With schools nationwide preparing for fall and the federal government encouraging in-person classes, key concerns for school officials, teachers and parents include the risks that coronavirus poses to children and their role in transmission of the disease.

A new KFF brief examines the latest available data and evidence about the issues around COVID-19 and children and what they suggest about the risks posed for reopening classrooms. The review concludes that while children are much less likely than adults to become severely ill, they can transmit the virus. Key findings include:

• Disease severity is significantly less in children, though rarely some do get very sick. Children under age 18 account for 22% of the population but account for just 7% of the more than 4 million COVID-19 cases and less than 1% of deaths.
• The evidence is mixed about whether children are less likely than adults to become infected when exposed. While one prominent study estimates children and teenagers are half as likely as adults over age 20 to catch the virus, other studies find children and adults are about equally likely to have antibodies that develop after a COVID-19 infection.
• While children do transmit to others, more evidence is needed on the frequency and extent of that transmission. A number of studies find children are less likely than adults to be the source of infections in households and other settings, though this could occur because of differences in testing, the severity of the disease, and the impact of earlier school closures.
• Most countries that have reopened schools have not experienced outbreaks, but almost all had significantly lower rates of community transmission. Some countries, including Canada, Chile, France, and Israel did experience school-based outbreaks, sometimes significant ones, that required schools to close a second time.

The analysis concludes that there is a risk of spread associated with reopening schools, particularly in states and communities where there is already widespread community transmission, that should be weighed carefully against the benefits of in-person education.

Key Points:

• With just a few weeks remaining before schools in the U.S. are scheduled to reopen, and the federal government encouraging in-person schooling, there remain many questions about the risk COVID-19 poses to children and their role in transmission of the disease. Indeed, other countries have not reopened schools with the levels of community transmission found in the U.S., coupled with its insufficient testing and limited contact tracing.
• Our review of the latest available data indicates that, while children who are infected with COVID-19 are more likely to be asymptomatic and less likely to experience severe disease (though a small subset become quite sick), they are capable of transmitting to both children and adults.
• What remains unclear and where evidence is still needed is: whether children are less likely to be infected than adults and, when infected, the frequency and extent of their transmission to others. There is some evidence for an age gradient in infectiousness, with younger children less likely and older children more likely to transmit at levels similar to adults.
• While other countries that reopened schools have generally not experienced outbreaks in school settings, almost all had significantly lower levels of community transmission than the U.S. and greater testing and contact tracing capacity. Moreover, several disease clusters connected to schools and children have been reported.
• Taken together, the evidence indicates that where there is already widespread community transmission, as in many areas in the U.S., there is clearly a risk of further spread associated with reopening schools. The risks of reopening need to be considered carefully in light of the recognized benefits of in-person education.

Introduction

Policymakers in the United States are struggling to decide whether and how to reopen schools and daycares, at the same time that parents and caregivers are trying to weigh the risks and benefits of different approaches to schooling for their children. Indeed, our latest national poll found that most parents are worried about their child or a family member, as well as teachers and staff, getting sick from coronavirus if schools reopen and think it is better to wait.

With only a few weeks remaining until most U.S. schools are scheduled to begin, the White House for months has emphasized the importance of reopening schools and having students physically present in classrooms, although more recently has supported a more flexible approach for schools and parents. For its part, the Centers for Disease Control and Prevention (CDC) recently released updated guidance, including a review of the data, for school administrators, parents, and caregivers facing decisions around schooling, while also issuing a statement that having children physically present in reopened schools this fall was of utmost importance. CDC states, that, “No studies are conclusive, but the available evidence provides reason to believe that in-person schooling is in the best interest of students, particularly in the context of appropriate mitigation measures similar to those implemented at essential workplaces.”

Still, many large school districts, especially in locations where there is widespread community transmission, have opted for a virtual rather than an in-person start to the school year, citing the risks that the virus poses to students, teachers, staff, and households. Our recent analysis found, for example, that 1.5 million teachers are at high risk of severe disease if infected with coronavirus, due to underlying health conditions and age. In addition, we found that millions of seniors live in households with school-aged children.

