COVID-19 in children and adolescents in Gauteng

Globally, preliminary data on COVID-19 suggests that children and adolescents (0-19 years) typically comprise a small fraction of recorded cases, and are less likely to get seriously ill or die. Between 06 March and 27 October 2020, children and adolescents constituted 8% of all confirmed COVID-19 cases in Gauteng, with 17-19 year-olds contributing the largest share (29%) of cases among the 0-19 year-olds. The total number of COVID-19 cases amongst those aged 0-19 years is proportionately much lower than for the adult population. However, the proportion of child and adolescent cases increased from the end of lockdown level 3, suggesting an increasing risk as restrictions eased.

Children and adolescents (0-19 years) make up a relatively small proportion of confirmed COVID-19 cases in Gauteng, but their risk of COVID-19 infection seems to be increasing as lockdown restrictions are eased

On 9 December 2020, Health Minister Dr Zweli Mkhize announced that South Africa was entering a second wave of COVID-19 infections, raising again the question of what is driving the patterns of growth.

Our latest Vignette explores confirmed COVID-19 cases in children and adolescents (0-19 years) in Gauteng from March to October 2020. To date, COVID-19 cases in children and adolescents have constituted a small proportion of total confirmed cases in Gauteng. However, there are indications that this trend may be changing, with an apparent increasing risk of COVID-19 infections among children and adolescents over time.

From 06 March to 27 October, children and adolescents constituted 8% (n=16 250) of all confirmed COVID-19 cases in the Gauteng Province, with 17-19 year-olds contributing the largest share (29%) of these cases. Possible explanations may include that late adolescents (17-19 year-olds) are more likely to present as symptomatic, more likely to undergo testing, more mobile and socially active than younger children, and that they returned to school earlier than other school-going children.

Infants (<1 year) comprise 6% of the total number of 0-19 year olds infected. By contrast, in the age group 1-10, each year of age contributed on average 3% of cases to the total number of 0-19 year olds confirmed to have had COVID-19. The relatively higher proportion amongst infants may be due to their likelihood to undergo routine post-natal testing. In addition, they may also be at higher risk of infection due to immature immune systems, smaller airways, and close contact with mothers.

Data for November 2020 shows a slight decline in the proportion of cases in children and adolescents, which may be attributable to many late adolescents focusing on matric and other exams over this period. Recent reports of super spreader events and the increased movement of children since school closures means that it is likely that the proportion of children and adolescents testing positive for COVID-19 will increase from December.

With contributions of thoughts and edits from Julia de Kadt, Graeme Götz, Christian Hamann, Gillian Maree, and Alexandra Parker.