How do COVID children deaths compare to flu children deaths?

Over the last year, COVID-19 killed more than twice as many young children as influenza did on average during the previous four years pre-COVID.

COVID killed 117 children aged 1-4 in the US over the July 2021 – June 2022 period, whereas influenza killed an average of 57 children aged 0-4 in the US per year over the period 2015–2019.

One might wonder, though, are COVID deaths overcounted? In other words, do they represent deaths with COVID rather than for COVID?

First of all, this question should also be asked about flu deaths. How many of the 57 children dying on average in 2015-19 died with the flu rather than for the flu? 41% of children flu hospitalizations below 1 year old had comorbidities¹ and 49% of children below 16 years old², compared to 30% in COVID hospitalizations below 4 years old³. This suggests that, if anything, accounting for comorbidities would make the ratio (COVID deaths attributed to COVID only / flu deaths attributed to flu only) higher, not lower.

Another data point is that, according to the CDC, 85% of children’s hospitalizations (0-4 years old) were primarily for COVID⁴. If we use the 85% coefficient, the 117 children deaths last year become 99 deaths, still almost double (1.75x) the average flu deaths (and note that flu deaths are in age 0-4 whereas COVID deaths are in age 1-4 – we should add to the COVID tally the unknown number of deaths in age 0-1). But again, one wonders how many flu hospitalizations were due primarily to the flu.

That said, there is a way to answer the question of under/over counting: excess deaths regardless of cause.

Euromomo data⁵ shows that many more children died in 2021-22 than in previous winters (table below). And that’s with the flu having almost disappeared. This suggests that the impact of COVID on children deaths last winter was higher than the impact of influenza on children deaths in the pre-COVID period.

A final consideration: the impact of COVID on children has been contained thanks to the many mitigation measures adopted in 2020-22 (lockdowns, masks, testing, isolation, etc. – in children and/or in the adults that could infect them). Imagine how much higher would have been COVID’s death toll in children had these mitigations not been in place! Hence, the 2x danger ratio mentioned in the first line of this article probably under-estimates how much more dangerous COVID is compared to the flu.

1. https://onlinelibrary.wiley.com/doi/epdf/10.1111/irv.12939

2. https://academic.oup.com/ofid/article/6/Supplement_2/S918/5605711

Note: I had to provide two data points for <1yo and <16yo because I couldn’t find data for flu hospitalizations with comorbidities in the 0-4 age group, in order to match the age group used for COVID. That said, as the first data point (<1yo) is 41% and the second one (<16yo) is 49%, it’s plausible to assume that the rate for 0-4yo is around 40%-50%, still higher than COVID’s 30%.

3. https://www.tandfonline.com/doi/full/10.1080/13696998.2022.2046401

4. https://www.cdc.gov/mmwr/volumes/71/wr/mm7111e2.htm

5. https://www.euromomo.eu/graphs-and-maps