Enlarge /. NEW YORK CITY – AUGUST 8: A child wears a face mask while riding a bike in Madison Square Park.
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The US is currently debating whether and how schools can safely reopen while dealing with a cloud of misinformation from the president. The debate is complicated by a mix of ambiguous data about how much children are contributing to the spread of the virus and some dramatic cases of the spread of the pandemic in schools. Given the confusing and sometimes anecdotal evidence, it can be difficult to get a decent picture of how SARS-CoV-2 and COVID-19 affect children.
Fortunately, the American Academy of Pediatrics and the Children's Hospital Association have decided to offer perspective. The two groups have collected and compiled data at the country level on a range of statistics in children to create a national picture. While there are definitely limitations on the data, the picture they paint is one where the national surge in infections is accompanied by a surge in cases in children, with nearly 100,000 new cases in the last two weeks of July.
Data and its limits
The American Academy of Pediatrics and the Children's Hospital Association analyzed infections in children at weekly intervals to track the progression of the pandemic in the United States. Their most recent report is up to July 30th and they have data going back to mid-April.
However, these data come from individual countries that do not follow a standardized reporting system. As a result, there are many quirks, and the quality of the data can vary based on the question asked.
For symptomatic COVID-19 cases, the data are quite good: 48 countries give the age of the people affected. Texas only provides data on part of its population (about 8 percent), while New York does not provide data. New York City, on the other hand, does, which means nearly half of the Empire State's citizens are included. From there, however, it goes downhill. Only 44 states and New York City report the ages of people who have died of COVID-19, 20 states plus NYC report the ages of hospital patients, and only eight states report the ages of those who test positive for the virus receive.
The complications don't end there, however, as states differ in how they break down their age categories. Most place the dividing line between adults and children in a place very close to the end of public schooling – usually around the age of 17, 18, or 19. However, Florida and Utah divide cases as younger or older than 14, while South Carolina and Tennessee place a divider at age 20. The effects appear to be mixed. Florida, which ranks second in the total confirmed SARS-CoV-2 tests, also ranks second for COVID-19 cases in childhood, despite its relatively young cutoff. The two states with the older limits (South Carolina and Tennessee) are outside the top 10 states with the most positive tests, but are in the top 10 for childhood cases.
An increase in cases
Focusing on the higher quality data first, the report says the United States has had a total of about 340,000 childhood cases since mid-April, with half of the 50 states having at least 5,000 cases. This means that children make up 8.8 percent of all US cases. As seen elsewhere, children don't often get very severe COVID-19 symptoms. Twenty states reported no child deaths from COVID-19, with children accounting for just 0.06 percent of total deaths from COVID-19 – that's a total of 86 deaths.
The report compares the number of cases now reported to the number we were in two weeks prior to the current data. It was found that there were over 97,000 new cases in childhood during this period. That was enough to increase the total childhood cases as a percentage of all COVID-19 cases from 8.0 to 8.8 percent, which continued an ongoing trend – four weeks earlier, children made up just 7.1 percent of the cases while they were in early June were only 5.2 percent.
From there, however, we get to less reliable data. Hospitalization information is only available in 20 states and New York City. These data show that the rate at which children are hospitalized with COVID-19 symptoms has steadily declined, from a high of 3.8 percent in May to 2 percent now. But again, the growing number of children with COVID-19 symptoms means that an increasing percentage of total hospital stays are children. In total, we know of nearly 2,700 children hospitalized for COVID-19 symptoms, with that number increasing by 600 in the past few weeks.
With so few countries offering age data for testing, the results have been vastly different. On the low side, West Virginia saw a childhood test positive rate of just 3.6 percent. At the other end of the scale, Arizona suffering from a major outbreak had a positive rate of nearly 18 percent in children.
State by state
Even in symptomatic cases, there were great differences from state to state. Cumulatively, most states with high childhood cases were those with major outbreaks, such as California, Arizona, and Florida. In terms of recent developments, states such as Oklahoma and Missouri saw the highest percentage increases in symptomatic cases in children in the past two weeks. These differences underscore that the pandemic remains a dynamic problem in which local conditions can cause dramatic changes.
The overall picture of this report is at least partially in line with what we heard earlier. Children remain a small fraction of the worst cases; With over 160,000 dead in the US, fewer than 100 are children. However, this by no means means children are immune to COVID-19, and the boom in all cases has been accompanied by an increase in the overall proportion of cases affecting those under the age of 20. And all of this takes place before most schools open, a situation that could endanger a much larger proportion of the children.
The last thing this report underlines is that the current data tracking system in the United States is severely hampered by differences in reporting from state to state. If we want to have a clearer picture of what is going on with the childhood pandemic, we need to start standardizing the tracking of diagnoses and outcomes.