Why are kids being hospitalized from COVID-19 at higher rates in the US than in England?


Children in the United States are much more likely to be hospitalized with COVID-19 than children in England.

American kids under age 18 are being newly admitted to hospitals with the virus at a rate up to four times higher than youngsters in England, according to a DailyMail.com analysis of publicly available data.

This is despite the UK experiencing another wave of infections and having one of the highest seven-day incidence rates of Covid in the world.

Health experts tell DailyMail.com that neither masks nor vaccination rates explain the disparity because face coverings are not required in any schools in England and the U.S. has higher rates of vaccinations among kids.

Instead, they point to more widespread testing in the UK, which has outpaced the U.S., and higher rates of chronic conditions such as obesity, which increases the risk of Covid-related hospitalization. 

From September 30 to October 6, between 0.07 children per 100,000 and 0.19 per 100,000 in England were being admitted to hospitals with Covid. Over the same time period, between 0.29 and 0.33 per 100,000 children in the U.S. were hospitalized due to the virus, up to four times higher

From September 30 to October 6, between 0.07 children per 100,000 and 0.19 per 100,000 in England were being admitted to hospitals with Covid. Over the same time period, between 0.29 and 0.33 per 100,000 children in the U.S. were hospitalized due to the virus, up to four times higher

Doctors say frequent testing among England's schoolchildren may be one of the factors behind the lower rate of pediatric hospitalizations. Pictured: A pupil is tested for COVID-19 in Sheffield, England, September 3

All secondary school students in England, are tested at home twice a week, something not done in the U.S, likely resulting in more cases earlier, preventing hospitalization. Pictured: Jordan Barsous, 4, is swabbed for COVID-19 at Palos Verdes High School in Palos Verdes Estates, California, August 2021

Doctors say frequent testing among England’s schoolchildren may be one of the factors behind the country’s lower pediatric hospitalization rates. All secondary school students in England (left), are tested at home twice a week, something not done in the U.S (right), likely resulting in more cases earlier, preventing hospitalization 

For the analysis, DailyMail.com looked at numbers compiled by the U.S. Centers for Disease Control and Prevention (CDC) and National Health Services (NHS) England.

Between September 30 and October 6, the latest dates for which complete data is available, 0.07 children per 100,000 to 0.19 per 100,000 were being admitted to hospitals with COVID-19.

Comparatively, over the same time period, between 0.29 and 0.33 per 100,000 children in the U.S. were hospitalized due to the virus.

The biggest disparity was seen on October 6 with 4.14 times as many American kids per 100,000 admitted to hospitals compared to English kids.

So what’s behind this gap?

‘There are some things to think about,’ Dr Peter Chin-Hong, an infectious disease specialist who treats adults at the University of California, San Francisco, told DailyMail.com.  

‘The UK doesn’t have mask mandates [for kids] and vaccines for adolescents have not been as available as they are in the U.S.’ 

In early September, millions of children returned to schools in England with face coverings not required in classrooms.

By comparison, in the U.S., the CDC recommends wearing masks indoors for everyone aged two and older, regardless of vaccination status.

Some states have adopted the CDC recommendation while others, such as Florida and Texas, have prohibited mask mandates in schools.

And while masks are a politically divisive issue in the U.S., members of both the Conservative and Labour Parties in the UK have stated that wearing masks prevent children from being able to communicate and socialize.

COVID-19 vaccines don't explain the difference because more kids in the U.S. are vaccinated with 58.5% of 12-to-15-year-olds and 63.7% of 16-to-17-year-olds with at least one dose and 47.6% and 54.9%, respectively, are fully vaccinated

COVID-19 vaccines don’t explain the difference because more kids in the U.S. are vaccinated with 58.5% of 12-to-15-year-olds and 63.7% of 16-to-17-year-olds with at least one dose and 47.6% and 54.9%, respectively, are fully vaccinated

In the UK, 20% of 12-to-15-year-olds and 55% of 16-to-17-year-olds have received at least one dose and 1% and 10%, respectively, are fully vaccinated

In the UK, 20% of 12-to-15-year-olds and 55% of 16-to-17-year-olds have received at least one dose and 1% and 10%, respectively, are fully vaccinated

Vaccinations also doesn’t seem to be behind higher rates of hospitalization in the U.S.

According to the CDC, 58.5 percent of 12-to-15-year-olds and 63.7 percent of 16-to-17-year-olds have received at least one dose and 47.6 percent and 54.9 percent, respectively, are fully vaccinated.

Children between ages five and 11 were just authorized to receive vaccines on Tuesday so the impact of their vaccination rates won’t be seen for several weeks.

