COVID-19 in children: Analysis of the first pandemic peak in England

Shamez Ladhani, Zahin Amin-Chowdhury, Hannah G. Davies, Felicity Aiano, Iain Hayden, Joanne Lacy, Mary Sinnathamby, Simon De Lusignan, Alicia Demirjian, Heather Whittaker, Nicholas Andrews, Maria Zambon, Susan Hopkins, Mary Ramsay

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)


Objectives: To assess disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared with adults during the first pandemic peak in England. Setting: England. 

Participants: Children with COVID-19 between January and May 2020. Main outcome measures: Trends in confirmed COVID-19 cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity rates in children compared with adults; community prevalence of SARS-CoV-2 in children with acute respiratory infection (ARI) compared with adults, case-fatality rate in children with confirmed COVID-19 and excess childhood deaths compared with the previous 5 years. 

Results: Children represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%-34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%-45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children. 

Conclusions: Children accounted for a very small proportion of confirmed cases despite the 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 of SARS-CoV-2.

Original languageEnglish
Article number320042
Pages (from-to)1180-1185
JournalArchives of Disease in Childhood
Early online date12 Aug 2020
Publication statusE-pub ahead of print - 12 Aug 2020


  • epidemiology
  • virology


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