COVID-19 in U.S. children and adolescents: What we know

COVID-19 in the U.S.

What we know aboutCOVID-19 in children

Questions answered on the vaccine, the Delta variant and the beginning of the U.S. school year

Pfizer and BioNTech have asked U.S. regulators to authorize emergency use of their COVID-19 vaccine for children ages 5 to 11, potentially the first shot available to this age group.

Meanwhile, the U.S. academic year is underway as the Delta variant dominates outbreaks, leaving parents concerned about their children’s safety at school. Pediatric cases of COVID-19 surged and peaked in mid-September. The CDC has not found that the contagious Delta variant is more severe than previous variants.

Here’s a look at what the data can tell us about pediatric COVID-19:

Have more kids gotten COVID-19 than earlier in the pandemic?

Yes

More COVID-19 cases among children have been reported with the proliferation of the Delta variant in the U.S.

New weekly cases of COVID-19 in children

250 thousand

243K

226K

211K

207K

204K

200

182K

180K

179K

173K

171K

165K

154K

150

144K

140K

128K

124K

121K

118K

112K

99K

100

94K

88K

80K

74K

73K

72K

71K

64K

61K

57K

53K

51K

50K

49K

46K

44K

42K

41K

40K

39K

37K

36K

34K

33K

28K

26K

24K

22K

19K

18K

16K

14K

12K

10K

Sept. 2020

Sept. 2021

243K

250 thousand

226K

211K

207K

204K

200

182K

180K

179K

173K

171K

165K

154K

144K

150

140K

128K

124K

121K

118K

112K

99K

94K

100

88K

80K

74K

73K

72K

71K

64K

61K

57K

53K

51K

50K

49K

46K

44K

42K

41K

40K

39K

37K

36K

34K

33K

28K

26K

24K

22K

19K

18K

16K

14K

12K

10K

Sept. 2020

Sept. 2021

252K

243K

250 thousand

226K

211K

207K

204K

200

182K

180K

179K

173K

171K

165K

154K

144K

150

140K

128K

124K

121K

118K

112K

99K

94K

100

88K

80K

74K

73K

72K

71K

64K

61K

57K

53K

51K

50K

49K

46K

44K

42K

41K

40K

39K

37K

36K

34K

33K

28K

26K

24K

22K

19K

18K

16K

14K

12K

10K

Sept. ’20

Sept. 2021

Source: American Academy of Pediatrics

Note: Numbers shown reflect cases among those 17 and under

Are cases among kids becoming more severe?

No

The CDC has found statistically similar levels of severity in pediatric COVID-19 cases before and after the Delta variant.

Do kids make up a higher share of the case rate overall?

Yes

Children made up only 2.6% of COVID-19 cases in April of last year, where they now make up an estimated 26.7% of cases.

Weekly share of COVID-19 cases that are children

Source: AAP

Note: Numbers shown reflect cases among those 17 and under

Are kids making up a higher share of COVID-19 deaths?

Yes

The percentage of children among COVID-19 deaths has increased since the start of the pandemic. However, that number remains fairly small at around 0.08% of COVID deaths, or 520 total deaths. The percentage has risen not because the Delta variant is more severe in children but because around 80% of those over 75 have gotten vaccinated and fewer deaths are occurring among older patients.

Pediatric COVID-19 deaths

Source: AAP

Note: Numbers shown reflect deaths among those 17 and under

Has COVID-19 killed more children than the flu?

Yes

Pediatric deaths to the flu vary by season, and in the 2020–’21 flu season only one child died, an unusually low death toll likely due to masking and social distancing measures. In flu seasons prior to that dating back to the 2004–’05 season, pediatric deaths ranged from dozens to nearly 300.

Pediatric flu and COVID deaths by flu season

Pediatric flu deaths

400

288

200

‘04-05

‘20-21

Pediatric COVID-19 deaths

351

‘19-20

‘20-21

Pediatric flu deaths

Pediatric COVID-19 deaths

400

351

288

Only one pediatric flu death occurred in the 2020 season

200

‘04-05

‘20-21

‘19-20

‘20-21

Pediatric COVID-19 deaths

Pediatric flu deaths

400

351

288

200

Only one pediatric flu death occurred in the 2020 season

‘04-05

‘20-21

‘19-20

Source: Centers for Disease Control and Prevention

Note: The CDC defines flu season as beginning in October of a given year to the end of September of the following. The pediatric COVID-19 deaths shown are within the given year’s flu season for comparison.

Do mask requirements in schools lead to fewer outbreaks?

Study says yes

A recent study of 999 schools in Pima and Maricopa counties in Arizona showed schools with early mask requirements experienced significantly fewer COVID-19 outbreaks than schools with no mask requirements. While more comprehensive data are unavailable, the counties in Arizona had sizable samples of schools with some sort of mask requirement (519) and schools without (480).

% schools in Maricopa and Pima counties reporting COVID-19 outbreaks

No mask requirement

24%

Late mask requirement

20%

Early mask requirement

No mask requirement

24%

Late mask requirement

20%

Early mask requirement

No mask requirement

24%

Late mask requirement

20%

Early mask requirement

Source: CDC

Note: The state of Arizona defines an outbreak as two or more cases of COVID-19 among staff and students at a school who are not of the same household. “Late mask requirements” denote schools that enacted a mask policy a median of 15 days after school started. The study’s authors noted that the results do not take into account vaccination coverage for staff members or students. Public health experts also say the level of transmission in the surrounding community and that community’s adherence to masking and other social distancing measures can impact the ability to determine transmission in schools. A scientific study of the impact of masks on COVID-19 transmission in school would require one group to abstain from mask wearing, which is not considered ethical.

Are masks being worn in schools?

Not everywhere

Many school districts are not enforcing mask-wearing among students, and some states have gone as far as to ban school districts from enforcing mask-wearing.

State policies on mask requirements in schools

Banned

Banned, not enforced

Required

No policy

Is the rate of pediatric COVID-19 hospitalizations increasing?

Yes

Of overall COVID-19 cases, the percentage of hospitalizations under 18 is increasing. This still accounts for only about 2.5% of hospitalizations for COVID-19, and only about 0.9% of children known to contract COVID-19 are hospitalized. A higher share of kids among COVID-19 hospitalizations is likely due to the increasing vaccination rate among older adults which has decreased the rate of hospitalizations among that age group.

Share of kids among COVID-19 hospitalizations

Source: AAP

Note: Numbers shown reflect hospitalizations among those 17 and under

Are vaccines available for all children?

Not yet

The vaccine has not yet been approved for children under the age of 12. Vaccination rates for adolescents are slightly lower than those of young adults, and they greatly lag rates among those over 65. An advisory panel of experts to the FDA will hold a meeting Oct. 26 to review data on the Pfizer-BioNTech COVID-19 vaccine in children ages 5 through 11.

Vaccinations by age group

Under 12

<1%

13 - 15

43%

16 - 17

51%

18 - 24

52%

25 - 39

56%

40 - 49

65%

50 - 64

73%

65 - 74

85%

75+

80%

Under 12

<1%

13 - 15

43%

16 - 17

51%

18 - 24

52%

25 - 39

56%

40 - 49

65%

50 - 64

73%

65 - 74

85%

75+

80%

Under 12

<1%

13 - 15

43%

16 - 17

51%

18 - 24

52%

25 - 39

56%

40 - 49

65%

50 - 64

73%

65 - 74

85%

75+

80%

Source: CDC

Note: The vaccines given to those under 12 were in clinical trials.

Sources

American Academy of Pediatrics; Centers for Disease Control and Prevention

Edited by

Chris Canipe, Lisa Shumaker and Caroline Humer