The level of COVID-19 among children reflects cases in the community, not whether schools were open

COVID-19 case rates among children track much more consistently with overall case rates in a state than with trends in in-person learning in K-12 schools, according to a CNN analysis of state-level data.

The five states with the least COVID-19 cases per 100,000 residents are also the five states with the lowest case rates among children: Hawaii, Vermont, Maine, Oregon and Washington. Similarly, four of the five states with the most COVID-19 cases per 100,000 residents are also those with the highest case rates among children: North Dakota, Tennessee, South Dakota and Rhode Island.

Utah was the exception. However, while most states report cases among children through age 17 or 18, Utah only reports up to age 14. Florida is the only other state to cap this age group at 14.

This distinction is important, as some research has found that COVID-19 may spread more easily in high school settings than elementary school settings. In new federal guidelines for school reopening, released last week by the US Centers for Disease Control and Prevention, recommendations for high schools are distinctly more restrictive than those for middle and elementary schools.

In comparing among methods of school instruction, COVID-19 case rates among children varied much more.

In both Iowa and Wyoming, all students have the option to return to traditional in-person learning, according to Burbio’s K-12 School Opening Tracker. But COVID-19 case rates among children in Iowa are about 22% lower than in Wyoming. Meanwhile, Maryland and New Mexico have the least in-person offerings, according to the tracker, and Maryland’s case rate among children is about 40% less than New Mexico’s.

The new CDC school reopening guidelines recommend learning modes based on thresholds that reflect measures of community transmission — new cases reported per 100,000 people and test positivity rate in the past seven days — not just among children.

The CDC guidelines also emphasize mitigation strategies that should be “strictly implemented,” including physical distancing, correct and universal masking, and maintaining clean, healthy facilities.

The CDC has also said COVID-19 cases are likely underestimated among young people, and most pediatric infections may be asymptomatic.

The CNN analysis used the latest report from the American Academy of Pediatrics to assess COVID-19 case rates among children. Data for Texas and New York were not available. Data for overall case rates are from Johns Hopkins University.