Living with kids ups risk of COVID-19 infection, hospital admission during wave 2

There appears to be a higher risk of reported SARS-CoV-2 infection and COVID-19 outcomes among adults living with children during the second wave as opposed to the first wave of the pandemic, according to a study in England.

This evidence, however, does not equate to a substantially increased risk of COVID-19 deaths. In addition, the absolute increases in risk are small.

“These increased risks during wave 2 were observed at a time when schools remained open, raising the possibility that widespread school attendance may have led to increased risks to households, but other differences between households with and without children could also have explained these observational findings,” the researchers said.

This population-based cohort study used primary care data and pseudonymously linked hospital and intensive care admission and death records from England during wave 1 (1 February to 31 August 2020) and wave 2 (1 September to 18 December 2020). Participants included two cohorts of adults (aged ≥18 years) registered at a general practice on 1 February and 1 September 2020.

During wave 1, living with children did not correlate with significantly increased risks of recorded SARS-CoV-2 infection, COVID-19-related hospital or intensive care admission, or death among 9,334,392 adults aged ≤65 years. [BMJ 2021;372:n628]

In wave 2, on the other hand, living with children of any age correlated with a higher risk of recorded SARS-CoV-2 infection (for children aged 0–11 years: hazard ratio [HR], 1.06, 95 percent confidence interval [CI], 1.05–1.08; for children aged 12–18: HR, 1.22, 95 percent CI, 1.20–1.24) and COVID-19-related hospital admission (for children aged 0–11 years: HR, 1.18, 95 percent CI, 1.06–1.31; for children aged 12–18 years: HR, 1.26, 95 percent CI, 1.12–1.40).

In both waves, living with children aged 0–11 years correlated with a reduced risk of death from both COVID-19 and non-COVID-19 cases, while living with kids of any age correlated with a lower risk of dying from non-COVID-19 causes.

During wave 2, adults living with children aged 0–11 years were at an increased absolute risk of having SARS-CoV-2 infection (40–60 per 10,000 people, from 810 to between 850 and 870) and of being admitted to a hospital (1–5 per 10,000 people, from 160 to between 161 and 165). Moreover, living with children aged 12–18 years correlated with an increase of 160–190 per 10,000 in the number of SARS-CoV-2 infections and of 2–6 per 10,000 in hospital admission.

“Our finding of an increased risk to adults who live with children beyond SARS-CoV-2 transmission within schools during wave 2 may have been partly driven by indirect effects—for example, school opening may have allowed parents to travel to work outside the home, increasing potential contacts,” the researchers said.

“Potential differences also exist in the behaviours of households with children that also lead to increased social contacts, such as the need for childcare, greater likelihood of play and activity outside of schools, and more frequent shopping,” they added.

In addition, policy decisions around schools should consider the potential harms linked to school closures, including adverse mental health consequences and worsening inequalities. [Lancet Child Adolesc Health 2020;4:421; https://en.unesco.org/covid19/educationresponse/consequences; https://www.gov.uk/government/publications/spi-bdfe-covid-19-benefits-of-remaining-in-education-evidence-and-considerations-4-november-2020]

“Close monitoring and evaluation as schools reopen will be crucial to inform ongoing policy,” the researchers said.