COVID Positivity Rates Are Rising In NYC Among Very Young Children And Teens

New data from the Department of Health is showing a growing share of very young children and teenagers are testing positive for COVID-19 compared to earlier in the pandemic, a worrying sign that could have major implications for New York City's in-person schooling initiative.

Compared to other age groups, children aged 4 and under showed the highest weekly positivity rate: 3.2% for the week ending on October 31st, compared to 2.2% for city residents overall. The positivity rate was more than double that of the first week of September, when 1.4% of children under 4 tested positive.

Children ages 13 to 17 had the second highest weekly positivity rate. In early October, the rate among that group soared to 3.9% before declining to 2.6% in the last week of October.

Interestingly, positivity rates for children aged between 5 to 12 also began rising after September, but after peaking at 2.8%, have since declined to 1.5%.

The findings in the city are consistent with national trends, although experts have cautioned that the United States has yet to develop a consistent tracking system for coronavirus cases. However, state data collected by the American Academy of Pediatrics (AAP) has shown case rates as well as hospitalizations and deaths increasing at a faster rate in children and teenagers than those for the overall population.

Since the pandemic began, more than 927,000 children in the U.S. have tested positive for COVID-19, according to the AAP. Nearly 200,000 new cases in children were found in the month of October alone.

The pattern of infections among teenagers is consistent with findings from studies both in South Korea and in the U.S. In September, the Center for Disease Control and Prevention released a report showing teenagers as being twice as likely to become infected with COVID-19 as younger children.

Discerning whether the rise in cases also means that children are getting infected at a higher rate than earlier in the pandemic is difficult. Both on a national and local level, the rise comes amid more widespread and targeted testing of children as schools reopen. Because children tend to be asymptomatic, many cases were likely undiagnosed earlier during the crisis.

Knowing whether more children in New York City were being hospitalized would suggest whether they were also getting infected at a higher rate. But a breakdown of recent hospitalizations by age is not currently available on New York City's heath department website. (The data does show a breakdown by age for cumulative hospitalizations.)

Asked about the case trends among children, a Department of Health spokesperson said that the surge in infections had occurred across every age group and that the sample size of children tested is small relative to adults.

"Children under 18 are tested the least of any age group and so fewer positive results can have a greater influence on the percent of positive tests," the spokesperson said. "That said, the case rate among this age range is not increasing at a higher rate than the citywide average. We're seeing a surge of cases citywide across every age group, and residents should be aware and continue to wear a mask and social distance."

It is also important to note that case rates for children in New York City are relatively low. Overall, less than 5% of total coronavirus cases citywide are those in children. And deaths and severe illness continues to remain rare in young cases.

Dr. Wan Yang, an assistant epidemiology professor at Columbia University who regularly examines the city's coronavirus data, speculated that the rise in cases among children is likely a combination of more testing and an increase in infection rates.

She also stressed that the test positivity rate can be a confusing measure. "It really depends on who is getting tested," she said.

What is clear is that the city has prioritized testing for both staff and students at schools. City health data show that the testing rate for children has increased significantly beginning beginning in September. The testing rate for those between the ages of 13 and 17 rose by nearly 79% between September 26th and October 31st. Roughly 16,000 children in that age group received tests for the week ending on October 31st.

For children aged 5 to 12, the testing rate increased one and a half times in that period, with around 8,000 getting tested.

The increase was smallest for children under 4—only 4% during that same time frame. This group was also tested the least, around 4,000 in week ending on October 31st. Unlike schools, daycares do not have to perform random testing. Children in daycares are also not required to wear masks.

Contact tracing may also influence the testing outcome. Yang said that assuming test and trace teams are flagging students who may have been exposed to the virus, "you would expect the test positivity rate to increase just by the success of tracing those high risk individuals."

Still, the age breakdown of new virus cases, which was unveiled by the Department of Health on Monday, comes at a precipitous moment for the city in its battle against a second wave. Mayor Bill de Blasio has made the reopening of public schools one of his crowning policy achievements during the pandemic. Although the effort was heavily contested by some city officials and teachers, New York City became the first major school district to reopen in late September. On the heels of that precedent, other school districts have been reopening as well.

