SARS-CoV-2–Associated Deaths Among Persons Aged …

US Department of Health and Human Services/Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 1324 MMWR / September 18, 2020 / Vol. 69 / No. 37 US Department of Health and Human Services/Centers for Disease Control and Prevention SARS-CoV-2–Associated Deaths Among Persons Aged.

Since February 12, 2020, approximately 6.5 million cases of SARS-CoV-2 infection, the cause of coronavirus disease 2019 (COVID-19), and 190,000 SARS-CoV-2–associated deaths have been reported in the United States (1,2). Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults (3). Persons aged <21 years constitute 26% of the U.S. population (4), and this report describes characteristics of U.S. persons in that population who died in association with SARS-CoV-2 infection, as reported by public health jurisdictions. Among 121 SARS-CoV-2–associated deaths reported to CDC among persons aged <21 years in the United States during February 12–July 31, 2020, 63% occurred in males, 10% of decedents were aged <1 year, 20% were aged 1–9 years, 70% were aged 10–20 years, 45% were Hispanic persons, 29% were non-Hispanic Black (Black) persons, and 4% were non-Hispanic American Indian or Alaska Native (AI/AN) persons. Among these 121 decedents, 91 (75%) had an underlying medical condition,* 79 (65%) died after admission to a hospital, and 39 (32%) died at home or in the emergency department (ED).† These data show that nearly three quarters of SARS-CoV-2–associated deaths among infants, children, adolescents, and young adults have occurred in persons aged 10–20 years, with a disproportionate percentage among young adults aged 18–20 years and among Hispanics, Blacks, AI/ANs, and persons with underlying medical conditions. Careful monitoring of SARS-CoV-2 infections, deaths, and other severe outcomes among persons aged <21 years remains particularly important as schools reopen in the United States. Ongoing evaluation of effectiveness of prevention and control strategies will also be important to inform public health guidance for schools and parents and other caregivers.

Public health jurisdictions in the United States use standard definitions to identify cases of COVID-19§ and multisystem inflammatory syndrome in children (MIS-C),¶ a severe illness characterized by fever, multiorgan system involvement, laboratory evidence of inflammation, and laboratory or epidemiologic evidence of SARS-CoV-2 infection or exposure. SARS-CoV-2–associated deaths were defined as deaths associated with COVID-19 or MIS-C per the determination of the jurisdiction. Persons aged <21 years who met the definition for a SARS-CoV-2–associated death and died during February 12–July 31, 2020, were included in this study. Fifty states, New York City, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands were asked to submit information on SARS-CoV-2–associated deaths among persons aged <21 years, including COVID-19 or MIS-C case status (as determined by each jurisdiction), demographics, dates of illness onset and hospitalization, underlying medical conditions, and location of death. Number of days from illness onset to hospitalization, days from hospitalization until date of death, and days from onset to date of death were calculated for decedents with available data.

Cases of SARS-CoV-2 infection among persons aged <21 years in the United States were first reported in March 2020 (Figure 1); the first SARS-CoV-2–associated fatality among persons in that age group also occurred in March. During February 12–July 31, a total of 391,814 cases of confirmed or probable COVID-19 or MIS-C in persons aged <21 years were reported through case-based surveillance in the United States.

Among the 55 health jurisdictions invited to submit information on SARS-CoV-2–associated deaths among persons aged <21 years, 47 responded; 20 reported no deaths,** and 27 identified 121 deaths†† that met inclusion criteria. Overall, 120 (99%) decedents met the confirmed or probable COVID-19 case definition, and 15 (12%) met the MIS-C case definition, including 14 (12%) who met both case definitions. Twelve (10%) deaths were in infants aged <1 year, 24 (20%) in children aged 1–9 years, and 85 (70%) in persons aged 10–20 years; the median age at death was 16 years (interquartile range [IQR] = 7–19 years) (Figure 2) (Table). Among the 121 decedents, 76 (63%) were male, 54 (45%) were Hispanic, 35 (29%) were Black, and five (4%) were AI/AN.

Among the 121 decedents, 30 (25%) were previously healthy (no reported underlying medical condition), 91 (75%) had at least one underlying medical condition, and 54 (45%) had two or more underlying medical conditions. The most frequently reported medical conditions were chronic lung disease, including asthma (34 [28%]), obesity (33 [27%]), neurologic and developmental conditions (26 [22%]), and cardiovascular conditions (22 [18%]).

Overall, 79 (65%) deaths occurred after hospital admission. Among the remaining 42 decedents, 16 (38%) died at home, 23 (55%) were critically ill and died in the ED, one (2%) died in hospice care, and the location of death was unknown for two (5%). Out-of-hospital deaths occurred in all age groups; however, the highest proportions of deaths at home or in the ED occurred in infants (33%) and adolescents and young adults aged 14–20 years (37%)§§ (Supplementary figure, https://stacks.cdc.gov/view/cdc/93381). Among the 79 decedents who died in the hospital, the median interval from onset of symptoms until admission was 3 days (IQR = 1–7 days),¶¶ and the median interval from hospital admission until death was 8 days (IQR = 4–21.5 days).*** Among 94 decedents with known illness onset date, median interval from onset of symptoms until death was 11 days (IQR = 6–24 days).

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