Does COVID-19 Affect the Health of Children and Young People More Than We Thought?

Contrary to the current narrative, the risks of COVID-19 (coronavirus) disease in children and young people depend largely on where individuals live and how vulnerable they are to disease and ill health. It is commonly accepted, at least for now, that children and young people under 20 years of age have largely been spared the direct epidemiological effects on their own health and survival of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for COVID-19 disease. This narrative is based predominantly on early data from the countries first affected by the virus, notably China (Wuhan province) and Italy in early 2020, and also from other high-income countries (HICs) including the United States and some European nations. This narrative has conditioned the subsequent screening and testing for SARS-CoV-2 virus in children and young people under 20, which have been notably lower than for other age cohorts in many, but not all, countries. But demographic profiles differ widely between countries, and assumptions and narratives based on evidence taken from ageing societies, typical of HICs, may not hold for more youthful and growing populations, as illustrated by the contrast between the age-cohort profiles of COVID-19 cases for Italy and Kenya. For this reason, and given that the vast majority of the world’s children and young people live in low- and middle-income countries (LMICs) and territories, we began to investigate the burden of COVID-19 cases among children and young people under 20 globally.