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Why are COVID-19 cases in children at their highest numbers since the pandemic began?

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COVID-19 case numbers continue to break records in the US and unfortunately, the increases are now also reflected in pediatric cases: at least 61,000 COVID-19 cases were diagnosed in children last week. Since the pandemic began, the percentage of pediatric cases has risen steadily, from 2% of cases in April to 11% now. Per the  AAP State-Level Data Report, which has been tracking pediatric cases, over 853,000 children have tested positive for COVID-19 since the onset of the pandemic (representing 1,134 cases per 100,000 children) with nearly 200,000 of those diagnosed in October. While testing rates in children have definitely increased recently, there are still likely many cases that were never formally diagnosed by test. 

Unfortunately, the AAP report does not offer an explanation as to why pediatric cases are rising. For the most part, it’s thought that the numbers are simply reflective of what’s happening in communities as a whole. Bessey Geevarghese, a Northwestern pediatric infectious disease physician explains that : “Levels are much higher [in children] since overall cases are going up,” she says. “Children are most likely to get COVID-19 from household contacts.” 

While experts say there are likely a few factors behind it, luckily schools are still not thought to be driving the community transmission of COVID. Infectious disease expert Dr. Amesh A. Adalja (Johns Hopkins Center for Health Security) says “Pure educational activities don’t seem to be driving it.”  Per a NYT article on this topic, “the bulk of evidence now suggests only limited transmission from young children to adults, but the risk among older children in middle and high schools is less clear.” There is some concern that an uptick in extracurricular activities, such as playing sports without masks, has led to more pediatric cases. 

Additionally as the weather changes, cooler temperatures are driving people inside, which is known to increase the risk of spread. Last week Dr. Fauci said that “small indoor gatherings of family and friends are driving outbreaks across the country.” 

That said, the rise in cases for all ages is especially a concern as we approach the holidays. “We are entering a heightened wave of infections around the country,” Dr. Yvonne Maldonado, chair of the AAP Committee on Infectious Diseases and Stanford Professor of Pediatrics, said in a statement. “We would encourage family holiday gatherings to be avoided if possible, especially if there are high risk individuals in the household.”

While experts expect that things will continue to get worse before they get better, for worried parents reading this, the most recent AAP Statement says that “At this time, it appears that severe illness due to COVID-19 [remains] rare among children.” With data collected from 24 states between 5/21-10/29/20, the rate of hospitalization of all COVID-19 cases in children was an average of 1.8% (with a range of 0.5-6.7% in individual states) and the percent of child cases resulting in death was 0.01% (0-0.14%). Still, it is best to keep our guards up and to continue following the rules of COVID-19 prevention.

Jackie Phillips, MD, November 3, 2020