Struggles surrounding decisions around schooling and childcare reflect some of the most perplexing aspects of the COVID-19 pandemic so far: understanding the risks the virus poses to children and their role in transmission of the disease. While researchers have been actively investigating these topics since the emergence of the pandemic, our understanding is, in many cases, still incomplete. Here, drawing on published literature and expert opinion, we summarize what is known about children and coronavirus, and what the information gaps remain.

Current Evidence on COVID-19 and Children

Disease severity is significantly less in children, though a small subset become quite sick: We know children of all ages can indeed be infected with coronavirus but the evidence at this point is quite clear that overall, children who become infected experience a milder disease course than adults. As one expert review panel stated, we are “essentially certain” the risk of death and of severe illness from COVID-19 in children is extremely low. Another expert panel organized by the National Academies of Medicine reported that “compared with adults, children who contract COVID-19 are more likely to experience asymptomatic infection or mild upper respiratory symptoms”, and that over 90 percent of children testing positive will have no or mild symptoms. While the infection has been known to cause an inflammatory condition (MIS-C) in some children, and these cases are serious (342 have been reported to date), so far such cases are very rare and most children who do experience the condition eventually recover.

One reflection of the generally milder disease course in children is that the reported number of COVID-19 deaths among children under the age 18 in the U.S. is less than 1% of reported COVID-19 deaths, even though children make up 22% of the U.S. population [see Box 1].

Evidence is mixed about whether children are less likely to become infected when exposed. Regarding risk of infection there is some evidence that, compared to adults, children are less likely to become infected when exposed to the virus. One prominent study estimated susceptibility to infection for those under 20 years of age to be about half that of those over 20 years, and several large-scale seroprevalence studies have found lower prevalence of infection in children, especially younger children, compared to adults. Still, the evidence is somewhat mixed on this point, with other studies showing children, especially older children (>10 years) having been infected at rates similar to adults in some places. A recent (pre-publication) review of the evidence concludes there is “significantly lower” susceptibility to infection for children under 10 compared to adults, but the same conclusion cannot be drawn for children 10 and older.

A number of biological explanations have been posited for this difference between children and adults in severity and infection risk, including less expression of a key receptor in the upper airways of children, and some level of pre-existing immune cross-reactivity to SARS-Cov-2 in many children due to recent exposure to related viruses (such as common cold viruses). Still, investigations continue and more evidence is needed to fully understand if lower infection rate in children is a real phenomenon and what explains it.

Children do transmit to others but more evidence is needed on the frequency and extent of that transmission. We do not yet know for sure how common transmission from children is compared to transmission from adults. We know that children are capable of transmission to others, but the frequency and extent of this transmission remains under investigation, and this is a question where only weak, and sometimes contradictory evidence, is available.

For example, multiple studies indicate that children have viral loads and shed virus in similar amounts to adults, which might indicate risk of transmission is similar across age groups. Without a doubt transmission from child-to-child and child-to-adult can occur, but a number of studies find children, particularly young children, are less likely to be source of infection in households and other settings, compared to adults. A number of these studies conclude that a majority of documented transmissions between children and adults have occurred from adults to children, rather than the other way around, but more detailed information is needed to fully understand this dynamic. There is new evidence, including from a recent comprehensive study from South Korea, suggesting there is an age gradient in terms of transmission risk from children, meaning younger children (<10 years old) are less likely to transmit compared to adults, while older children (10 and older) may transmit at levels similar to adults.

Evidence is so far lacking partly because doing studies and collecting the necessary information has been challenging for a number of reasons, including:

• Children have been less likely to be tested for coronavirus infection compared to adults. Testing (particularly in the US where testing capacity constraints have been common) has been focused on symptomatic patients (especially those with severe symptoms), and children exhibit fewer and milder symptoms compared to adults.
• Because children are less likely to be symptomatic, they may also be less likely to be identified as the “index” case during a contact tracing investigation and therefore their role in transmission could be underrecognized.
• Children may have different social mixing patterns compared to adults, coming into close contact with others at different rates. This may complicate comparisons of transmission between children and adults. On the one hand, children may have had fewer contacts than adults during times when schools and daycares were closed, but, on the other, may have a greater number of close contacts than adults when in a more typical school environment.

