COVID-19 Deaths in Children and Young People: Active Prospective National Surveillance, March 2020 to December 2021, England

Abstract

Background: COVID-19 deaths are rare in children and young people (CYP). The high rates of asymptomatic and mild infections complicate assessment of cause of death in CYP. We assessed the cause of death in all CYP with a positive SARS-CoV-2 test since the start of the pandemic in England.

Methods: CYP aged <20 years who died within 100 days of laboratory-confirmed SARS-CoV-2 infection between 01 March 2020 and 31 December 2021 in England were followed-up in detail, using national databases, surveillance questionnaires, post-mortem reports and clinician interviews.

Findings: There were 185 deaths during the 22-month follow-up and 81 (43.8%) were due to COVID-19. Compared to non-COVID-19 deaths in CYP with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age (aOR 1.06 95%CI 1.01-1.11, p=0.02) and underlying comorbidities (aOR 2.52 95%CI 1.27-5.01, p=0.008), with a shorter interval between SARS-CoV-2 testing and death. Half the COVID-19 deaths (41/81, 51%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days. Of the COVID-19 deaths, 61 (75.3%) had an underlying condition, especially severe neurodisability (n=27) and immunocompromising conditions (n=12). Over the 22-month surveillance period, SARS-CoV-2 was responsible for 1.2% (81/6,790) of all deaths, with an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections in CYP aged <20 years estimated through real-time, nowcasting modelling and a mortality rate of 0.61/100,000.

Interpretation: COVID-19 deaths remain extremely rare in CYP, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.

Note:
Funding Information: None.

Conflict of Interests: None.

Ethical Approval: UKHSA has legal permission to process confidential information for national surveillance of communicable diseases without individual patient consent (Regulation 3 of Health Service Regulations 2002) and ethics committee approval is not required.

Keywords: COVID-19, mortality, survival analysis, cause of death