Continued proportional age shift of confirmed positive COVID-19 incidence over time to children and young adults: Washington State March—August 2020
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Abstract
As the coronavirus (COVID-19) epidemic passed initial infection peak in Washington State, phased re-opening lifted stay-at-home orders and restrictions leading to increased non-essential work, social activities and gathering, especially among younger persons.
Methods
A longitudinal cohort analysis of Washington State Department of Health COVID-19 confirmed case age distribution 1) March-April 2020 (N = 13,934) and 2) March-August 2020 (N = 76,032) for proportional change over time using chi square tests for significance.
Results
From March 1st to April 19, 2020 COVID-19 age distribution shifted with a 10% decline in cases age 60 years and older and a 20% increase in age 0-19/20-39 years (chi-square = 223.10, p < .001). Number of cases over the initial analysis period were 0–19 years n = 515, 20–39 years n = 4078, 40–59 years n = 4788, 60–79 years n = 3221, 80+ years n = 1332. After the peak (March 22, 2020), incidence declined in older age groups and increased among age 0–19 and 20–39 age groups from 20% to 40% of total cases by April 19 and 50% by May 3. During this time testing expanded with more testing among older age groups and less testing among younger age groups while case positivity shifted young. Percent positive cases age 0-19/20-39 years through August 2020 increased to a consistent average of 60% [age 0–19 increased to 19% (N = 10257), age 20–39 increased to 42% (N = 30215)].
Conclusions
An increased sustained proportion of COVID-19 incidence is present among children (age 0–19) and young adults (age 20–39) indicating an elevated role in disease spread during the epidemic creating a possible reservoir of disease with spillover risk to more vulnerable older persons and those with comorbid conditions. Media savvy age-appropriate messaging to enhance mitigation compliance among less vulnerable, more mobile and lower priority vaccination age groups will be a continued necessity and priority to reduce overall population incidence.
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SciScore for 10.1101/2020.11.12.20229468: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyses were performed using Microsoft Excel for percentage calculations, an online chi square calculator for two-sided significance testing with a .05 level of significance and an online chi-squared test for trend. Microsoft Excelsuggested: (Microsoft Excel, RRID:SCR_016137)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 LimitationRecognize…SciScore for 10.1101/2020.11.12.20229468: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyses were performed using Microsoft Excel for percentage calculations, an online chi square calculator for two-sided significance testing with a .05 level of significance and an online chi-squared test for trend. Microsoft Excelsuggested: (Microsoft Excel, RRID:SCR_016137)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:Limitations: While testing overall increased during the period evaluated, the percentage of younger people being tested decreased slightly compared to persons age 60 and older. Absent information to link family and household level data with parent’s occupation to identify the source of exposure in the 0-19-year-old age group, one could assume some infections are driven by contact with family members working outside of the home and social interaction as Washington State public schools have been closed since March 11, 2020. A study by the American Academy of Pediatrics found only 10 states reported testing by age further hampering the ability to evaluate level of COVID-19 disease incidence in the population by age.30 Testing by age was only available for Washington State in the first time period of our analysis. The broad age categories of 0-19 years and 20-39 years used by WA State DOH do not allow for more specific analysis regarding transmission and mitigation recommendations. Age of COVID-19 confirmed case positive is not reported by race in weekly online DOH data. The Washington State stay-at-home policy is temporally associated with the first observed case decline after March 22, 2020.31 However the decline was only among age 40 and above with no decline in children or younger adults and cases rose again to a second peak in June indicating a persistent transmission rate among the population less than age 40 resistant to public health mitigation efforts. After mask wearing...
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.
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SciScore for 10.1101/2020.05.21.20109389: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyses were performed using Excel for percentage calculations and an online chi square calculator was used for two-sided significance testing with a .05 level of signficance. Excelsuggested: NoneResults 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:Limit…
SciScore for 10.1101/2020.05.21.20109389: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Statistical analyses were performed using Excel for percentage calculations and an online chi square calculator was used for two-sided significance testing with a .05 level of signficance. Excelsuggested: NoneResults 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:Limitations: While testing overall has increased during the period evaluated, the percentage of younger people being tested has decreased slightly compared to persons age 60 and older. Absent information to link family and household level data with parent’s occupation to identify the source of exposure in the 0-19-year-old age group, one could assume the infections are driven by contact with family members working outside of the home as Washington State public schools have been closed since March 11, 2020. The Washington State stay-at-home policy is temporally associated with the observed case decline after March 22, 2020.9 Specific advisories to children and teenagers age 0-19 years and 20-39-year-old adults to increase awareness of COVID-19 transmission and infection among younger age groups may be advisable to reduce overall COVID-19 incidence levels and enhance movement towards levels that will allow phased reopening of the state and counties.10 Our findings indicate a justifiable concern regarding the phased reopening plan for Washington State in late May in light of the shift in COVID-19 incidence from older to younger age with the majority of current cases now in the combined 0-19/20-39-year-old age group. This specifically affects counties with a high percentage population age 20-39 years. Continued tracking of age trends are warranted and will help target which activities can be opened and when that might occur. Going forward, younger persons with possible greater co...
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.
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