So far, there have not been any major outbreaks linked to public schools. As of Tuesday, less than .2% of more than 105,000 teachers and students tested have come up positive for COVID-19. About a quarter of a million children are currently attending classes in-person. Many private schools, including Catholic schools and yeshivas, have also resumed in-person classes.

While public school enrollment is lower than what the mayor had hoped, Yang said smaller class sizes as well as the use of cohort models that require children to attend on alternate days enables schools to maintain better social distancing.

But the degree of precaution may become harder to sustain as the number of children in schools now stands to grow. The Department of Education is giving families one last chance to opt-into in-person learning this week, a period that was initially supposed to be once every quarter. Education officials later switched to a final opt-in deadline, saying multiple opt-in windows would have been too disruptive for schools.

On top of that, with each passing day, the citywide average positivity rate is getting closer to 3%, a threshold above which the mayor has said he would order schools to shut down in-person learning and move fully toward remote.

While many perceived the trigger as a safeguard aimed at reassuring parents, public health experts have described the threshold as arbitrary rather than based on epidemiological reasons.

"It was just consensus as opposed to knowing that something drastic happens when you get to 3%," said Dr. Irwin Redlener, the professor of pediatrics and director of the National Center for Disaster Preparedness at Columbia University.

The decision to close schools, he said, has become complicated by the fact that the positivity rate now varies wildly by neighborhood. While the virus is clearly spreading more broadly across the five boroughs, there are still pockets where positivity rates are below 1%. Pointing out the differences in positivity rates and the localized nature of outbreaks, Governor Andrew Cuomo has applied a "micro-cluster" approach, which targets testing and restrictions in small geographically defined parts of the state.

Redlener said that he believed there is a case to be made for keeping schools open in neighborhoods with low positivity rates, although he acknowledged that it would be difficult because staff and teachers often commute from all parts of the city.

"I don’t envy the mayor or governor in this situation," he said. "Anything you do can be criticized. There's just not enough information."

Dr. Denis Nash, an epidemiologist at CUNY, argued that having good surveillance testing in schools would make it possible for the city to have a more nuanced policy.

Otherwise, he said, the citywide positivity rate "is a very crude metric that doesn't necessarily tell us what is happening in schools."

Mark Levine, the Manhattan City Councilmember who chairs the health committee, said on Tuesday that it had become apparent to him that New York City was already in a second wave. In the face of worsening data, the mayor has insisted that New Yorkers still have a chance to fend off a surge.

Levine said he believed the decision to close schools boiled down to limiting the activity and travel of residents.

"The question is going to be whether we need New Yorkers to hunker down again," he said. "Having hundreds of thousands of people moving around the city to go to school would be counterproductive."

There are also economic disparities to consider. As it was prior to the pandemic, the public education experience for New York City children has been far from equitable. Remote learning has threatened to only exacerbate learning gaps among children. Last month, Schools Chancellor Richard Carranza said that schools had 77,000 outstanding requests for learning devices like tablets and laptops, nearly a month after classes began.

Redlener said government officials need to keep economic and racial inequities in mind as they decide policies impacting schools.

"It’s really very important that we make sure that we don’t further disadvantage children," he said.

Mark Treyger, the Brooklyn City Councilmember who chairs the education committee, said he saw the latest data showing lower infection rates among children aged 5 to 12 as a vindication for a school reopening proposal he released in July. Under his plan, the city would have allowed in-person instruction five days a week for elementary schools only. Middle and high schools would have continued to learn remotely, while their buildings could be used by elementary schools to ensure better social distancing.

At the time, Treyger had argued that on top of scientific evidence that younger children do not transmit the virus as much as older children, educational research has found that elementary school represents the formative years of learning for children. "If we do not make sure they are reading at level by second grade, it’s very hard to catch up," he said.

Middle and high schools have arguably struggled the most under the city's blended model because of teacher shortages resulting from the number of subjects taught. Some students have found themselves arriving in classrooms only to be taught remotely through a computer.

"Cancel the hybrid model. It’s not working, it never worked," he said.

Treyger said he has requested coronavirus testing data by school from education officials but has thus far come up empty. In light of a pending citywide schools closure, he urged the mayor to come up with a transition plan that would preserve in-person learning for the most vulnerable.

"We don’t have much time to get this right for them," he said.