COVID-19 Deaths Among Americans Under 21, February–July 2020

Between February 12, 2020, and this report, the United States had recorded about 6.5 million SARS-CoV-2 infections and 190,000 deaths. COVID-19 is usually milder in children than adults, and people under 21 make up 26% of the population. CDC asked health departments to report every death among them linked to COVID-19 or multisystem inflammatory syndrome in children (MIS-C) from February 12 to July 31, 2020. Of 55 jurisdictions, 47 responded; 20 reported no deaths and 27 reported 121.

In that period, people under 21 accounted for 391,814 cases — about 8% of the total — but about 0.08% of deaths.

Who died

Hispanic, Black and American Indian/Alaska Native young people — 41% of Americans under 21 — accounted for 94 of the 121 deaths.

Age at death among people under 21 with SARS-CoV-2–associated deaths. From CDC's MMWR.

Health conditions

• 30 (25%) had been previously healthy; 91 (75%) had at least one underlying condition and 54 (45%) two or more.
• Most common: chronic lung disease, including asthma (28%), obesity (27%), neurologic and developmental conditions (22%) and cardiovascular conditions (18%).
• 120 met the COVID-19 case definition and 15 the MIS-C definition (14 met both).

Where and how fast

• 79 (65%) died after hospital admission; 16 died at home and 23 in the emergency department. Out-of-hospital deaths were most common among infants (33%) and those aged 14–20 (37%).
• For those who died in the hospital, the median time from first symptoms to admission was 3 days, and from admission to death 8 days. From symptoms to death, the median was 11 days.

Cases and deaths among people under 21 by week. From CDC's MMWR.

Why the disparities

Racial and ethnic minority young people are also overrepresented among children hospitalized with COVID-19 and MIS-C. Their families are more often essential workers who can't work from home, raising exposure at home. Crowded housing, food and housing insecurity, wealth and education gaps and racial discrimination, along with barriers to care — no insurance, child care, transportation or paid sick leave — likely contribute, as do higher rates of underlying conditions.

What's needed

As schools reopen, young people exposed to SARS-CoV-2 should be watched for complications, and surveillance of infections, hospitalizations and deaths in this age group should continue, along with evaluation of prevention strategies to guide schools, parents and caregivers.

Sources

Based on Bixler D, Miller AD, Mattison CP, et al., "SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020," Morbidity and Mortality Weekly Report 69(37), CDC; a work of the United States government in the public domain.