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COVID-19 in children: analysis of the first pandemic peak in England
  1. Shamez N Ladhani1,2,
  2. Zahin Amin-Chowdhury1,
  3. Hannah G Davies1,2,
  4. Felicity Aiano1,
  5. Iain Hayden1,
  6. Joanne Lacy1,
  7. Mary Sinnathamby1,
  8. Simon de Lusignan3,4,
  9. Alicia Demirjian4,5,6,
  10. Heather Whittaker7,
  11. Nick Andrews7,
  12. Maria Zambon8,
  13. Susan Hopkins4,
  14. Mary Elizabeth Ramsay1,9
  1. 1 Immunisation and Countermeasures Division, Public Health England, London, UK
  2. 2 Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
  3. 3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  4. 4 Antimicrobial Resistance and Hospital-acquired Infections Department, Public Health England, London, UK
  5. 5 Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
  6. 6 Faculty of Life Sciences and Medicine, King's College London, London, UK
  7. 7 Statistics, Modelling and Economics Department, Public Health England, London, UK
  8. 8 Microbiological Services Colindale, Public Health England, London, UK
  9. 9 London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Shamez N Ladhani, Immunisation and Countermeasures Division, Public Health England Colindale, London NW9 5EQ, UK; DrShamez{at}


Objectives To assess disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared with adults during the first pandemic peak in England.

Setting England.

Participants Children with COVID-19 between January and May 2020.

Main outcome measures Trends in confirmed COVID-19 cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity rates in children compared with adults; community prevalence of SARS-CoV-2 in children with acute respiratory infection (ARI) compared with adults, case-fatality rate in children with confirmed COVID-19 and excess childhood deaths compared with the previous 5 years.

Results Children represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%–34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%–45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children.

Conclusions Children accounted for a very small proportion of confirmed cases despite the large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2.

  • virology
  • epidemiology

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  • Contributors SNL is responsible for national surveillance of COVID-19 surveillance in children at Public Health England. All contributed to the results, interpretation and discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Public Health England (PHE) has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases. This includes PHE’s responsibility to monitor the safety and effectiveness of vaccines, and as such, individual patient consent is not required. PHE’s Caldicott Guardian approved the collection of data by RCGP RSC to support national surveillance.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. No additional data available.

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