Study Finds Significant Racial, Socioeconomic Disparities In COVID-19 Among Children

A new study of children tested for COVID-19 in D.C. revealed significant racial and socioeconomic disparities, both in test positivity rates and known exposure to the virus. The study is published in the journal Pediatrics.

Results from a testing site run by Children's National Hospital showed Black children were more than four times as likely as white children to test positive for the virus, and Hispanic children were more than six times as likely as white children to test positive. Nonwhite children were also more likely to have known exposure to the virus.

The study looked at the first 1,000 children and young adults tested at a drive-through and walk-up testing site on Trinity Washington University's campus in March and April. (The site is no longer offering tests.) Children traveled from D.C., Maryland and Virginia to get tested at the site.

The patients were all 22 years old or younger and were referred to the testing site by physicians. All had reported mild symptoms and had either known exposure to the virus, high risk status or a family member with a high risk status, or a requirement to be tested for work. The tests were performed earlier into the pandemic, when the criteria for getting a test was stricter.

Dr. Monika Goyal, the study's lead author and a pediatric emergency medicine specialist at Children's National, said the goal of her research "was to assess whether or not the racial, ethnic and socioeconomic-related differences or disparities that we've been seeing in adults have extended to children as well."

Disparities Persist, Regardless Of Age

The disparities among adults in the D.C. region have been dramatic. White people account for 20% of reported positive cases of COVID-19 in D.C., but they represent about 46% of the city's population. Black residents, who represent 46% of the city's population, account for 50% of those who have tested positive, and 74% of those who have died.

Per capita, Latinos experience the highest infection rates in the city: About 11% of D.C.'s population is Latino, but 26% of the people who have tested positive for COVID-19 identified as Hispanic or Latino.

Patterns of racism and discrimination mean that Black and Latino people in the District have been more likely to be exposed to the virus through work, and less likely to have access to high-quality health care and the resources to maintain their health in the first place. As APM Reports recently noted, D.C. officials were also slow to get testing facilities up and accessible for people living in the almost-exclusively Black neighborhoods east of the Anacostia River.

At least 864 people who have tested positive for COVID-19 in D.C. are 19 years old or younger; These age groups represent 8% of all those who have tested positive. And the research from Children's National confirms that racial disparities do, in fact, transfer over to the child and young adult population. White children tested positive 7% of the time. But Black and Hispanic children tested positive at much higher rates: 30%, and 46%, respectively. The children who went to the site were not just from D.C., some families traveled from Maryland and Virginia to receive tests.

"Although it was beyond the scope of this study to understand the causes for these differential rates of infection, the causes may be multifactorial, and include, but are not limited to structural factors, poorer access to health care, limited resources, as well as bias and discrimination," the study authors wrote.

Children who lived in households with lower incomes also tested positive at higher rates than wealthier children, though the study says the racial and ethnic disparities in infection rates "only slightly attenuated after adjustment for socioeconomic status."

Goyal says that moving forward, the team is working to understand the root causes of the disparities and "develop interventions to help try to mitigate those."

Public health experts consider the test positivity rate to be a helpful measure for gauging whether enough tests are being administered. A high test positivity rate means that the health care system is likely undercounting people with mild symptoms — and doctors are mostly testing people who are likely to be infected. Overall, the first 1,000 young people at the Children's National site tested positive 20% of the time, a figure that experts consider to be high.

"I think access to testing was a huge issue early in the pandemic, and it continues to be an issue," says Goyal, the study lead author. Though testing has become more accessible in D.C., a lab backlog has led to significant delays for test results in recent weeks. "As the pandemic unfolds, I really, truly believe that we need to continue to consider increasing access to testing."

The authors also wrote that their findings may even be an underestimate of the racial and ethnic disparities, since getting tested at the Children's National site required a physician referral and the site may have not been equally accessible to all city residents.

"Racial/ethnic and socioeconomically disadvantaged groups have less access to primary care physicians," they wrote. "In addition, referral to the testing site by clinicians may have been differentially provided, and advertisement of the testing site may not have been uniformly distributed among all potential referring clinicians. Furthermore, the testing site was available a few days per week and during the hours of 10 a.m. and 2 p.m. which may not have been convenient for all."

The data from Children's National showed that families of Black and Hispanic children were more likely to know they had been exposed to the virus. Of the 106 children who had known exposure to the virus, white children made up 11%. Black children made up 35% of those with known exposure, and children of other racial or ethnic groups made up 20% of those who knew about exposure to the virus. Children who came from families with lower incomes also reported higher rates of known exposure.

As a possible explanation for the particularly high rates of infection among Hispanic children, the study cited previous research that found that Hispanic people were more likely to live in apartment buildings, live in multigenerational households, depend on public transportation and work outside of their homes than other ethnic groups — all factors that heighten the risk of contracting COVID-19 or spreading it to family members.

"Another explanation for the disproportionately higher rates of SARS-CoV-2 [COVID-19] infection among minority youth may be due to prior experiences of bias and discrimination, which can lead to distrust of the healthcare system and delays in seeking care, and thus, spread of infection to household members," the authors wrote.

'Children Are Indeed At Risk'

Goyal says the high positivity rate among young people is also part of a growing body of evidence debunking the notion that children are less likely to contract the virus.

"For a good amount of the early part of the pandemic, I think many of us felt that children were relatively spared from COVID," Goyal says. "Our data, along with some of the other recent data that are emerging, absolutely show that children are indeed at risk for infection."

A recent study from the Children's Hospital of Chicago found that children infected with the coronavirus are carrying at least as much of the virus in their noses and throats as adults, though its findings did not prove anything about children's capacity to spread the virus to others.

Knowledge about children and virus transmission is of particular interest, as local school systems are making decisions about whether, when and how to reopen.

"This study wasn't designed to assess the impact of policies regarding school reopening, but we hope that policymakers who are going to be making those decisions do take our data into account," said Goyal.