SARS-CoV-2 may affect more children than scientists initially thought

Pediatrician

Researchers have estimated that the number of children in the United States who spent time in a hospital with COVID-19 is likely higher than officials had previously thought. And the projected numbers of severe cases in children may overtax the health system, they warn.

According to a study paper newly published in the Journal of Public Health Management & Practice, officials may have been underestimating the impact of SARS-CoV-2 on children.

Researchers from the Women’s Institute for Independent Social Enquiry in Olney, MD, the University of South Florida in Tampa, and the University of the West Indies in Barbados supplied the calculations for the paper.

The investigators’ estimates were informed by the number of U.S. children who attended a pediatric intensive care unit (PICU) through April 6, 2020, as well as by studies of the COVID-19 epidemic in China during January–February 2020.

Their projections also suggest that, in some scenarios, U.S. pediatric health care services may well become overwhelmed by the number of ill children requiring care.

176,190 children affected already?

Official data indicate that in the U.S., 74 children received care at PICUs between March 18 and April 6 due to COVID-19.

Based on these numbers, the researchers estimate that "2,381 children in the community [contracted] SARS-CoV-2 for each single child […] admitted to the PICU."

"Overall, […] an estimated 176,190 children aged 0 to 17 years" had likely contracted SARS-CoV-2 by April 6, the investigators write.

In their projections, the investigators indicate that in a "best-case" scenario, in which 1 in 200 children in the U.S. contract SARS-CoV-2, as many as 991 children would require hospitalization.

"Of those, 109 would become critically ill and require PICU care," the study authors write.

In the "worst-case" scenario, in which 3 out of 5 children would contract SARS-CoV-2, 118,887 children would require care in the hospital, and 13,038 would require treatment in a PICU.

Given that the mean hospitalization period for COVID-19 in children is 14 days, and that there are approximately 5,100 PICU beds across the U.S., pediatric health care services could easily crack under the pressure.

Socioeconomic factors may influence risk

The major urban areas have around 94% of the ICU beds, and the researchers worry that children from the poorer socio-economic backgrounds may face an increased risk of severe outcomes.

"Although the risk of severe illness from COVID-19 is lower in pediatric cases than adults, hospitals should be prepared and have the proper equipment and staffing levels to deal with a potential influx of younger patients," emphasizes study co-author Jason Salemi, Ph.D.

Existing information indicates that the children most at risk of developing COVID-19 are those with underlying health conditions — including type I diabetes, cancer, and chronic lung diseases.

However, the study authors stress that other factors may also play an important role in whether children can stay safe and healthy.

In the study paper, the investigators indicate that those who come from low-income families, as well as "those living in large families or crowded housing, the homeless, those in uninsured and undocumented families, those living in polluted environments or areas without reliable access to clean water, and those confined in institutions" pertain to higher-risk populations.

"Government officials and policymakers should understand the likelihood of capacity challenges, which underscores the importance of effective mitigation strategies such as frequent and thorough handwashing and persisted social distancing measures."

– Jason Salemi, Ph.D.