A Comprehensive Assessment of Pediatric COVID-19 in Atlanta, GA: Risk Factors for Infection and Severity Level, and the Role Children Play in Household Transmission Open Access

Nowak, Kacy (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/6q182m29w?locale=en


Background: To date, there have been over 3.4 million reported pediatric COVID-19 cases and 379 pediatric COVID-19 deaths in the US. Although severe infections and death rates are low among the total US pediatric population (0.19%), there has been a 4% increase in weekly pediatric incidence during the Spring of 2021. Furthermore, the Centers for Disease Control and Prevention reports disproportionate health outcomes among racial/ethnic minority groups. Black children make up only 14% of the US pediatric population, yet they account for 29% of MIS-c patients. Hispanic/Latino children represent 25% of the US pediatric population yet account for 34% of MIS-c patients.

Objective: This study aims to better understand risk factors associated with an increased likelihood of pediatric COVID-19 infections and severe outcomes. Furthermore, this study aims to explore the role children play in household transmission of COVID-19.


Methods: COVID-19 test results (n=18,507) and infection severity (n=2,848) data of children ≤ 18 from CHOA were analyzed using univariate, multivariate, and polytomous logistic regression to compare children with and without COVID-19 and children with and without a severe infection across demographic, socioeconomic, and health characteristics. Survey data from 15 households were collected to compare secondary infection rates across household characteristics.


Results: Black (aOR= 1.65, 95% CI: 1.02-2.71) and Hispanic/Latino children (aOR= 5.19, 95% CI: 3.07-8.83) had a higher likelihood of a positive COVID-19 test. Among infected individuals, black children were more likely to have MIS-c (aOR=1.47, 95% CI: 1.02-2.15). Obesity was significantly associated with disease severity including ICU admission (aOR= 2.07, 95% CI: 1.28-3.39) and MIS-c diagnosis (aOR= 21.35, 95% CI: 13.39-34.49). Household survey data showed three children served as an index case in their households (20% of total index cases), and all three cases were infected from a school or sport exposure. The average number of secondary infections among children index cases was 3.0 members/ household.


Discussion: Like with adults, the disproportionate likelihood of COVID-19 infection and severe outcome among minority groups highlights the need for improved public health policies with optimal use of resources for health equity. Increased understanding of co-morbidities leading to more severe infections is needed to reduce morbidity and mortality of SARS-CoV-2.

Table of Contents

Table of Contents



Risk Factors for Severe COVID-19 Infections 5

Disproportionate Risk of COVID-19 Infections and Severe Outcomes among Minority Groups 7

Influence of School Closures on Child Health and Well-Being 10


Abstract 16

Introduction 17

Materials and Methods 18

Results 21

Discussion 26

Conclusion 29

Tables and Figures 30

Table 1. Demographic and Epidemiological Characteristics of Test-Positive vesus Test-Negative Children (0-18 years) in CHOA System 30

Table 2: Demographic and Epidemiological Characteristics of CHOA COVID-19 Patients Based on General Hospital Admission Status 32

Table 3: Demographic and Epidemiological Characteristics of CHOA COVID-19 Patients based on ICU/PICU Admission vs General Hospital Admission 33

Table 4. Demographic and Epidemiological Characteristics of CHOA COVID-10 Patients Based on MIS-c Diagnosis 36

Table 5. Demographic and Epidemiological Characteristics of CHOA COVID-19 Patients Based on Infection Severity Level (Mild, Moderate, Severe) 38

Table 6. Potential Risk Factors for severe COVID-19 infection among CHOA Patients with COVID-19 40

Figure 1. Assessing Potential Characteristics Associated with a Positive COVID-19 Test Result among Children Tested at CHOA 41

Figure 2. Potential Risk Factors Associated with Hospitalization among Pediatric Patients at CHOA 42

Figure 3: Potential Risk Factors Associated with ICU Admission versus General Hospital Admission among COVID-19 Pediatric Patients at CHOA 42


Abstract 45

Introduction 45

Methods 46

Results 47

Discussion 49

Tables and Figures 51

Table 1. Household Characteristics During Infection Duration and Secondary Infection Rate 51



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