by Professor Karen Luyt Programme Lead for the National Child Mortality Database and Professor of Neonatal Medicine at the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust.
Here at the National Child Mortality Database we’re often asked about the impact that Covid-19 has had on child mortality over the course of the pandemic. During the last 18 months we have contributed to some important studies around this issue, and been privileged to collaborate with some outstanding investigators in shining a light on the impacts of Covid-19 on children. Today, these pieces of work are starting to be published in academic journals, and we want to make sure that the insights we’ve gained are accessible for everyone. In this blog we’ll therefore aim to address five frequently asked questions, with reference to those published pieces of work.
How many children have died of Covid-19 during the pandemic?
A recent study based on NCMD data for the first year of the pandemic and published in the journal Nature Medicine shows that 61 children in England tested positive for Covid-19 when they died. However, as part of the study these deaths were reviewed by expert clinicians, who ultimately found that in only 40% (25) of those cases did Covid-19 actually contribute to the death. This shows that the risk of death from infection for children is low, and perhaps even lower than some simple analyses would suggest.
How much of a health risk does Covid-19 infection pose to children?
The risk in terms of deaths is low – across the entire population, the 25 deaths mentioned above work out to an overall fatality rate of 2 per million. Even taking into account changing infection rates, the infection fatality rate works out to about 5 per 100,000. A second study we worked on, which focused on risk factors, showed that up to the end of February 2021 6,338 children had been admitted to hospital with Covid-19 in England, and 259 had been admitted to paediatric intensive care.
In terms of health risks more broadly though, we likely won’t have an answer to this question for some years to come; SARS-CoV-2 is a novel coronavirus and we can’t say with certainty what impacts infection in childhood could have over the life course.
What impact did the pandemic have on child mortality overall?
The effects of the pandemic, and the policies implemented to control it, were complex and far-reaching. However, in a third study using NCMD data we showed that overall child mortality fell in the year April 2020 – March 2021 to 3,067, 356 deaths fewer than the year before and the lowest level of child mortality on record. The greatest reduction was seen in children under 10. The reasons for this fall are difficult to pick apart, but it may be that some of the policies implemented to control Covid-19 (such as social distancing) and some of the indirect effects (such as reduced road traffic) actually helped to protect children too.
Are some children at greater risk than others?
The Nature Medicine study showed that children with other existing health conditions were at a higher risk of dying from Covid-19 infection. Of the children included in the study who had died, 76% had chronic conditions, 64% had multiple comorbidities and 60% had life-limiting conditions. The study also found that Asian and Black children and young people were more likely to die. In another paper that we collaborated on, we also showed that the risk of being admitted to paediatric intensive care with Covid-19 was higher for Black children and young people.
Does the low fatality rate mean that the government made a mistake suggesting vaccines for children?
No. The evidence gathered from the NCMD data was shared with the government’s Joint Committee on Vaccination and Immunisation (JCVI), and was cited by them as contributing to their guidance on Covid-19 vaccination in children aged 12 to 15 years. Our data contributed to the evidence base demonstrating that overall mortality from infection in children is low, but also that the benefits of vaccination substantially outweigh the potential risks for extremely vulnerable children, such as those with neurological conditions. Both of these considerations have been factored into the JCVI’s recommendations and the rollout of the vaccination programme.
In general, then, the data we see on Covid-19 in children is positive: the risk of children dying of Covid-19 is low. However, as with all our work, it’s important to reflect that every child death is a tragedy and there is always more we can do to improve and save lives. We’re pleased that the unique dataset held by the NCMD has been put to good use during the pandemic to better understand what is happening in real time and mitigate the impact of Covid-19 on children – and we are hopeful that the learning from this crisis can be reapplied to save lives in future.