A new study conducted in England shows that the risk of death due to COVID-19 remains very low for children and young people, and most deaths occur in those with underlying health conditions. Marta Bertran of the U.K. Health Security Agency, London, and colleagues present these findings November 8 in the open access journal PLOS Medicine.

Pediatric deaths due to COVID-19 are rare, and because infection tends to be mild in children and young people compared to adults, it can be challenging to assess COVID-19 severity and cause of death for those with serious underlying health conditions. In addition, because death due to COVID-19 is so uncommon for children, limited data exist to examine such fatalities at the population level.

To improve our understanding of pediatric COVID-19 deaths—and which factors might be linked to an increased risk of death—Bertran and colleagues analyzed detailed data on everyone aged less than 20 years in England who died within 100 days of a confirmed COVID-19 infection between March 2020 and December 2021.

The analysis showed that, of 185 total deaths that occurred, 81 were due to COVID-19. Of those who died from COVID-19, 75% had underlying health conditions, primarily severe neurodisability and conditions involving a compromised immune system. Half of COVID-19 deaths occurred within seven days of infection and the majority within 30 days of infection.

These findings confirm that death due to COVID-19 remained rare in children and young people even as new variants of the SARS-Cov-2 virus emerged during the study period. They also highlight which children might be at greater risk of COVID-19 death, which could help inform parents, clinicians, and policymakers about prevention through vaccination, for example, and seeking early treatment.

The authors note that this study emphasizes the need for detailed review of individual cases in order to collaboratively monitor rare COVID-19 outcomes in children. They also note that the study period occurred prior to the rise of the omicron variant, which now dominates cases worldwide.

Coauthor Shamez Ladhani adds, "Our national surveillance in England continues to show a very very low risk of death due to COVID-19 in children and teenagers, with most fatalities occurring in those with multiple and life-limiting underlying conditions."