Transmission in School Settings

Most countries that have reopened schools have not experienced outbreaks but almost all have had significantly lower rates of community transmission than the U.S. and higher testing and contact tracing capacity. In many countries around the world, schools and daycares have reopened following a period of lockdown. So far, most have not seen cases surge after re-opening. For the most part, the lack of a surge in cases and the ability to control any outbreaks in most countries that have re-opened schools is in large part explained by their significantly lower levels of community transmission at the time schools re-opened compared to much of the U.S. now, as well as their greater testing and contact tracing capacity.

In Table 1, we compare U.S. COVID-19 data to 13 other countries that have reopened schools. We looked specifically at the 7-day average of cases, cases per million, and test positivity rate as of the date each country reopened schools compared to the U.S. as of the most recent date. As shown, all countries that have reopened had significant lower case counts and cases per million than the U.S. currently has and all but one (Japan) had lower positivity rates. For example, when South Korea opened schools on June 8, the country had a 7-day average of just 44 cases nationwide (or 0.9 per million population), after more than two months of limited transmission; it also already had widespread testing (a test positivity rate of 0.3%) and contact tracing in place, meaning it was well positioned to respond quickly to any school outbreaks. By contrast, the U.S. is currently averaging at more than 65,000 cases a day (or 195 per million population) and its test positivity rate is 8%. Many other countries, such as Finland, Iceland, New Zealand, and Vietnam, similarly had low case numbers, cases per million, and positivity rates when they opened schools and have avoided large school-based outbreaks so far.

At the same time, school associated outbreaks have occurred in some countries. Not all countries have avoided school-associated outbreaks. For example, schools in Canada, Chile, France, and Israel have reported outbreaks, sometimes significant ones, necessitating re-closure of schools in some cases. Israel, in particular, has had several outbreaks at schools after reopening, including an outbreak in a high school where 13.2% of students tested positive for coronavirus as did 16.6% of staff and school-based cases have been linked to increasing community transmission. The country reopened when it had significant fewer cases, cases per million, and positivity rate than the U.S. does today (see Table 1); it reopened its entire school system with few social distancing or other mitigation measures. In Sweden, a country which never closed its schools for children under 16, health authorities have reported that teachers are no more at risk in schools than adults in other professions and community transmission was not affected by schools being open. There have been school outbreaks and deaths among school teachers in Sweden, but insufficient testing and contact tracing at Swedish schools make it difficult to draw definitive lessons from the Swedish school experience.

Like schools, daycare-associated outbreaks also have been reported, including in the U.S., such as in California and Texas.

Conclusion

Taken together, the evidence indicates that while children are much less likely than adults to become severely ill from COVID-19, they do transmit virus. It is still unclear to what extent children, especially younger ones, are likely to get infected or transmit the infection to others compared to adults. However, where there is already widespread community transmission, as is the case in many areas in the U.S., there is clearly a risk of spread associated with reopening schools. This challenge may be more pronounced where testing and contact tracing capacity is limited. As such, the risk of re-opening schools needs to be considered carefully in light of the recognized benefits of in-person education.

At almost 27 weeks since the first coronavirus case appeared in the United States, we have reached 4 million cumulative cases — only 15 days after crossing 3 million. While cases are climbing at increasing rates and the economy continues to suffer, the debate around the safety and feasibility of reopening schools for in-person instruction continued this week, as state and local officials released their decisions around in-person or online learning and the Centers for Disease Control and Prevention released its own guidance on reopening schools.

Amidst these developments, we released our latest poll, which found that parents overwhelmingly prefer that schools wait to restart in-person classes to reduce infection risk (60%) rather than open sooner so parents can work and students can return to the classroom (34%). Parents of color (76%) are even more likely than white parents (51%) to prefer that schools wait to return to in-person classes.

Increasing federal funding to state and local governments to help schools reopen safely was among the public’s top priorities for Congress, with 55% saying it should be a top priority.

