Intended for healthcare professionals

Letters Risks to children during covid-19 pandemic

Risks to children during the covid-19 pandemic: some essential epidemiology

BMJ 2020; 369 doi: (Published 10 June 2020) Cite this as: BMJ 2020;369:m2290
  1. Sunil S Bhopal, NIHR academic clinical lecturer in population health paediatrics1,
  2. Jayshree Bagaria, independent public health practitioner1,
  3. Raj Bhopal, emeritus professor of public health2
  1. 1Newcastle University, Newcastle upon Tyne NE1 7RU, UK
  2. 2Usher Institute, University of Edinburgh, Edinburgh, UK
  1. sunil.bhopal{at}

Difficult and varying decisions are being made worldwide about ways to protect children from covid-19. Green warns of the dangers of scarring a generation through curtailment of child protection systems during the pandemic.1

Given multiple unknowns, we think that caution from parents and carers is natural, not least because the rare inflammatory syndrome reported in recent weeks remains under investigation.2 But caution in the form of shielding is not risk-free, and children cannot be kept at home if they are to thrive.

To help decision making we have compiled information for parents, teachers, clinicians, and policy makers grappling with this quandary. We examined mortality data for 0-19 year olds, showing that across France, Germany, Italy, Korea, Spain, the United Kingdom, and the United States there were 44 deaths from covid-19 in 0-19 year olds (total population 135 691 226) up to 19 May 2020.34 Over a normal three month period, in these countries, published Global Burden of Disease data estimate that more than 13 000 deaths would be expected from all causes in this age group, including over 1000 from unintentional injury and 308 from lower respiratory tract infection including influenza.5 Covid-19, by this estimate, was responsible for about 0.333% of deaths of 0-19 year olds. Results were similar for each country. We are regularly updating a data table including deaths by age categories and country, and we welcome feedback (; this table and fuller details also in press6).

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


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