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Rapid response to:


Risks to children and young people during covid-19 pandemic

BMJ 2020; 369 doi: (Published 28 April 2020) Cite this as: BMJ 2020;369:m1669

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Rapid Response:

Risks to children during the pandemic: some essential epidemiology for parents, clinicians and policymakers

Dear Editor,

Difficult decisions are being made worldwide variably about how best to protect children from the direct and indirect consequences of COVID-19. The different policies of European countries in relation to children returning to school are an example of confusing variability[1].

Peter Green warns of the dangers of scarring a whole generation given our systems of child protection have been severely curtailed during the pandemic[2]. Given multiple unknowns, we think caution from parents and carers is natural, not least because we need to understand the implications of the rare inflammatory syndrome reported in recent weeks[3]. However, caution in the form of shielding is not itself risk free and children cannot be kept at home if we want them to thrive.

To help provide some context for parents, teachers, clinicians and policymakers grappling with this, we examined age-specific mortality data which shows that deaths from COVID-19 fortunately remain infrequent in children and young people[4]. Across the USA, England, Italy, Germany, Spain, France and Korea there were 43 deaths from COVID-19 in 0-19 year olds (total population 135,691,226) in the three months to 12 May 2020 [4–6]. In this period, in these countries, we estimated from published Global Burden of Disease data that we would expect more than 36,000 deaths from all causes in this age group, including over 3,000 from unintentional injury and 891 from lower respiratory tract infection including influenza [7]. COVID-19, by this measure, was responsible for an estimated 0.117% of deaths of 0-19 year old in these three months. Results are similar for each country. We provide a data table including deaths by age-categories, and by country online ( and welcome feedback on this.

Given these data, we think the medical community should be upfront with parents, carers, teachers, clinicians and decision-makers that the direct impact of COVID-19 on children is currently small in comparison with other risks that children confront, and that the main reason we are keeping children at home is to protect adults. This conclusion may change as the pandemic evolves, and the epidemiology of COVID-19 in children should be closely monitored.


1 Connolly K, Willsher K. European schools get ready to reopen despite concern about pupils spreading Covid-19. The Guardian. 2020. (accessed 13 May 2020).
2 Green P. Risks to children and young people during covid-19 pandemic. BMJ 2020;369. doi:10.1136/bmj.m1669
3 Mahase E. Covid-19: concerns grow over inflammatory syndrome emerging in children. BMJ 2020;369. doi:10.1136/bmj.m1710
4 National Institute for Demographic Studies (INED) (distributor). The demography of deaths by COVID-19 (2020) Extract from: (Accessed 13 May 2020).
5 Centers for Disease Control and Prevention: National Center for Health Statistics. Provisional Death Counts for Coronavirus Disease (COVID-19). 2020. (accessed 13 May 2020).
6 NHS England. COVID-19 Daily Deaths. (accessed 13 May 2020).
7 Global Burden of Disease Study 2017 (GBD 2017) Data Resources | GHDx. (accessed 13 May 2020).

Competing interests: No competing interests

16 May 2020
Sunil S Bhopal
NIHR Academic Clinical Lecturer in Population Health Paediatrics
Dr Jayshree Bagaria, Independent Public Health Practitioner; Prof Raj Bhopal, Emeritus Professor of Public Health, Usher Institute, University of Edinburgh
Newcastle University
Newcastle upon Tyne, NE1 7RU