Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rarely fatal in children and young people (CYP, <18 years old), but quantifying the risk of death is challenging because CYP are often infected with SARS-CoV-2 exhibiting no or minimal symptoms. To distinguish between CYP who died as a result of SARS-CoV-2 infection and those who died of another cause but were coincidentally infected with the virus, we undertook a clinical review of all CYP deaths with a positive SARS-CoV-2 test from March 2020 to February 2021. The predominant SARS-CoV-2 variants were wild-type and Alpha. Here we show that, of 12,023,568 CYP living in England, 3,105 died, including 61 who were positive for SARS-CoV-2. Of these deaths, 25 were due to SARS-CoV-2 infection (mortality rate, two per million), including 22 due to coronavirus disease 2019—the clinical disease associated with SARS-CoV-2 infection—and 3 were due to pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. In total, 99.995% of CYP with a positive SARS-CoV-2 test survived. CYP older than 10 years, Asian and Black ethnic backgrounds and comorbidities were over-represented in SARS-CoV-2-related deaths compared with other CYP deaths. These results are important for guiding decisions on shielding and vaccinating children. New variants might have different mortality risks and should be evaluated in a similar way.
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We would like to thank the three senior clinical expert reviewers who independently reviewed clinical case notes of the CYP who died with a positive SARS-CoV-2 test: P. Fleming, Professor of Infant Health and Developmental Physiology, University of Bristol; G. Rossouw, General Paediatrics and Neonates, Research Fellow, National Child Mortality Database (NCMD); and D. Alison Perry, Paediatric Intensive Care, Bristol Royal Hospital for Children. We are grateful to members of the Child Death Overview Panels for their support and expertise and all child death review professionals for submitting data and providing additional information when requested. The entire NCMD team (particularly N. Cook, S. Stoianova, V. Sleap and T. Williams) have been very helpful in providing data for linkage and supporting analysis. We thank the NHS Digital and the NHS England and NHS Improvement Children and Young People teams (particularly R. Owen, S. Solti and T. Watson-Koszel) for their contributions and support. We thank Public Health England’s Field Service and National Child and Maternal Health Intelligence Network teams for their collaboration in establishing the real-time surveillance system on child deaths potentially related to COVID-19 and their ongoing support in the daily linkage with SARS-CoV-2 test results. We would like to acknowledge support from the National Institute of Health Research (NIHR) through the National School for Public Health Research Programme and the Applied Research Collaboration North West London. We would like to thank the Royal College of Paediatrics and Child Health for their contributions and support. Parent and public involvement is at the heart of the NCMD program. We are indebted to C. Bevan (Stillbirth and Neonatal Death Charity), T. McAlorum (Child Bereavement UK) and J. Ward (Lullaby Trust), who represent bereaved families on the NCMD program steering group, for their advice and support with setting up the real-time child mortality surveillance system at the beginning of the COVID-19 pandemic. The authors received no specific funding for this work. Three of the authors are in receipt of research funding for their broader employment. R.H. is in receipt of a funded fellowship from Kidney Research UK (grant no. TF_010_20171124). J.W. is in receipt of a Medical Research Council Fellowship (grant reference MR/R00160X/1). L.K.F. is in receipt of funding from Martin House Childrens Hospice (there is no specific grant number for this funding). R.V. is in receipt of a grant from the NIHR (grant no. NIHR202322, ‘Understanding the disruption of children and young people’s health and healthcare use during and after COVID-19 to inform healthcare and policy responses’). These funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The NCMD program, including this work, is funded by NHS England and commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme.
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