A new study published by researchers in Germany says that youth aged both 5 to 11 and 17-and-under have very limited risk of severe disease or death from Coronavirus Disease 2019 (COVID-19).
In a Nov. 30 preprint study published by eight German researchers, the team stated, “As compared to adults, the overwhelming evidence demonstrates that children and adolescents usually have mild disease courses, along with low disease-associated morbidity and mortality.”
“Nevertheless, their absolute risk remains difficult to assess.”
The paper found a problem in the existing narrative on adolescent pandemic risk wherein because of “a high rate of undetected cases among children” that reporting to Germany’s statutory notification systems “significantly underestimate overall infections in this age group.”
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Researchers cautioned both that “unless corrected accordingly, this can lead to a substantial overestimation of the overall risk for children and adolescents,” and that “a relevant number of patients with laboratory-confirmed SARS-CoV-2 infections during a hospital stay for different reasons may inflate the number of cases and thus the risk assessment even further.”
As a result of this conflict, the team set out to solve the following problem: “Without reliable data on actual infection-associated disease burden, a meaningful risk-benefit assessment of pandemic control and mitigation measures affecting this particular age group is impossible.”
Researchers collected data from three different sources. First, a study referred to as the SARS-CoV-2 KIDS study, which extracted data from adolescents aged 17-and-under across 14 German pediatric hospitals between June of 2020 and May of 2021.
KIDS tested the blood of 10,358 participants undergoing hospital visit for “routine clinical procedures” for the “IgG-specific S1 domain of SARS-CoV-2 spike protein,” which allowed the study to estimate that 10.8 percent of Germany’s youth had been exposed to SARS-Cov-2, the virus that causes COVID-19.
The second source of data was described as “a national, prospective registry for children and adolescents hospitalized with a SARS-CoV-2 infection” established in March of 2020 and managed by the German Society of Pediatric Infectious Diseases (DGPI).
The “DGPI Registries” is a voluntarily-reported database containing cases of kids aged 17-and-under who had laboratory-confirmed SARS-CoV-2 infections.
The third was Germany’s “statutory notification system,” which chronicles laboratory-confirmed infections. The study notes that labs are required to report positive cases to local health authorities, and local health authorities are mandated to report their figures to the Robert Koch Institute, which is Germany’s national health center.
Researchers looked to examine the number of hospitalizations associated with a lab-confirmed SARS-CoV-2 infection, adding the caveat, “The reason for hospitalization was not always the patient’s SARS-CoV-2 infection. In some cases, the infection was detected during an inpatient stay for another medical reason.”
Nonetheless, when compiling its data set, the team said it did not exclude cases that reported additional infections, but noted cases involving additional infections amounted to 10 percent of all reports they discovered.
The study also examined the number of instances of COVID-19 requiring both therapy, ICU admission, and death.
Underreporting was discovered in the DGPI database when contrasted against the statutory notification system, researchers noted, suggesting the discrepancy is caused by the voluntary versus compulsory requirements for reporting between the two sources.
For example, while the team noted that the statutory system only held cases between the ages of 0 and 14 and the DGPI database children as old as 17, it noted between March of 2020 and May of 2021 that DGPI contained 1,226 cases aged 14-and-under compared to 4,035 in the statutory system, resulting in an underreporting factor of 3.29.
The study clarified, “Because case definitions in the DGPI register and the statutory notification system were identical, this provides a reasonable basis for correcting the underreporting of the DGPI cases based upon the statutory notification system.”
“Limiting the analysis to children up to the age of 14 (rather than 17) is a minor limitation,” they added.
Germany’s population of children aged 5 to 11 is listed by the study as 5,267,742. Based on the KIDS study’s seroprevalence rate of 10.8 percent, the number in this age bracket exposed to SARS-CoV-2 was estimated at 568,916.
In terms of hard data, the study found that the number of SARS-CoV-2-associated hospitalizations reported to the DGPI database, adjusted for the underreporting factor of 3.29, only totaled 576.
The numbers for COVID-19 therapy and ICU admissions fell dramatically to 89 and 39 respectively.
Deaths due to COVID-19, which were not adjusted for underreporting, were only 4 in this age bracket.
For all children aged 17-and-under, the study found a total of only 14 deaths.
The study explained its reasoning for not adjusting death for underreporting in line with how the other figures were handled, “The DGPI registry captured almost all of these fatalities, with 13 reported cases as compared to the 14 recorded in the statutory notifications system.”
The data showed that for 5 of 13 cases, “The patients had been in palliative care due to an underlying disease prior to their SARS-CoV-2 infection.”
In the Discussion section of the paper, the team stated, “Primarily healthy children ages 5-11 have the lowest risk with a 0.2/10,000 rate of ICU admission.”
“Due to an absence of cases, their case fatality rate cannot be calculated.”
Notably, the data indicated that the 5 to 11 bracket was actually at lower risk than the 0 to 5 or the 12 to 17 brackets, “For the outcome measurements of both hospitalization and therapy requiring COVID-19, the rates were highest in the age group <5 years, followed by the age group 12-17 years. By contrast, they were lowest in the age group 5-11 years…”
Raw data indicated that 3,199 total SARS-CoV-2-associated hospitalizations were registered with children aged 5-and-under, a bracket composed of 3,969,138 individuals, 428,667 suspected of being exposed to the virus.
For COVID-19 therapy and ICU admissions, these numbers were 517 and 79 respectively.
8 of the 14 deaths registered were in kids between 0 and 5.
In the 12 to 17 bracket, composed of 4,507,064 total individuals with an estimated 486,763 SARS-CoV-2 exposures, fared better than the infants, but still worse than the age bracket next in line for Germany’s coming mandatory vaccination scheme.
Hospitalizations were registered as 1,557 in total, COVID-19 therapies at 352, ICU admissions at 135, and deaths at 2.
The team noted their study “has several limitations,” explaining the specifics are “mainly due to uncertainties in the raw data in the three different sources, which are mostly estimates.”
They also admit that “We do not know the exact number of SARS-CoV-2 infections in children in Germany,” and reminded readers their figures are based on simple math using the seropositivity rate estimated in the KIDS study.
In an additional caution, the study also warned its total dataset may be smaller than reality because, “As in all voluntary reporting systems, reporting may be biased towards more severe cases. This presumption is supported by the fact that only 30% of all hospitalizations were captured, while more than 90% of deaths were reported.”