New case of COVID-19 has been declining in Oregon since late last year, but the state is experiencing a change in who is testing positive. Since January, the share of new cases in Oregonians has grown by about 50% from 10 to 19 years, while the share has shrunk between 20 and 50 years old, according to an analysis by The Lund Report.
This shift seems to be part of a national trend. Nationwide weekly data collected by the American Academy of Pediatrics shows a similar increase in the percentage of new cases in young people. Hospital survey data show the same pattern: the percentage of patients admitted to hospital for COVID under the age of 19 has almost doubled since January.
Nevertheless, adults are responsible for the vast majority of hospitalizations. Reports from 48 states and Washington DC to the U.S. Department of Health and Human Services show that there have been more than 2.3 million COVID hospital admissions among adults since November 1 through last Saturday. This compares with 81,300 hospitalizations in children.
Unlike elderly adults, who are at greatest risk for death and serious illnesses due to COVID, the vast majority of children experience only mild symptoms, mostly cough, fever, headache and runny nose. There are also only two Oregonians younger than 20 dead. In contrast, about 490 died between the ages of 50 and 69, and there were more than 1,850 deaths among those aged 70 and older.
The changing case demographics comes at an awkward time for policymakers planning the reopening of schools. Limited data on the severity of variants in children make it difficult to exclude this as a contributing factor. There is no national database of school attendance policies, and there are few useful statistics on child behavior, leaving researchers without important tools.
The same circumstances also offer hope: this early evidence suggests that the vaccines work. It is not so much that children are admitted to hospital more, but that elderly people become less ill. In a study of nearly 600,000 vaccinated Israelis published in the New England Journal of Medicine, it was found that severe COVID cases fell faster than common infections in the first few weeks after the first shot of vaccination.
There has also been a sharp increase in cases of Israeli youth in Israel, with the highest per capita percentage of the world population, according to a report in the British Medical Journal last month. The magazine also reported that 60% of the cases were found in a town in northern Italy with ‘children of primary or secondary school age’. This trend has caused concern among Italian health workers.
The trend was much less visible in the US, in part due to problems with data collection coming from the Trump administration.
But when the Lund report shared the investigation with them, they said it could very well be that the vaccines have an effect.
“It makes sense,” said Dr. Sean O’Leary, vice chairman of the American Academy of Pediatrics’ Committee on Infectious Diseases, said. “We have no hard data to say that this is what is happening, but it is logical that we can see some changing demographics” due to mass vaccinations, he said. “We know the vaccine works.”
The rate of pediatric COVID ‘has gradually climbed through the pandemic, which probably represents a real increase in children becoming infected compared to older populations, not that the virus is getting worse in children,’ O’Leary said, although the increase last year and the summer probably represented an extra test capability. The US is succeeding somewhat in reducing the spread among the elderly, he added.
In Oregon, the last state in the country to vaccinate elderly people living in the community, health officials administered at least one dose to more than 540,000 people 65 and older, according to the Oregon Health Authority. This is about 70% of the population, based on estimates by Portland State University’s population research center.
But immunizing those who are already being chased away may have less of an impact on cutting virus numbers than vaccinating those most at risk, such as essential workers. The number of cases has the furthest case in the ages of 20 to 50, which includes a large fraction of those first vaccinated in Oregon: medical workers and teachers.
Another factor to consider is the distribution of varieties – from Britain, South Africa and Brazil – and those originating in the United States.
“I am not aware of strong evidence to suggest that any of these variants in children are worse than the variants that have spread in the US, or that they are disproportionately infected in children as adults compared to previous variants,” O’Leary said.
With so many competing factors, it’s hard to unravel the relative weight of each one. But some of the factors most cited for the increase in cases among younger people – the timing of the distribution of households, the availability of tests and the role of university students – seem unlikely to fully explain the trend.
Data from college campuses
Cases among university students are a clear contributing factor, says dr. Chunhuei Chi, Professor of International Health at Oregon State University and Director of the Center for Global Health. OSU saw a significant increase in COVID cases on its Corvallis campus in February, although numbers have fallen in recent weeks.
Chi said the OSU tests every student who lives in the dormitories weekly and notes that simply a more regular test is likely to turn up a larger fraction of asymptomatic cases that would otherwise have slipped under the radar. Chi said he has spoken to students who have caught COVID several times already, and said mild cases of COVID could result in a much shorter period of natural resistance. (O’Leary, of the American Academy of Pediatrics, said this is possible, but not clearly established by research.)
