Coronavirus infections in kids: California sees alarming surge in cases in late July

While reports indicate a surge in cases among children, epidemiologists say more precise data are needed to shed light on possible causes.

Just as schools prepare for a new academic year amid a simmering debate over whether it’s safe for kids to return to classrooms comes worrisome news that infections among children are growing rapidly.

A summary of publicly reported state data on children and COVID-19 by the American Academy of Pediatrics and Children’s Hospital Association found cumulative child cases reported nationally grew by 97,078 from July 16 to July 30, a 40% increase over that time. Much of that surge was in states in the South and West.

And Bay Area  experts say they’re seeing a similar jump in California. George Lemp, an infectious disease epidemiologist and former director of the California HIV/AIDS Research Program at the University of California Office of the President, has been tracking cases in the state by age group every two weeks and found they increased 36% among children 17 and younger from June 28-July 12 to July 12-25.

Increases among adults during that same period grew more slowly — 15% for 18-36 year olds and 20% to 23% for older adults, Lemp said.

“I’ve been noticing that for the last month and wondering why that’s been occurring,” Lemp said. “What’s concerning to me is why children and adolescents are becoming a higher percentage of cases in the state of California.”

While COVID-19 hospitalizations and deaths among children remain mercifully rare, the reported new cases among children suggest that they may be more susceptible to infection and capable of spreading the virus than previously thought.

That didn’t surprise doctors who have urged caution about the threat posed by the new virus to children and their families.

“I’ve always been of the opinion that this is an equal opportunity virus — it can infect a child as much as can infect an adult,” said Dr. Mobeen H. Rathore, a professor and expert in pediatric infectious diseases and immunology at the University of Florida and Wolfson Children’s Hospital. “I still believe children are as likely to get infected as anybody else.”

Why more children are becoming infected now remains unclear. Rathore says it likely has to do with more widely available testing. Because children tend to show mild if any symptoms of COVID-19, and are frequently ill with colds and other common ailments, fewer were tested in the early months of the pandemic when testing was more limited.

Schools and businesses also closed across the country in the spring as the pandemic spread like wildfire, with only adults in health, public safety, food and other essential jobs venturing out to work. But over the summer, more businesses reopened and restrictions on activities eased. As cases spread among adults, they likely passed them on to children as well.

“Now that we’re testing,” Rathore said, “we’re finding more of them.”

State data show children 17 and younger account for 10% of California’s total of more than 561,000 cases.

The American Academy of Pediatrics and Children’s Hospital Association report that found a 40% surge among children in late July was based on data reported by 49 states, New York City, Washington, D.C., and Puerto Rico.

The report found a total of 338,982 child COVID-19 cases reported nationally through July 30, representing 8.8% of the 3,835,573 cases at the time, with an overall infection rate of 447 cases per 100,000 children in the population.

Data from New York City and 20 states that report hospitalization by age — California isn’t among them — found children accounted for 0.6% to 3.7% of total reported hospitalizations.

Data from New York City, Washington, D.C., and 43 states including California that reported deaths by age
showed children accounted for 0%-0.8% of all COVID-19 deaths. California was among 20 states that reported no child deaths.

“I think that’s the only silver lining to this cloud — kids don’t seem to get as ill,” Rathore said.

But the American Academy of Pediatrics and Children’s Hospital Association researchers noted that the format, content, and metrics of reported COVID-19 data “differed substantially by state.” While California and a dozen other states count children through age 17, others include older teens and even young adults up to 24.

The wide age ranges in reported cases frustrates scientists like Lemp who note that studies indicate significant difference in the way the virus affects younger and older children and more specific age data would help. A large study last month in South Korea found, for example, that children ages 9 and younger were less likely to transmit the virus, while older children spread it as easily as adults.

“Is it more adolescents who are out and about, not social distancing? Are they driving that? We don’t have that data,” Lemp said. “It seems that’s something state and local governments should be providing to the public. Without that information, we’re not able to clearly understand how to reduce risks for people.”