Retrospective cohort study of COVID-19 among children in Fulton County, Georgia, March 2020–June 2021

  1. Chloe M Barrera
  2. Mallory Hazell
  3. Allison T Chamberlain
  4. Neel R Gandhi
  5. Udodirim Onwubiko
  6. Carol Y Liu
  7. Juliana Prieto
  8. Fazle Khan
  9. Sarita Shah

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Abstract

To describe case rates, testing rates and percent positivity of COVID-19 among children aged 0–18 years by school-age grouping.

Design

We abstracted data from Georgia’s State Electronic Notifiable Disease Surveillance System on all 10 437 laboratory-confirmed COVID-19 cases among children aged 0–18 years during 30 March 2020 to 6 June 2021. We examined case rates, testing rates and percent positivity by school-aged groupings, namely: preschool (0–4 years), elementary school (5–10 years), middle school (11–13 years), and high school (14–18 years) and compared these data among school-aged children with those in the adult population (19 years and older).

Setting

Fulton County, Georgia.

Main outcome measures

COVID-19 case rates, testing rates and percent positivity.

Results

Over time, the proportion of paediatric cases rose substantially from 1.1% (April 2020) to 21.6% (April 2021) of all cases in the county. Age-specific case rates and test rates were consistently highest among high-school aged children. Test positivity was similar across school-age groups, with periods of higher positivity among high-school aged children.

Conclusions

Low COVID-19 testing rates among children, especially early in the pandemic, likely underestimated the true burden of disease in this age group. Despite children having lower measured incidence of COVID-19, we found when broader community incidence increased, incidence also increased among all paediatric age groups. As the COVID-19 pandemic continues to evolve, it remains critical to continue learning about the incidence and transmissibility of COVID-19 in children.

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  1. Version published to 10.1136/bmjpo-2021-001223
  2. ScreenIT

    SciScore for 10.1101/2021.10.30.21265680: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethical considerations: As a public health surveillance activity in response to the COVID-19 emergency response, this activity was deemed exempt from IRB by the GDPH Review Board.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This evaluation was subject to limitations. First, while Fulton County Board of Health offered testing to individuals of all ages beginning in May, 2020, not all testing facilities in and around Fulton County made COVID-19 testing readily available to children. This is an important factor that likely contributed substantially to the number of pediatric tests being far fewer than the number of adult tests. Second, data available from case investigations of young children depend entirely on interviews with proxies, which do not always result in the most accurate data on symptomaticity or source of infection. It is also important to acknowledge we did not have data on whether children were attending school in-person during this time frame, limiting an ability to make inferences about the role schools may have played in pediatric COVID-19 transmission; however, studies have revealed low rates of COVID-19 transmission within schools when mitigation strategies are in place.22,23 Strengths of this study include our data sources. In Georgia, SendSS is the most comprehensive surveillance data source for COVID-19 cases and includes data on cases tested across the majority of testing sites in Fulton County. This allowed us to observe pediatrics trends using the most data possible for cases diagnosed among Fulton County residents, regardless of testing location. Because our datasets included case age, we could also examine COVID-19 trends among smaller, informative pediatric age groups.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.10.30.21265680v1 on medRxiv