Coronavirus: Brazil and Children's Deaths

For the longest time, I have heard that COVID-19 rarely results in the death of a child. Yet, I keep hearing stories about childing dying from COVID-19. For awhile, I'd read about random unfortunate deaths happening in Florida where as of August 2020 the total was 8 children. Fast forward from that date in August to now and health experts are still saying that deaths are rare and it is okay to open schools. 

The BBC (Apr 14) recently had this article up about Brazil and children dying from COVID-19, which seems to me to contradict that narrative:

Between February 2020 and 15 March 2021, Covid-19 killed at least 852 of Brazil's children up to the age of nine, including 518 babies under one year old, according to figures from the Brazilian Ministry of Health. But Dr Marinho estimates that more than twice this number of children died of Covid. A serious problem of underreporting due to lack of Covid testing is bringing the numbers down, she says.

Dr Marinho calculated the excess of deaths by unspecified acute respiratory syndrome during the pandemic, and found that there were 10 times more deaths by unexplained respiratory syndrome than in previous years. By adding these numbers, she estimates that the virus in fact killed 2,060 children under nine years old, including 1,302 babies.

The 2,060 children is just an estimate, but it doesn't seem like a crazy estimate as the official number is 852. If this was the United States, this would equal to 3,205 when adjusted for population. Is that really considered rare?

The CDC has this to say about children dying from the flu:

While any death in a child from a vaccine preventable illness is a tragedy, the number of pediatric flu deaths reported to CDC each season is likely an undercount. For example, even though the reported number of deaths during the 2017-2018 flu season was 188, CDC estimates the actual number was closer to 600. It is likely the actual number of children who died from flu during the 2019-2020 season is higher as well.

If the United States is used as a baseline, that would seem to imply that deaths from COVID-19 versus the flu is at least 5x more deadly in the Brazil (600 estimated flu deaths in the United States versus a population adjusted estimate of 3,205 COVID-19 deaths in Brazil). I would think that 10x might be a more realistic estimate. 

Why would I think 10x? The problem with comparing the CDC data to the BBC data is that there is a different criteria for the definition of children. The CDC states that children are defined as those up to the age of 17. In the BBC article, the definition is children up to the age of 9. 

What's the situation in the United States? Per the American Academy of Pediatrics (Apr 8), the official number is that 292 children have died from COVID-19 (number is derived from individual state data). Now, of course, that number is probably somewhat under-estimated. As a note, similar to the CDC and Brazilian age definitions, the states also have definition differences where ages range from anywhere between 0 - 14 and 0 - 20.  

Let's just use the official numbers. The United States has 292 deaths due to COVID-19 (different age ranges) while Brazil is at 852 (up to age 9). Maybe we can say children dying from COVID-19 in the United States is rare, but that just doesn't feel right to describe what is going on in Brazil. The BBC comes up with a number of potential reasons for this:

1. The number of cases in Brazil (but let's be honest that the United States has the most official cases and our official numbers are far lower).

2. An overwhelmed health care system.

3. The P.1 variant.

4. Lack of testing for children, resulting in COVID-19 cases turning more serious.

5. Poverty.

I think the point to keep an eye on is #3, the P.1 variant. Does this variant hit children harder than previous variants?