OSU’s approach is not the only way colleges are confronting the COVID crisis. The number of COVID cases at Portland State University has largely followed the trends in the city, says Dr. Mark Bajorek, director of health services at the university. Tests are voluntary and have decreased from 30 to 40 tests per day during the winter peak of the epidemic to five to ten late. Bajorek noted that some students may have been exposed, but no symptoms were less than enthusiastic about being tested: “Do I really want to know?” asked some.
It is difficult to unravel the impact of collegiate COVID cases, but a national collection of case numbers among the youth conducted by the academy is a natural experiment. Most states consider children younger than 18 or younger than 20. If we compare the two, we tell something about what young adults aged 18 to 19 are talking about.
After the removal of statements identified by academia as inconsistent with data, there is a clear increase in the statements that children under 20 follow around ‘school time’. The data for the states that monitor children has also risen nationally for those under 18 since January, in a way that has not been the case lately.
Another contributing factor to the number of cases is the timing. In Oregon, cases among children often peaked a week later than in adults, a trend that appears to reflect test patterns (children are tested after an adult tested positive) and transmission. In Oregon’s most recent report on COVID in children, from January, it was found that 47% of cases in children came from the household, compared to 20% in adults.
With children’s cases left behind in adults, it’s just simple math that the share in children will increase as the adult business declines. But this trend should disappear about a week after the cases are settled. But that hasn’t happened: to date, the trend in Oregon has continued, even after the number of cases has stopped declining so rapidly.
Data on who becomes seriously ill with COVID in Oregon is less complete. The federal records for hospitalization in Oregon and Washington have for at least the past four months erred in the number of children admitted each day with suspected COVID. Prior to Oct. 19, Oregon never admitted more than 15 children in a day with suspected COVID. Since then, every day more than thirty people have reported, although it makes no sense at all compared to the trend in adults.
Bill Hall, a deputy assistant secretary of public affairs at the U.S. Department of Health and Human Services, acknowledged the issue and said a data quality team is reviewing it. But he did not respond to questions from The Lund Report about how it happened or when it would be rectified. Politico also recently reported that the agency’s inspector general is investigating failures at US Centers for Disease Control and Prevention. It is said that the lack of race data in case of Trump administration was the first focus.
Some states are certified to collect data directly from hospitals and pass it on to federal agencies – but not Oregon or Washington. An HHS document notes that Oregon was undergoing a certification process in December.
Jonathan Modie, a spokesman for Oregon’s health authority, declined to say what the state’s reporting status was, or shed light on where the erroneous data came from.
A more comprehensive overview of who is admitted to the hospital would be possible in the United States. HHS has requested that hospitals provide COVID admissions in ten-year-old age groups. However, this data is not absent in state files and can not be used in facility-level files, which count the patient less than four.
Hall declined to comment on questions.
Little is known about variants
Perhaps the biggest source of uncertainty is the role of variants. Only a fraction of confirmed COVID cases are currently being followed up in Oregon.
According to Oregon State, director of OSU’s Center for Genome Research and Bioprocessing, Oregon State evaluated approximately 100 to 200 cases per week, including wastewater samples. “We have not recently detected any variants (ie the United Kingdom, Brazil, South Africa),” he said in an email.
At Oregon Health & Science University, scientists aim for 200 or 250 series per week; researchers at the University of Oregon are analyzing 25, though its lab may increase, a spokesman said.
This is not enough analysis to give a clear picture of trends.
According to the New York Times, Oregon has so far followed up less than 2% of the cumulative cases.
In January, OHSU found that variant B.1.1.7, the variant that originated in the United Kingdom, is in Oregon. Since then, OHSU researchers have found a new variant in Oregon with a feature – aptly known as ‘eek’ – that researchers say could make it more resistant to the vaccine. Although the number of cases has fallen, the number of cases of B.1.1.7 variants has increased, and some believe that it will be the dominant form of COVID-19 in the US in the spring. A dashboard from the genomic testing company Helix recently found the B.1.1.7 variant in about 30% of the samples.
Limited order in the US has reduced the country’s ability to know for sure what’s going on, says dr. Maureen Hoatlin, a biomedical consultant and recently retired faculty member at the OHSU. What is happening in Europe will be observed later in the US, she said via email.
In Italy, doctors specifically raised the alarm about the possibility that the B.1.1.7 variant would spread more widely in children.
“We fly blind in the U.S. with respect to the variants,” Hoatlin said.
– Jacob Fenton from The Lund Report