Why coronavirus stalks children of colour

One of the notable features of the new coronavirus, evident early in the pandemic, was that it largely spared children. Some become severely ill, but deaths have been few, compared with adults.

But people of colour have been disproportionately affected by Covid-19, the illness caused by the coronavirus, and recent studies have renewed concern about the susceptibility of children in these communities.

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They are infected at higher rates than white children and hospitalized at rates five to eight times that of white children. Children of colour make up the overwhelming majority of those who develop a life-threatening complication called a multisystem inflammatory syndrome or MIS-C.

Of more than 180,000 Americans who have died of Covid-19, fewer than 100 are children, according to the Centers for Disease Control and Prevention. But children of colour comprise the majority of those who have died of Covid-19.

The deaths include 41 Hispanic children, 24 Black children, 19 white children, three Asian American children, three American Indian/Alaska Native children and two multiracial children.

The unique vulnerabilities of these youngsters are coming to light even as the number of infections in children is rising and schools and parents around the country are grappling with nettlesome decisions about reopening safely.

The susceptibility of minority children to the disease is not unique to the United States. Black children hospitalized in the United Kingdom were more likely than whites to be transferred to critical care and to develop MIS-C, according to a study published last week in the journal BMJ.

“Children don’t exist in a vacuum,” said Dr Monika K. Goyal, a pediatric emergency medicine specialist at Children’s National Hospital in Washington.

Among 1,000 children tested for Covid-19 at a site in Washington in March and April, nearly half of the Hispanic children and nearly one-third of the Black children were positive for the coronavirus, Goyal found in a recent study.

“They live in homes where their parent or caregiver doesn’t have the luxury of telecommuting, so they are at increased risk of exposure,” she added. “They are also more likely to live in multigenerational households. It’s all connected.”

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Poverty also is linked to a higher risk of infection, and Goyal’s research, published Tuesday in the journal Pediatrics, found that children from low-income families were much more likely to become infected than those with the most affluent parents.

The higher infection rates appear to be driven by greater exposure to the virus, Goyal said: “There’s nothing to indicate that there’s some sort of genetic predisposition to Covid-19 based on race or ethnicity.”

Dr Yvonne Maldonado, a professor of paediatrics at Stanford, agreed.

“I know exactly what’s happening to those kids,” she said. “Their parents are front-line, blue-collar or essential workers.”

Maldonado said she had frequently treated adult patients with the coronavirus who said their partners or children were sick, as well.

Researchers at Harvard have documented higher infection rates in Massachusetts communities with high proportions of immigrants, high numbers of food service workers and high numbers of people living in large, shared households.

Immigrants may hesitate to seek medical care, and employees who work in the foodservice industry often lack adequate paid sick leave, said Jose Figueroa, assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health.

“What you have is the perfect recipe for fast transmission of Covid-19 in the Latino community,” he said. “Working adults who keep going to work because they need to put food on the table and pay the rent, and who often have young children.”

While restaurant patrons worry about the distances between tables and wonder whether to dine outdoors, “someone is preparing the food in the back, and they don’t have the luxury of being outdoors,” Figueroa said. “They’re in small kitchens cooking the food, and even if they’re wearing masks, they’re often in small, confined spaces.”

The true number of children who have been infected with the coronavirus may not be known, as young children tend to have milder courses of the disease and have never been routinely tested in the United States.

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A mother in the Bronx, who asked to be identified only as Darlene to protect her child’s privacy, said her son was sick for months during the spring peak of the coronavirus outbreak in New York City. But health providers in the Bronx deflected her repeated requests to have the 3-year-old tested in March and through much of April, because he did not have a fever and was not having difficulty breathing, she said.

When she managed to get him tested in April, the result was negative. But her son was lethargic, complained of a stomach ache, had persistent diarrhea and often woke up wailing in the middle of the night.

Ordinarily an active and playful toddler, he had difficulty walking and fell a number of times, Darlene said: “I knew something was wrong — this was not my baby.”

Finally, in June, as his symptoms were resolving, Darlene was able to take him to his regular doctor at Mount Sinai Hospital in Manhattan, who tested him for antibodies to the virus. The result was positive, indicating he had indeed been infected. (Other family members tested negative for antibodies).

Goyal’s study reported that Hispanic children were six times more likely to test positive for the coronavirus than white children who came to the testing site in Washington. Black children were twice as likely to test positive as white children.

Two other reports by the CDC last month underscored the heightened risk of poor outcomes for children of colour.

Hispanic children were at greatest risk of severe disease. They were hospitalized at a rate nearly eight times that of white children, according to the CDC. Black children were hospitalized at a rate five times that of white children.

The CDC study, which looked at 576 children younger than 18 who had been hospitalized in 14 states between March 1 and July 25, found that nearly half had at least one underlying health condition. The most common was obesity, followed by chronic lung disease and premature birth.

Among the hospitalized children whose race and ethnicity was known, nearly half were Hispanic and 29% were Black. Hispanic and Black children also had higher rates of underlying health conditions: 45% and 29%, respectively. Among white children, 15% had underlying health problems.

Another CDC paper looked at 570 children with MIS-C in 40 states, the District of Columbia and New York City, between March 2 and July 18. Of those whose race was known, only 13% were white, 40% were Hispanic and 33% were Black.

Just under 3% were Asian, and about 10% were listed as “other” or multiracial. Fewer than 1% of the children were American Indian/Alaskan Native or Native Hawaiian/Pacific Islander.

Two-thirds of the children had no preexisting medical conditions before the onset of MIS-C, although the proportion of those who were obese was slightly higher than in the general population. The most common symptoms were abdominal pain, vomiting, a skin rash and diarrhoea.

While children overall have been less severely affected by the disease, there was a 21% increase in confirmed infections among children between the second and third weeks of August, according to the American Academy of Pediatrics.