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Clinical Context

Black communities have been disproportionately affected by the COVID-19 pandemic, and the epidemiology of COVID-19 was stacked against Black people from the outset of 2020. The current review highlights this issue, with a focus on children and adolescents. Overall, children have accounted for 18% of all cases of COVID-19 in the US, and each new variant has been associated with a higher proportion of cases among children. At the peak of the Omicron variant wave, 30% of cases of COVID-19 were among children, although children represent just 22% of the US population.

The prevalence of COVID-19 appears similar among Black and White children, although lower rates of COVID-19 testing likely mask a higher rate of infection among Black children. Still, there is no doubt that COVID-19 has carried a higher rate of consequences among Black children. The current report enumerates these consequences and also describes some of the root causes of these disparities.

Study Synopsis and Perspective

Black children had almost 3 times as many COVID-related deaths as White children, and about twice as many hospitalizations, according to a new report commissioned by the Black Coalition Against COVID.^[1]

The report said that 1,556 children had died from the start of the pandemic until November 30, 2022, with 593 of those children being under 4. Black children died of COVID-related causes 2.7 times more often than White children and were hospitalized 2.2 times more often than White children, the report said.

Lower vaccination rates for the Black populations may be a factor. The report said that 43.6% of White children had received 2 or more vaccinations compared with 40.2% of Black children.

“First and foremost, this study repudiates the misunderstanding that COVID-19 has not been of consequence to children, who have had more than 15.5 million reported cases, representing 18 percent of all cases in the United States,” Reed Tuckson, MD, a member of the Black Coalition Against COVID board of directors and former Washington, DC, public health commissioner, said in a news release. 

“And second, our research shows that like their adult counterparts, Black and other children of color have shouldered more of the burden of COVID-19 than the white population.”

The study was conducted by the Satcher Health Leadership Institute of the Morehouse School of Medicine, Atlanta, Georgia. It is based on studies conducted by other agencies conducted over the course of 2 years.

Black and Hispanic children also had more severe COVID-19 cases, the report said. Among 281 pediatric patients in New York, New Jersey, and Connecticut, 23.3% of severe cases were Black and 51% of severe cases were Hispanic. 

The report also notes that 1 in 310 Black children lost a parent or caregiver to COVID-19 between April 2020 and June 2012 compared with 1 in 738 White children. 

Economic and health-related hardships were experienced by 31% of Black households, 29% of Latino households, and 16% of White households, the report said.

“Children with COVID-19 in communities of color were sicker, hospitalized and died at higher rates than white children,” Sandra Harris-Hooker, the interim executive director at the Satcher Health Leadership Institute of Morehouse School, said in the release. “We can now fully understand the devastating impact the virus had on communities of color across generations.”

The report recommends several changes, such as modifying eligibility requirements for the Children’s Health Insurance Program to help more children who fall into coverage gaps and expanding the Child Tax Credit.

Clinical Implications

• Overall, children have accounted for 18% of all cases of COVID-19 in the US, and each new variant has been associated with a higher proportion of cases among children. At the peak of the Omicron variant wave, 30% of cases of COVID-19 were among children, although children represent just 22% of the US population. The prevalence of COVID-19 appears similar among Black and White children, although lower rates of COVID-19 testing likely mask a higher rate of infection among Black children.

• Black children in the US experience more than double the rate of hospitalization and mortality related to COVID-19 compared with White children, and 31% of Black households with children have faced economic hardship during the COVID-19 pandemic, which is nearly double the rate in White households with children. The first year of the pandemic was marked by a 29.5% increase in the rate of gun violence among children and adolescents. This increase was most pronounced in Black communities.
• Healthcare team members must be proactive and pay special attention to the interventions needed to protect the health and well-being of Black children and minorities. Special efforts should be urgently undertaken to address the consequences of the COVID-19 pandemic.

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