Question:
We just learned from a study from the UK in the Annals of Internal Medicine that adults with DS have a 10 times higher risk of dying from covid-19. Why is there such a difference between adults with DS and children with DS? https://www.acpjournals.org/doi/10.7326/M20-4986
Answer:
The study in the Annals of Internal Medicine journal referenced in the question is one of many COVID-19 studies that have been done since the pandemic started in early 2020. Researchers have learned a tremendous amount about COVID 19 since the pandemic started and continue to learn more as additional information and data are gathered.
This particular study found that people with Down syndrome were at higher risk of being hospitalized and dying from COVID-19 than people without Down syndrome. However, the number of individuals in the study with Down syndrome and COVID-19 was small (only 37 positive tests). One has to be cautious about applying those findings to all people with Down syndrome and COVID-19. Dr. Kishore Vellody and Dr. Andrew Nowalk from University of Pittsburgh Medical Center discussed this study in one of their podcasts, Does Having DS Lead to Higher Risk of COVID?.
A much larger international study has subsequently come out in the pre-print version (it has not gone through the peer review process yet, but it has been reviewed by the many people involved in the study). The full-text can be found at this link.
The study’s findings included the following:
- Risk factors for severe illness or death from COVID-19 were similar for people with and without Down syndrome. They included:
- Male gender
- Diabetes
- Obesity
- Dementia
- Congenital heart defects
- Older age (particularly over age 40 for people with Down syndrome)
- Age seems to be of particular importance in people with Down syndrome. Those over the age of 40 had a higher risk of dying from COVID-19 than people without Down syndrome of similar ages. The mortality rates were 3.5 times higher in people with Down syndrome.
- The number of infections and low number of deaths in children with Down syndrome were similar to those in children without Down syndrome. The reasons children, with and without Down syndrome are less severely affected is not known at this time. More study is needed to understand COVID-19 in younger individuals. Links to more information on COVID-19 in children are provided below.
Based on this study and what else we know about COVID19 we would offer these thoughts and recommendations:
- Everyone (whether they have Down syndrome or not) has some risk of developing COVID-19. We recommend all people follow the Centers for Disease Control and Prevention guidelines for wearing a mask, social distancing, and practicing good hand hygiene.
- Thus far, children with and without Down syndrome have been less likely than adults to experience severe illness or death from COVID-19. More study is needed to understand the effect of COVID-19 in younger individuals.
- Some people are at higher risk for severe illness or death from COVID-19. Many of the risk factors for severe illness or death from COVID-19 are more common in people with Down syndrome. Obesity, dementia, congenital heart disease, and (possibly) diabetes occur more frequently in people with Down syndrome. This means that a higher percentage of people with Down syndrome are at higher risk for severe illness or death from COVID-19.
- The risk of more severe COVID-19 infection goes up with age. People with Down syndrome greater than age 40 years of age are particularly more susceptible.
Information on COVID-19 in Children
- Article from the Mayo Clinic that includes possible reasons children that get COVID-19 may be less severely affected
- Article from the CDC on COVID-19 in children
- NIH treatment guidelines for children with COVID-19