But as Congress finalizes negotiations around the next coronavirus stimulus package, 72% of the public say increasing federal funding to limit the spread of coronavirus — including testing, contract tracing and personal protective equipment (PPE) — should be a top priority for Congress. It’s the highest-ranked priority in the poll, and the only one seen as a top priority by a majority of Democrats, Republicans, and independents.

The media and President Trump in his latest coronavirus briefings largely focused on the share of cases attributed to a younger population in the most recent resurgences in hotspot states, but our analysis highlights how continued community transmission has implications beyond increased cases. As of July 23, we identified 36 states that are now coronavirus hotspots — based on cases and positivity rates increasing, or meeting specific thresholds. That means approximately 73.5% of the U.S. population is now living in a hotspot.

Long-term care (LTC) facility deaths in these hotspot states as of July 23 have risen at six times the rate as LTC deaths in non-hotspot states. Long-term care cases in Texas and Florida have increased by approximately 50% in two weeks. Adults 65 and older account for 16% of the US population but 80% of COVID-19 deaths in the US. Nearly half of all COVID-19 deaths have been in long-term care facilities.

Here are the latest coronavirus stats from KFF’s tracking resources:

Global Cases and Deaths: Total cases worldwide reached 15.5 million between July 16 and July 23 – with an increase of approximately 1.7 million new confirmed cases. There were also approximately 43,600 new confirmed deaths worldwide between July 16 and July 23, bringing the total to 633,394 confirmed deaths.

U.S. Cases and Deaths: Total confirmed cases in the U.S. passed 4 million this week. There was an approximate increase of 463,000 confirmed cases between July 16 and July 23. Approximately 5,900 confirmed deaths in the past week brought the total to over 144,000 confirmed deaths in the U.S.

U.S. Tests: There have been over 48 million total COVID-19 tests with results in the U.S. In the past 7 days, 1.7% of the total U.S. population was tested.

Race/Ethnicity Data: As of this week, Black individuals made up a higher share of cases/deaths compared to their share of the population in 30 of 49 states reporting cases and 34 of 44 states reporting deaths. In 7 states (MI, TN, MO, IL, WI, KS, and NH), the share of COVID-19 related deaths among Black people was at least two times higher than their share of the total population.

Hispanic individuals made up a higher share of cases compared to their share of the total population in 35 of 45 states reporting cases and 10 of 44 states reporting deaths. In 8 states  (NE, VA, WI, AR, IA, MN, TN, and SD), Hispanic peoples’ share of cases was more than 3 times their share of the population. COVID-19 continues to have a sharp, disproportionate impact on American Indian/Alaska Native as well as Asian people in some states.

State Reports of Long-Term Care Facility Cases and Deaths Related to COVID-19 (Includes Washington D.C.)

• Data Reporting Status: 47 states are reporting COVID-19 data in long-term care facilities, 4 states are not reporting
• Long-term care facilities with known cases: 13,411 (across 44 states)
• Cases in long-term care facilities: 322,505 (across 43 states) 
• Deaths in long-term care facilities: 59,506 (in 42 states)
• Long-term care facility cases as a share of total state cases: 10% (across 43 states)
• Long-term care facility deaths as a share of total state deaths: 44% (across 42 states)
• Texas, South Carolina, Utah, and Florida reported a >20% increase in LTC deaths over the last 14 days. Texas reports the highest increase — a 64% increase in LTC deaths between July 9 and July 23
• The states that have historically had the highest deaths in LTC facilities overall (NY, NJ, MA, PA, and IL) all saw less than a 3% increase in LTC deaths over 14 days. These states are not classified as hotspots. There is evidence to suggest that LTC deaths are rising in hotspot states (such as in TX, SC, UT, FL) at a faster pace than in non-hotspot states (NY, NJ, MA, PA, and IL).

State Social Distancing Actions (includes Washington D.C.)

