While early evidence and experience with coronavirus disease 2019 (COVID-19) suggests that children are less susceptible to infection and have a lower risk for symptomatic and severe disease, pediatric patients are not immune from the virus. We examined pediatric COVID-19 hospitalization trends in 22 states for indications of both severity among this population and spread of the virus.

Methods

Using data extracted from the University of Minnesota COVID-19 Hospitalization Tracking Project,¹ we identified the 22 states that reported cumulative COVID-19 hospitalizations overall and for patients 19 years and younger (in some states younger than 17 or 14 years) between May 15, 2020, and November 15, 2020. The University of Minnesota institutional review board reviewed the study data and determined that it was not human subject research. We combined state-level hospitalization data with population estimates from the US Census.² Cumulative pediatric COVID-19 hospitalizations per 100 000 children were calculated at regular time intervals, and growth rates were calculated on the changes in per capita hospitalizations. Cross-sectional analyses done include tabulations by state over time.

Results

There were a total of 301 102 COVID-19 hospitalizations and 5364 pediatric COVID-19 hospitalizations in 22 states during the study period (Table). At the beginning of the study, the average cumulative hospitalization rate per 100 000 children was 2.0, increasing to 17.2 by the end of the study. There were large variations across states at the beginning and end of the study and in the extent of change in rates. For example, at the start of the study, Hawaii and Rhode Island had the lowest pediatric hospitalization rates at 0.0 per 100 000 children, whereas New Jersey and Colorado had the highest at 5.0 and 4.4 per 100 000 children. At the end of the study, Hawaii and New Hampshire had the lowest rates at 4.3 and 3.4 per 100 000 respectively and South Dakota and Arizona had the highest rates at 33.7 and 32.8 per 100 000. There was also significant variance between states in the magnitude of change from the beginning to the end of the study period, with rates in Hawaii and New Hampshire increasing by 4.3 and 1.0 per 100 000 compared with much larger growth in the rates in Arizona and South Dakota (32.0 and 31.2 per 100 000 respectively). Several states saw significant growth in 3 months, with Utah experiencing a 5067% increase from 0.3 hospitalizations to 15.5 per 100 000 at the high end, compared with 42% increase from 2.4 to 3.4 per 100 000 in New Hampshire. The Figure shows the percentage of cumulative COVID-19–related hospitalizations attributable to pediatric patients during the study period for each state.