At the beginning of the pandemic, there was a general perception that children and teenagers were much less likely to get COVID-19 than adults. It was fueled by early data from across the globe that found very low rates of COVID in adolescents (defined as ages 10-19) and youth (15-24). But the data was mixed and some questioned its validity.
Now new research published this week in JAMA Open has found that adolescents and youth in the U.S. actually had a greater relative risk of getting COVID than older adults in the fall of 2020, before vaccines were available.
The study, conducted by researchers at Touro University and its affiliated New York Medical College, found that in 16 of 19 states examined, the rate of infection was significantly higher in adolescents and youth than in older adults, age 65+ and in some cases, it was twice as high.
The researchers wanted to address some of the shortcomings of the older studies, for example, some were conducted while schools were still closed, when adolescents and youth likely had reduced exposure to the virus compared to adults. Also, there was a bias against testing young people at the start of the pandemic because of the perception that they were not catching it, so data may have underreported rates of infection.
This study looked at data in states that had a surge of the original SARS-CoV-2 strain (a 75% increase in cases) in the fall of 2020, before vaccines were available. “The fact that vaccines were not yet available is important because it means that the findings could not be attributable to the effects of vaccination,” said Dr. Barbara Rumain, associate professor at Touro University and corresponding author on the study.
“The higher rates were probably due to social-behavioral differences such as lack of masking and lack of social distancing in adolescents and young adults,” continued Rumain. On the other hand, older adults likely felt vulnerable and adhered to masking and social distancing guidelines.
The authors believe that the risk in young people may be even greater than was reported here. That’s because adolescents and youth are less likely to show symptoms and be tested, leading to underreporting of COVID in these age groups.
As of May 19, 2020, the American Academy of Pediatrics reported that there were 13,253,639 cases of COVID in children younger than 18 and at least 1,032 deaths.
Contrary to popular perceptions, adolescents are more likely than older adults to contract COVID. And even though the infections could be milder in adolescents, getting long COVID is a real possibility.”
Dr. Barbara Rumain, Associate Professor, Touro University
The authors believe that this information can inform decision-making on the personal and state level. For example, the Florida Department of Health recommended against vaccination in children 5 to 17, which the authors said, seemed to go against the data from this study and the documented number of deaths in children (1000+). According to a meta-analysis published in the journal Nature, the prevalence of long-COVID in children up to age 18 years old is about 25%. The greater the number of infections to start with, the greater the number that will end up as long COVID.
In addition, the increased risk of young people, likely because of greater levels of socializing, may inform policies in schools and personal mask-wearing choices.
The authors recommended that efforts should be made to reduce exposure in young people, with masking and social distancing in schools and other social settings. They also recommended public health messaging more targeted at young people.
“People, especially adolescents, need to wear masks and social distance,” says Rumain. “The pandemic is not over.”
Schneiderman, M., et al. (2022) Incidence and Relative Risk of COVID-19 in Adolescents and Youth Compared With Older Adults in 19 US States, Fall 2020. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2022.22126.