• Status of reopening: Proceeding in 21 states, paused in 8 states, new restrictions in 15 states, reopened in 7 states
• Stay At Home Order: Original stay at home order in 1 state, stay at home order eased or lifted in 44 states, no action in 6 states
• Mandatory Quarantine for Travelers: Original traveler quarantine mandate in place in 9 states, new traveler quarantine mandate in place in 3 states, traveler quarantine mandate eased or lifted in 16 states, no action in 23 states
• Non-Essential Business Closures: Some or all non-essential businesses permitted to reopen (some with reduced capacity) in 43 states, new business closures or limits in 3 states, no action in 5 states
• Large Gatherings Ban: Original gathering ban/limit in place in 5 states, gathering/ban limit expanded or lifted in 38 states, new gathering/ban limit in place in 7 states, no action in 1 state
• Restaurant Limits: Restaurants reopened to dine-in service in 45 states, newly closed to dine-in service in 1 state, new capacity limits in 4 states, no action in 1 state
• Bar Closures: Closed in 9 states, reopened in 30 states, newly closed in 9 states, new service limits in 3 states
• Face Covering Requirement: Required for general public in 31 states, required for certain employees in 11 states, allows local officials to require them for general public in 4 states, no action in 6 states
• Primary Election Postponement: Postponement in 15 states, no postponement in 36 states
• Emergency Declaration: There are emergency declarations in all 51 states.

State COVID-19 Health Policy Actions (Includes Washington D.C.)

• Waive Cost Sharing for COVID-19 Treatment: 3 states require, state-insurer agreement in 3 states; no action in 45 states
• Free Cost Vaccine When Available: 9 states require, state-insurer agreement in 1 state, no action in 41 states
• States Requires Waiver of Prior Authorization Requirements: For COVID-19 testing only in 5 states, for COVID-19 testing and treatment in 6 states, no action in 40 states
• Early Prescription Refills: State requires in 16 states, expired requirements in 2 states, no action in 33 states
• Premium Payment Grace Period: Grace period extended for all policies in 2 states, grace period extended for COVID-19 diagnosis/impacts only in 4 states, expired in 10 states, no action in 35 states
• Marketplace Special Enrollment Period: Marketplace special enrollment period still active in 5 states, ended in 7 states, no special enrollment period in 39 states
• Paid Sick Leave: 13 states enacted, 2 proposed, no action in 36 states

State Actions on Telehealth (Includes Washington D.C.)38 states overall have taken mandatory action expanding access to telehealth services through private insurers, including:

• New Requirements for Coverage of Telehealth Services: Parity with in-person services in 6 states, broad coverage of telehealth services in 6 states, limited coverage of telehealth services in 6 states, no action in 33 states
• Waiving or Limiting Cost-Sharing for Telehealth Services: Waived for COVID-19 services only in 7 states, waived or limited for all services in 8 states, expired in 1 state, no action in 35 states
• Reimbursement Parity for Telehealth and In-Person Services: Required for all services in 17 states, no action in 34 states
• Require Expanded Options for Delivery of Telehealth Services: Yes in 35 states, for behavioral health services only in 1 state, no action in 14 states

Approved Medicaid State Actions to Address COVID-19 (Includes Washington D.C.)

• Approved Section 1115 Waivers to Address COVID-19: 5 states (HI, NC, NH, WA) have approved waivers
• Approved Section 1135 Waivers: All states have approved waivers
• Approved 1915 (c) Appendix K Waivers: 50 states have approved waivers except Idaho
• Approved State Plan Amendments (SPAs): 47 states have temporary changes approved under Medicaid or CHIP disaster relief SPAs, 1 state has an approved traditional SPA
• Other State-Reported Medicaid Administrative Actions: All states report taking other administrative actions in their Medicaid programs to address COVID-19

The latest KFF COVID-19 resources:

• KFF Health Tracking Poll – July 2020 (News Release, Poll Findings)
• What Share of People Who Have Died of COVID-19 Are 65 and Older – and How Does It Vary By State? (News Release, Issue Brief)
• Hotspot States See More COVID Cases in Nursing Homes (Axios Column)
• Rising Cases in Long-term Care Facilities Are Cause for Concern (Issue Brief)
• How Much Fiscal Relief Can States Expect From the Temporary Increase in the Medicaid FMAP? (News Release, Issue Brief)
• Updated: Health System Dashboard (News Release, Issue Brief, Dashboard)
• Updated: Medicaid Waiver Tracker (Issue Brief)
• Updated: COVID-19 Coronavirus Tracker – Updated as of July 24 (Interactive)
• Updated: Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19 (Interactive)
• Updated: State Data and Policy Actions to Address Coronavirus (Interactive)
• Humanitarian Aid From Top Donors Down As U.N. Appeals Increase Amid Pandemic, Analysis Shows (KFF Daily Global Health Policy Report)

