Was the Delta spike in pediatric cases linked to more severe illness?


Was the spike in pediatric cases during the Delta wave of COVID-19 linked to an increase in severe illness? A report offers some answers.

Although the initial reports that COVID-19 never or rarely infected children proved to be false, pediatric cases remained relatively low until the Delta variant, which led to an alarming spike in children getting sick. Whether the increase in infectivity led to a higher risk of severe disease remained relatively unknown. An investigation looked at how the severity of COVID-19 changed from March 2020 to December 2021.1

The investigators used electronic health record data to look at encounters that happened in both in- and outpatient settings in 9 health system that participate in PEDSnet. They included all children aged <18 years who had a positive test for SARS-CoV-2. They categorized the severity as asymptomatic; mild, which were cases with some symptoms; moderate, which included cases with gastroenteritis, dehydration, and pneumonia; or severe, which were cases that required admission to the intensive care unit and mechanical ventilation.

There were 82,798 cases included with 54,948 children with asymptomatic COVID-19, 22,303 mild cases, 3781 moderate cases, and 1766 cases of severe COVID-19. In 2021, the moderate to severe cases peaked in June at 13.5% and then declined to 8.1% in December. When compared with July 2020 to February 2021, the adjusted odds ratio for moderate to severe illness was found to be at its highest in June 2021 (adjusted odds ratio, 2.8; 95% CI, 2.2–3.6) and then declined during the period when Delta was the predominant strain of COVID-19. Furthermore, the adjusted odds ratio for moderate to severe COVID-19 cases in children who have complex chronic conditions was 4.2 (95% CI, 3.9–4.5).

They concluded that the risk of severe COVID-19 disease in children had not really changed as the various strains rose to prominence over the course of the pandemic. Furthermore, they feel that the findings highlight the need to engage in timely testing and deploying of vaccine in children, along with reducing the spread of the disease in results. Investigators call for further research into understanding risk and protective factors for severe COVID-19 along with increasing the understanding of the long-term burdens of pediatric COVID-19 infection.


1. Forrest C, Burrows E, Mejias A, et al. Severity of Acute COVID-19 in Children <18 Years Old March 2020 to December 2021. Pediatrics e2021055765. doi: 10.1542/peds.2021-055765

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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