COVID-19 Hospitalization Data From 14 States: 1 in 3 Youths Admitted to ICU

Pediatric hospitalization, child in hospital bed
Pediatric hospitalization, child in hospital bed
Investigators analyzed hospitalization data of children in 14 states and found that — although COVID-19–associated hospitalization among children is low compared with that of adults — 1 in 3 hospitalized children was admitted to an ICU.

Although hospitalization rates related to coronavirus disease 2019 (COVID-19) among children is low compared with that among adults, 1 in 3 children were admitted to the ICU, similar to the proportion among adults, according to study results published in the Morbidity and Mortality Weekly Report.

Researchers analyzed data from the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system in 14 states, to characterize the morbidity and mortality of COVID-19 in children.

Between March 1 and July 25, 576 pediatric COVID-19 cases were reported to COVID-NET. The median patient age was 8 years (interquartile range, 9 months-15 years), and 292 (50.7%) were boys. Of the 526 children for whom race and ethnicity information were reported, 45.8% were Hispanic, 29.7% were Black, and 14.1% were White.

During the surveillance period, the cumulative COVID-19–associated hospitalization rate was 8/100,000 and was highest among children age <2 years (24.8%); rates were substantially lower in children aged 2 to 4 years (4.2%) and 5 to 17 years (6.4%). Weekly hospitalization rates among children increased steadily during the surveillance period (0.1-0.4/100,000, with a weekly high of 0.7/100,000). In addition, COVID-19–associated hospitalization rates were higher among Hispanic and Black children (16.4/100,000 and 10.5/100,000, respectively) than among White children (2.1/100,000).

Among 222 (38.5%) of 576 children with information on underlying medical conditions, 94 (42.3%) had one or more underlying conditions, with obesity being the most prevalent condition (37.8%). As childhood obesity is more prevalent in Black and Hispanic children, “understanding the underlying pathophysiologic association between obesity and [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is important to identifying possible clinical interventions and preventive strategies to reduce the risk for hospitalization,” noted the researchers.

Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an ICU, similar to the proportion among adults; however, case-fatality rate remained low, even among children hospitalized with more severe COVID-19–associated complications, such as multisystem inflammatory syndrome in children (MIS-C).

Limitations of the study included a biased sample, as approximately 60% of pediatric hospitalizations reported to COVID-NET have not had a chart review. In addition, COVID-NET did not systematically collect information on MIS-C until June 18.

“Ongoing monitoring of hospitalization rates, clinical characteristics, ICU admission, and outcomes in the pediatric population is important to further characterize the morbidity and mortality of COVID-19 in children,” concluded the researchers.

Disclosure: Evan J. Anderson, MD, and William Schaffner, MD, declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of their disclosures.


Kim L, Whitaker M, O’Halloran A, et al; COVID-NET Surveillance Team. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19 — COVID-NET, 14 states, March 1–July 25, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1081-1088.