The latest KHN COVID-19 stories:

• As Long Waits for Results Render COVID Tests ‘Useless,’ States Seek Workarounds (KHN, Daily Beast)
• Employers Require COVID Liability Waivers as Conflict Mounts Over Workplace Safety (CHL, Fortune)
• KHN’s ‘What The Health?’: Trump Twists on Virus Response (KHN)
• Lost on the Frontline (KHN, The Guardian)
• COVID Runs Amok in 3 Detroit-Area Jails, Killing At Least 2 Doctors (KHN, The Guardian)
• With DACA Ruling, Did Supreme Court Grant Trump New Powers To Reshape Health Care? (KHN, PolitiFact)
• Adjunct Professors: Jobs Are Low on Pay and Health Benefits With High COVID Risk (KHN, US News)
• Technology Divide Between Senior ‘Haves’ and ‘Have-Nots’ Roils Pandemic Response (KHN, CNN)
• Essential and in Danger: Coronavirus Sickens, Even Kills Public Health Workers (KHN, AP)
• For COVID Tests, the Question of Who Pays Comes Down to Interpretation (KHN, NBC News)
• Medicaid Mystery: Millions of Enrollees Haven’t Materialized (CHL, Los Angeles Times)
• Administration Eases Rules to Give Laid-Off Workers More Time to Sign Up for COBRA (KHN, NPR)
• NIH Project Homes In on COVID Racial Disparities (KHN)
• Scientists Want to Know More About Using UV Light to Fight COVID-19 Spread (KHN, NPR)
• Pandemic-Inspired Food Labeling Raises Alarms for Those With Food Allergies (KHN, Washington Post)
• Bingeing on Doom: Expert on the ‘Black Death’ Attracts Cult Following (KHN, Los Angeles Times)
• Behind The Byline: ‘Reporting From a Distance’ (KHN)
• Watch: COVID Patients and Families Battle to Get Benefits (KHN)

A new KFF analysis finds that 80 percent of people who have died of COVID-19 in the U.S. to date were age 65 or older, though the share varies considerably by state — from a high of 94 percent in Idaho to a low of 70 percent in the District of Columbia.

The analysis of data from the Centers for Disease Control and Prevention provides clear evidence of the toll that the novel coronavirus has taken on older Americans. It also provides a more detailed picture of where the impact on seniors has been the greatest.

The analysis finds that states that have seen the largest share of COVID-19 deaths among people 65 and older include those that have had a disproportionate number of deaths in long-term care facilities. These states include Idaho (with 94% of deaths among those 65 and older), New Hampshire (92%), Massachusetts (90%), Rhode Island (90%), Minnesota (89%), Connecticut (89%), Pennsylvania (87%), Ohio (86%), Kentucky (84%), and Delaware (83%).

States in which deaths among those 65 and older account for a somewhat lower share of all COVID-19 deaths compared to the national average are in the South and Sun Belt. Many of these states are hotspots where the virus has surged more recently and where deaths among older adults may be lagging, including Alabama (where 76% of COVID-19 deaths are among those 65 and older), Tennessee (76%), Nevada (75%), Arizona (74%), Mississippi (74%), Arkansas (71%), New Mexico (71%), and Texas (70%).

For more data and analyses regarding older Americans and the novel coronavirus pandemic, visit kff.org.

Since the early days of the pandemic, COVID-19 has taken its greatest toll among older adults in the US in terms of cases, hospitalizations and deaths. Months into the pandemic, older adults continue to be one of the populations most at risk of becoming seriously ill and dying from COVID-19. Adults 65 and older account for 16% of the US population but 80% of COVID-19 deaths in the US, somewhat higher than their share of deaths from all causes (75%) over the same period. Around the country, however, states have put in place a variety of policies regarding COVID-19, and on different timetables, which have contributed to different case trajectories and could result in variations across states in the proportion of COVID-19 deaths among older people. Other factors that may contribute to these differences include the prevalence of underlying medical conditions and racial composition of each state’s population.