Meanwhile, in the UK, vaccines are only authorized for those aged 12 and older.

Of 12-to-15-year-olds, fewer than 20 percent have received at least one dose and fewer than one percent are fully vaccinated, according to the UK Health Security Agency, which replaced Public Health England.

Meanwhile, of 16-to-17-year-olds, about 55 percent have received at least an initial dose and 10 percent are fully vaccinated. 

Dr James Versalovic, COVID-19 Command Co-Leader and Pathologist-in-Chief at Texas Children’s Hospital, in Houston, told DailyMail.com the vaccines also can’t be considered a factor because they are entirely different.

‘Pfizer is dominant in the U.S….and the only vaccine approved for kids…while AstraZeneca is dominant in the UK,’ he said.

‘Not only are they different manufacturers but they’re different types of vaccines.

Pfizer’s vaccine uses messenger RNA, or mRNA, to teach human cells how to make a protein that will trigger an immune response (antibodies) inside our bodies.  

Meanwhile, AstraZeneca’s immunization is known as a viral vector vaccine, which combines genetic material from the new virus with the genes of the adenovirus – a cause of the common cold – to induce an immune response.

Experts say this means there are other factors driving up hospitalization rates in the U.S. including environmental differences.

They say that one of those factors is testing, which is much more widely used in the UK than in the U.S.

Currently the UK’s Department of Education requires all secondary school students, between ages 11 and 18, be tested at home twice a week using rapid lateral flow tests.

The rapid test looks for antigens, proteins found on the surface of the virus, rather than genetic material, and returns results within minutes. 

‘The testing strategy in the UK has not been adopted in the U.S.,’ said Chin-Hong.

‘If you can test lots of kids who are readily available, you can pick out those with a very high viral load who can transmit the virus more easily and keep them home.’

But he says that because there is no regular testing at many U.S. schools, kids are being sent to classrooms instead of being kept at home because tests aren’t detecting these cases.

This can lead to these children being hospitalized themselves or infecting other children who end up hospitalized.

‘The reality is, if you’re testing so many kids that frequently – that we’re not doing in the U.S. – you’re expanding the denominator and detecting a number of kids including asymptomatic and mild cases,’ said Versalovic. 

‘This makes the hospitalization rate look smaller because the denominator is larger.’ 

More than 50% of children hospitalized with COVID-19 have had underlying conditions with the most common being obesity at 35 percent

More than 50% of children hospitalized with COVID-19 have had underlying conditions with the most common being obesity at 35 percent

‘Hospitalization is not the same as infection,’ Chin-Hong added.

‘Yes, the more people get infected the more they go to the hospital, but people go to the hospital when they have comorbid conditions.

‘Kids that don’t have well-controlled disease are going to end up hospitalized.’

For example, according to the NHS, 9.9 percent of four-to-five-year-olds are obese in England.

Comparatively, 13.4 percent among two-to-five-year-olds in the U.S. are obese. CDC data find.

Among pre-teens, the gap is much closer with 21 percent obese in the UK compared  to 21.9 percent in the U.S. 

‘I think there’s no doubt that chronic health conditions are playing a role,’ Dr William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, told DailyMail.com.

‘There were comments [at the CDC advisory committee meeting] that so many of the children being hospitalized [with Covid] today are…chubby.’

Few children have died of COVID-19 both in the U.S. and in England but 1.07 per 100,000 have died in the U.S. since the pandemic began compared to 0.69 per 100,000 in England

Few children have died of COVID-19 both in the U.S. and in England but 1.07 per 100,000 have died in the U.S. since the pandemic began compared to 0.69 per 100,000 in England

In fact, according to the CDC, more than one-third – 35 percent – of all U.S. children who have been hospitalized since the pandemic began have been obese.  

‘It won’t influence the spread of the virus but should a chubby child get infected higher chance they will become more seriously ill and get hospitalized,’ Schaffner said.

This also leads to higher risk of death.

Since the pandemic began, American children have been dying at a higher rate than English children.

The DailyMail.com analysis found that 1.07 per 100,000 children have died in the U.S. since March 2020 compared to 0.69 per 100,000 in the England.

Experts encourage parents to vaccinate their kids – and stress that the more adults get vaccinated and drive down COVID-19 transmission, the more pediatric hospitalizations will fall.  

‘The proportion of any adults in the community who get vaccinated needs to go up and up and we need to continue to use masks and social distancing and other ancillary means wherever kids congregate,’ said Schaffner.

Chin-Hong added: ‘You have to control the amount of virus in the community.

‘If you have these measures that bring transmission down low, that affects kids who live in the community.’

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