The Case Fatality Rate (CFR) in young Children under age 12
Updated 25 September 2021
It is important to know the case fatality rate (CFR) in children under age 12 (<12s) because Australia is probably 'opening up' in October 2021, and the <12s remain unvaccinated and no vaccine has yet been approved by the TGA for this group. The published data is contradictory and confusing and analysis on the CFR for the Delta strain has not been completed. Many of the relevant studies are analysed below. Use the contact page if you believe a useful study is missing.
The CFR <12s appears to be about 45 per million Cases or 0.000045
That equates to 54 child deaths in NSW and 1500 child deaths in Australia under age 12 simply because they have been left unvaccinated. See Vaccinating Children.
Some relevant journal articles
In Sept 2020 The Int Journal of Public Health published a CFR for the 0 - 19 year old group (median age 10 years) for Italian cases in the initial phase of the epidemic (pre Delta) showing 4 deaths in 8516 cases for a very high CFR of 0.000479 or 469 deaths per million Cases. The treatment of Covid-19 was not yet ideal and health facilities were swamped.
In December 2020 Levine et al published a meta-analysis (systematic pooling of all medical articles reaching a specified standard) of 27 articles from developed OECD countries published prior to September 2020. They showed an exponential relationship (log linear) between the CFR and Age. They also showed that 90% of the reason CFRs differ from place to place is because of the differences of the age groups that are present. The confidence interval for their relationship was tight down to the age of 5 years.
It is important to know the case fatality rate (CFR) in children under age 12 (<12s) because Australia is probably 'opening up' in October 2021, and the <12s remain unvaccinated and no vaccine has yet been approved by the TGA for this group. The published data is contradictory and confusing and analysis on the CFR for the Delta strain has not been completed. Many of the relevant studies are analysed below. Use the contact page if you believe a useful study is missing.
The CFR <12s appears to be about 45 per million Cases or 0.000045
That equates to 54 child deaths in NSW and 1500 child deaths in Australia under age 12 simply because they have been left unvaccinated. See Vaccinating Children.
Some relevant journal articles
In Sept 2020 The Int Journal of Public Health published a CFR for the 0 - 19 year old group (median age 10 years) for Italian cases in the initial phase of the epidemic (pre Delta) showing 4 deaths in 8516 cases for a very high CFR of 0.000479 or 469 deaths per million Cases. The treatment of Covid-19 was not yet ideal and health facilities were swamped.
In December 2020 Levine et al published a meta-analysis (systematic pooling of all medical articles reaching a specified standard) of 27 articles from developed OECD countries published prior to September 2020. They showed an exponential relationship (log linear) between the CFR and Age. They also showed that 90% of the reason CFRs differ from place to place is because of the differences of the age groups that are present. The confidence interval for their relationship was tight down to the age of 5 years.
The CFRs for <12s calculated from this relationship are all high and reflect the early lack of knowledge and resources. Only one article (from Spain) contributed specifically to the 0-9 age group with a CFR of 0.0023 or 2300 deaths per million Cases.
In July 2021 Smith C, et al published an un peer reviewed article 'Deaths in Children and Young People in England following SARS-CoV-2' in Research Square. They calculated a CFR for Children and Young Persons (under 18) of 0.000053 (or 53 deaths per million Cases) pre Delta in the UK. The mortality rate was 2.08 per million UK CYP <18 population.
On the 16 September 2021 the American Academy of Pediatrics and the Children's Hospital Association updated their State Data Report. Updated weekly HERE.
Most reporting US states define a Child as being aged 0-17 or 0-19. There were 480 deaths in reporting states in the US (21 May 2020 to 16 Sept 2021) out of 5,518,815 Child Covid-19 cases during the whole pandemic till Sept 2021. The CFR was 0.000087 or 87 deaths per million cases. The child population in 2019 was 75,266,842, suggesting a Child Mortality Rate of 4.8 per million population.
When data is taken from this source during the time Delta strain was prevalent in the US, there were 145 deaths (1 July 2021 to 16 September 2021) in 1,473,931 cases. The CFR for children under 18 was 0.000098 or 98 child deaths from Delta per million cases. The Mortality Rate was 9 deaths per million child population per year.
Child Deaths from Covid-19 are published By the Californian Health Department. The CFR for Children under 5 in California is 0.000087 (87 child deaths per million cases) - similar to all US data CFR for Children (0 - 19) reported above. The CFR in the 5 - 17 age group is lower in California than the 0 - 5 year group - 0.000047 or 47 deaths per million cases.
Most reporting US states define a Child as being aged 0-17 or 0-19. There were 480 deaths in reporting states in the US (21 May 2020 to 16 Sept 2021) out of 5,518,815 Child Covid-19 cases during the whole pandemic till Sept 2021. The CFR was 0.000087 or 87 deaths per million cases. The child population in 2019 was 75,266,842, suggesting a Child Mortality Rate of 4.8 per million population.
When data is taken from this source during the time Delta strain was prevalent in the US, there were 145 deaths (1 July 2021 to 16 September 2021) in 1,473,931 cases. The CFR for children under 18 was 0.000098 or 98 child deaths from Delta per million cases. The Mortality Rate was 9 deaths per million child population per year.
Child Deaths from Covid-19 are published By the Californian Health Department. The CFR for Children under 5 in California is 0.000087 (87 child deaths per million cases) - similar to all US data CFR for Children (0 - 19) reported above. The CFR in the 5 - 17 age group is lower in California than the 0 - 5 year group - 0.000047 or 47 deaths per million cases.
Goldstein and Lee 'Demographic perspectives on the mortality of Covid-19 and other epidemics', 20 August 2020, Proc. Natl. Acad. Sci. U.S.A. 117, 22035–22041, Full text here, demonstrate that the CFR against Age curve is the same for all countries if normalised by their method - and the normalised age dependent CFR increases by 11% per age grouping for all county's data sets. The all causes mortality shows the same property, the age dependent mortality increasing by 10% per age grouping. They also found that CFRs for children were slightly higher than they had expected.
Conclusion
An expected CFR for children under age 12 in Australia of 0.000045 is not unreasonable. It is in the range of CFRs published or estimated during the Delta strain period when medical knowledge had increase and health facilities were not yet overwhelmed. CFRs vary widely due to age mix of the population and resources and the variable tests, reporting methods and sources.