To examine the extent of state-level variation in the share of COVID-19 deaths accounted for by older adults, we analyze the distribution of COVID-19 deaths by age group at the state level, based on data from the Centers for Disease Control and Prevention (CDC) as of July 22, 2020, for the week ending July 11. The data are provisional and reflect a time lag due to differences in how states report data.

Of the 41 states and District of Columbia included in this analysis, the share of people 65 and older who have died of COVID-19 varies considerably by state (Figure 1).

.The percent of COVID-19 deaths accounted for by people 65 and older is consistently high and ranges from a high of 94% in Idaho to a low of 70% in the District of Columbia.

In most states, the share of adults 65 and older who have died due to COVID-19 is higher than their share of deaths from all causes (Figure 2).

.For example, in Idaho, a substantially higher share of people who have died of COVID-19 were 65 and older (94%) compared to deaths from all causes (76%). Similarly, in West Virginia, the share of people 65 and older who have died of COVID-19 was much higher than for all causes (90% vs 73%). This was true for almost all states included in the analysis except for Arizona, Arkansas, Kansas, New Mexico, New York and Texas, where the share of COVID-19 deaths and deaths from all causes were the same, and Nebraska where the share of COVID-19 deaths was lower than for all causes.

States that have reported a larger share of adults 65 and older who have died of COVID-19 tend to be those states that have had a disproportionate number of deaths in long-term care facilities. These include Idaho, with 94% of COVID-19 deaths among those 65 and older, as well as New Hampshire (92%), Massachusetts (90%), Rhode Island (90%), Minnesota (89%), Connecticut (89%), Pennsylvania (87%), Ohio (86%), Kentucky (84%), and Delaware (83%).

Many of the states that have reported a smaller share of adults 65 and older who have died of COVID-19 compared to the national average are in the South and the Sun Belt, including Alabama (76%), Tennessee (76%), Nevada (75%), Arizona (74%), Mississippi (74%), Arkansas (71%), New Mexico (71%), and Texas (70%). With the exception of Texas, these states have a population age distribution similar to the US average, which suggests that this finding is not a function of having a younger population. In these states, the pandemic is peaking later than in states that were hit earlier, which may contribute to a lag in deaths among older adults.

States that have experienced a large percentage of deaths at long-term care facilities are also more likely to have a larger share of COVID-19 deaths in the oldest age cohort, those 85 and older (Figure 3).

.In the US overall, 33% of people who have died from COVID-19 were age 85 and older, compared to 31% of people who died from all causes over the same period who were 85 and older. In states with a relatively large share of deaths in long-term care facilities, the percentage is higher, e.g., 48% in New Hampshire and Massachusetts, 46% in Rhode Island, 45% in Minnesota and Connecticut, 43% in Pennsylvania, 39% in Idaho, 37% in Kentucky, Delaware, and Ohio.

The number of adults 65 and older who have died of COVID-19 is considerably higher in some states than others, with 61% of all adults 65 and older who died of COVID-19 as of July 15, residing in just 7 states: New York, New Jersey, Massachusetts, Pennsylvania, Illinois, California, and Michigan (Figure 4).¹ 

.By comparison, only 36% of deaths among people 65 and older from all causes were among older adults residing in those 7 states.

The majority of people who have died of COVID-19 are 65 and older nationwide; however, there is a fair amount of variation across states. These differences may reflect a number of factors, including underlying demographic characteristics, other state-specific factors, and the timing of outbreaks. In states that were affected earlier, older adults tend to account for a higher share of deaths. This may be attributable to the relatively large number of deaths in long-term care facilities. States that have experienced more recent outbreaks have a somewhat smaller share of deaths accounted for by people 65 and older, but as the pandemic progresses, the share of deaths among older people in these states may rise, especially in states that are now experiencing a sharp rise in coronavirus cases in long-term care facilities.

