Fewer Children Died in 2020, Despite the Pandemic. Experts Are Trying to Figure Out Why

Since the global pandemic began, one of the grimmer features of daily life has been watching the coronavirus death count tick up and up as the months have gone by. With so much unnecessary death in 2020, it’s surprising that in many countries, at least according to preliminary numbers, there was one significant group that actually saw its death rates fall: children.

Data from the Human Mortality Database, a research project run by a global team of demographers, suggest that COVID-19 did not reverse years-long declines in child mortality, despite a mortality surge in the general population. Demographers, pediatricians and public-health experts say it’s possible that lockdowns and quarantines have prevented children from succumbing to deadly injuries and illnesses. But they also point out that other effects of the pandemic, such as lower vaccination rates and reduced prenatal care may increase childhood mortality rates going forward.

The database, jointly maintained by the University of California, Berkeley, the Max Planck Institute for Demographic Research in Rostock, Germany and the French Institute of Demographic Studies in Aubervilliers, France, publishes mortality figures for 38 countries on a weekly basis. As expected, the so-called “excess mortality”—the number of deaths in a population above a normal baseline—was consistently high throughout each country’s pandemic period. (There were a few exceptions like Australia and New Zealand, which managed to contain the virus with early and aggressive lockdown measures.)

When broken out by age, however, the data show that fewer children under age 15 died in 2020 compared with prior years, even after accounting for COVID-19-related deaths. Take the U.S., for example, where about 26,000 child deaths in 2020 have been recorded so far. That’s well below the average in recent years, as shown in the chart below:

At this point, it’s impossible to say with certainty how extreme an outlier 2020 was. Between January and mid-November, about 2,500 fewer children in the U.S. died last year compared with the average of the three years prior—a drop of about 9%. However, demographers caution that the 2020 tally is almost certainly undercounted due to lags in reporting. As the death records get updated in the coming weeks, the second half of 2020 will likely start to look more like the first half of the year, which clocked a 7% drop. That would put the yearly deficit at about 2,000 deaths below the 2017 to 2019 average.

It’s possible that, as longer death investigations begin to settle in the coming months and years, the gap between 2020 and previous years will shrink in terms of overall child mortality. But presuming 2020 child mortality remains lower than prior years once the data dust settles, it would be an extension of recent trends, says Magali Barbieri, the Human Mortality Database’s associate director. “One thing that’s happening is that mortality has been declining for the zero-to-14 group,” she says. “If you compare 2019 to previous years, you’ll see a deficit, as well.”

In any other year, a continuing decline in child mortality would be good news, but not unexpected. In a year like 2020, it’s astonishing. Given the deadliness of COVID-19 in so many demographics, it’s incredibly fortunate that children have been largely spared due to their effective immune system response to the virus that causes the disease. In the U.S., just over 100 children under age 15 died from COVID-19 in 2020. They account for 0.03% of the 376,000 COVID-19 deaths since the virus hit the country last spring and less than 0.5% of the 26,000 total child deaths from all causes. In a year characterized by catastrophe, that’s one small grace.

Explaining the drop in child mortality

“We are in a privileged historical position that, barring terrible tragedies, children live to grow up,” says Dr. Perri E. Klass, a New York pediatrician and author of the 2020 book A Good Time To Be Born: How Science and Public Health Gave Children a Future. Citing U.S. data, she notes that “most child deaths are in the first month of life, and they are linked to premature gestation and reasons that are connected to the circumstances right around their birth. We aren’t losing nearly as many children to the things that used to kill two- and three- and eight-year-olds, like diphtheria, sepsis, scarlet fever or polio.”

Indeed, the leading cause of childhood mortality in the U.S., after the newborn stage, is unintentional injury—things like drownings, car accidents, pedestrian fatalities and accidental suffocations, according to 2018 numbers from the U.S. Centers for Disease Control and Prevention.

The agency’s cause-of-death data for 2020 (with the exception of pneumonia, influenza and COVID-19-related deaths) won’t be available until the end of 2021. In the meantime, child health experts can only speculate how the pandemic is shaping the numbers. Several who spoke to TIME said it’s possible that lockdowns, quarantines and social distancing measures are keeping kids safer from physical and biological harm, even as they threaten social, emotional, and mental well-being. “If those data hold, and if it’s true that 2020 mortality was down, then it may well turn out to be around issues of safety, and of people moving less and driving less,” says Klass.

Some early reports support that idea: the U.S. Department of Transportation has estimated there was a 2% drop in motor vehicle traffic crashes during the first half of 2020 compared with the same time period in 2019. National drowning data are difficult to come by, but statistics compiled by Total Aquatic Programming, an aquatics consultancy that has tallied drownings since 2008, tabulated fewer child drownings in 2020 compared to 2019. Warm-weather places that publish running tallies of children who drowned, like Texas, Florida and Phoenix, Ariz., show similar numbers or modest decreases compared with recent prior years.

In addition to curbing injury rates, it’s possible the pandemic has kept young kids from getting severely ill. Influenza and pneumonia are leading causes of death among toddlers and young children, but last spring, researchers found that influenza, respiratory syncytial virus and other common respiratory viruses died out quickly in response to lockdown measures designed to target COVID-19—and they have not resurged, despite the onset of cold and flu season. (Klass points out that health protocols like wearing masks and washing hands don’t just prevent COVID-19 but other viruses, as well.)

Why it isn’t all good news

The problem, though, is that, in future years, we may see child mortality increase on a global scale due to the pandemic lockdowns of 2020 (and, perhaps, 2021). For instance, water safety advocates say that declined enrollment in swim programs coupled with a surge in demand for private pools could lead to more drownings. Also, delays in vaccinations for things like measles, fueled by school closures and suspended immunization campaigns in dozens of countries, could cause outbreaks of serious but otherwise preventable diseases. And reduced access to prenatal care during the shutdown could negatively affect fetal health.

On top of those concerns, stressors such as income losses, social isolation and ongoing health problems also could have lasting effects. “One cannot rule out the fact that the economic and social consequences of the pandemic on women of reproductive ages and their children had a detrimental impact on their health,” says Barbieri, whose preliminary research suggests that child mortality around the time of the 2008 economic recession increased among the poorest segments of the population.

Taken together, all these issues may end up setting back child mortality on a global scale. The outcome could be most dire in less developed countries, where health care infrastructure was already fragile, says Li Liu, associate professor at Johns Hopkins Bloomberg School of Public Health.

“Potentially, cases like preterm birth and congenital abnormalities may actually be going up, once we have all the data in,” she says. “We can speculate and come up with theories but we have to wait until data are available to test those theories.”

And therein lies the one sure thing among the uncertainty: Because COVID-19 has not led to many childhood fatalities, but has upended the lives of children and pregnant women in significant ways, researchers are seizing a unique opportunity to study child wellbeing and survival. That new knowledge can be used to develop public health practices that can keep children mentally sound and physically healthy and safe when life returns to normal.