COVID-19 in Children: Analysis of the First Pandemic Peak in England

Background: Children rarely develop severe or fatal coronavirus disease 2019 (COVID-19) as compared to adults. We assessed disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared to adults during the first pandemic peak in England. Methods: Public Health England conducts national COVID-19 surveillance using multiple national data sources. Daily positive and negative SARS-CoV-2 results are reported by public health, National Health Service and private laboratories across England. Individuals presenting with acute respiratory infection (ARI) in primary care were swabbed for SARS-CoV-2 as part of community-based surveillance. Daily death registrations were used to estimate childhood deaths compared to the previous five years. Findings: Between 16 January and 5 May 2020, 129,704 (24.0%) of 540,305 people tested positive for SARS-COV-2; of these, 35,200/536,278 (6.6%) with reported age were in children aged <16 years and 1,408 (4.0%) were positive, compared to 19.1-34.9% in adults. Children represented 1.1% (1,462/129,704) of total cases. COVID-19 cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individual presenting with ARI in primary care, 351 were children and 20 (2.8%) were positive compared to 9.3%- 45.5% in adults. Eight children died and four CFR, 0.3%; 95%CI, 0.07-0.7%) were due to COVID-19. We found no evidence of excess mortality in children. Interpretation: Children accounted for a very small proportion of confirmed cases despite large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission. Funding Statement: PHE Declaration of Interests: None. Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases. This includes PHE’s responsibility to monitor the safety and effectiveness of vaccines, and as such, individual patient consent is not required. PHE’s Caldicott Guardian approved the collection of data by RCGP RSC to support national surveillance.