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Covid-19: Minorities account for 78% of US deaths in under 21s, says CDC

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3681 (Published 18 September 2020) Cite this as: BMJ 2020;370:m3681
  1. Owen Dyer
  1. Montreal, Canada

The first US government review of covid-19 deaths in people aged under 211 has found that, of 121 such fatalities reported to the Centers for Disease Control and Prevention (CDC) before 31 July, 94 (78%) involved people belonging to minority groups.

Some 45% percent of deaths in those under 21 involved Hispanic people, while 29% involved non-Hispanic Black people, and 4% were American Indian or Alaska Native people. Together, these groups account for 41% of the US population aged under 21, but 78% of reported covid-19 deaths in that age group.

Males accounted for 63% of reported deaths in this age group. Some 10% of the deaths occurred in infants under 12 months, a further 20% in children aged 1 to 9, and 70% in those aged 10 to 20. Risk was highest after age 18, while the median age at death was 16.

A quarter of the reported deaths involved previously healthy people, while 75% had underlying conditions, of which the most common were chronic lung disease including asthma (28%), obesity (27%), neurologic and developmental conditions (22%), and cardiovascular conditions (18%).

Some 13% of reported deaths in under 21s occurred at home, and 19% in the emergency department. Of the 65% who died in hospital, among those whose infection date was known, median time to symptom onset was three days but varied widely (interquartile range 1-7 days), and median time to death was 11 days (IQR 4-21.5 days).

Although the report relies on data from all 50 states, three US territories, and the District of Columbia, it may not be a full accounting of covid-19 deaths in this age group before 31 July, the authors suggest, pointing to incomplete testing. Case fatality rates cannot be reliably calculated, they write.

The average age of infected people in the US has fallen steadily since April, and infections in the young are expected to spike as schools reopen.

“Disparities in social determinants of health, such as crowded living conditions, food and housing insecurity, wealth and educational gaps, and racial discrimination, likely contribute to racial and ethnic disparities in covid-19 incidence and outcomes,” the authors argue, pointing also to higher rates of essential work exposing family members, and to “difficulty and delays in accessing healthcare services because of lack of insurance, child care, transportation, or paid sick leave.”

The report appears in the CDC’s Morbidity and Mortality Weekly Report a publication that has been at the centre of a political firestorm this week. The website Politico published emails showing Trump political appointees at the health department’s public affairs office demanding that the CDC director Robert Redfield make changes to MMWR’s content, which they claimed was designed to “hurt” Trump’s election prospects.2

The political appointees were forced out of their posts on 16 September, in an apparent victory for the CDC’s independence.

Asked if the latest report had been altered in any way by political appointees, CDC spokesman Tom Skinner said, “This report underwent the routine scientific review process that all MMWR articles go through.”

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