covid-19. Given the evidence assembled here, it seems likely that most of that discrepancy represents missed Covid cases, not a rash of lockdown-induced fatalities. – Bloomberg