1. The Centers of Disease Control and Prevention dataset used in this analysis produces slightly different counts of deaths for July 11 than other sources producing these estimates, such as the Johns Hopkins University Coronavirus Resource Center or the COVID Tracking project. ↩︎

Source

Coronavirus: Reopening, Schools, And The Government Response

Newly updated and expanded, the Peterson-KFF Health System Dashboard compiles data on the U.S. health system’s performance in four areas: access and affordability, health and well-being, health spending, and quality of care. Users can explore trends over time, as well as disparities and differences across demographic groups. The dashboard also includes indicators comparing health outcomes and spending in the U.S. to that of similarly large and wealthy countries.

A new companion brief situates the data in broader trends in the U.S. health system and considers how the COVID-19 pandemic may impact measures of performance and quality. Among its key findings:

• As of 2017, rates of disease burden, a measure that accounts for both longevity and quality of life, are higher in the U.S. than in comparable countries. The high rate of disease burden in the U.S. can be attributed in part to conditions believed to be risk factors for developing serious illness from COVID-19, including chronic respiratory diseases, heart disease, and diabetes.
• From 2011 to 2018, the share of adults reporting problems paying medical bills dropped by more than a quarter. The potentially high cost of treating COVID-19 and shifts in the use of health care services during the pandemic could affect affordability of care.
• Racial disparities in health outcomes persist. In 2017, life expectancy among White people in the U.S. was 78.5 years, but among Black people, it was 74.9. The pandemic has exacerbated inequalities underlying this Black-White life expectancy gap and other disparities, and it has thus disproportionately affected communities of color.

The Health System Dashboard is available on the Peterson-KFF Health System Tracker, a partnership between the Peterson Center on Healthcare and KFF that monitors the U.S. health system’s performance on key quality and cost measures.

Most Say Things Will Get Worse Before They Get Better, and Just Over Half Now Say Their Mental Health is Worse Because of Coronavirus Worry and Stress

As state and local officials prepare for the new school year amid the COVID-19 pandemic, parents with children who normally attend school overwhelmingly prefer that schools wait to restart in-person classes to reduce infection risk (60%) rather than open sooner so parents can work and students can return to the classroom (34%), the latest KFF tracking poll finds. Parents of color (76%) are even more likely than white parents (51%) to prefer that schools wait to return to in-person classes.

With President Trump calling for schools to reopen and threatening to withhold federal funds from schools that don’t do so, there is a big partisan divide – with 87% of Democrats and 59% of independents preferring schools open later while 60% of Republicans prefer that schools open sooner.

The cautious approach to reopening schools may reflect a lack of confidence that schools have the resources to do so safely. Large majorities of the public (71%) say the public schools in their area need more resources to comply with public health recommendations around reopening, and 66% of parents say the same thing about their own child’s school.

“It’s a no-win choice for parents, but most are erring on the side of protecting kids, teachers and families by delaying school reopening and keeping kids home,” KFF President and CEO Drew Altman said.

The poll also shows how parents are pulled in both directions at once on the issue of school reopening.

Most parents with a child who normally attends school are worried about teachers and staff getting sick from coronavirus (79%) and children being unable or unwilling to comply with physical distancing practices (73%). But, nearly as many are worried about their child (70%) or themselves or a family member (69%) getting sick from coronavirus and that their child’s school will be unable to comply with public health recommendations (66%).

However, if schools don’t reopen, about two thirds say they worry about their children falling behind socially and emotionally (67%) and academically (65%). About half say they worry about losing income because they can’t go to work (51%) and not being able to pay enough attention to their kids while working at home (47%). Smaller shares worry about not getting needed social services (40%), and not having access to technology needed for online learning (31%), and their child not having enough food to eat (24%).

Parents of Color More Likely Than White Parents to Worry about the Pandemic’s Effects

Reflecting the disproportionate impact that the pandemic has had on communities of color, the poll finds parents of color are more likely to be worried about each of these concerns than white parents.

For example, about 9 in 10 parents of color are worried that their child (91%) or they or someone else in their family (90%) will get sick with coronavirus if schools reopen. Far fewer white parents say they are worried about their child (55%) or someone in their family (53%) getting sick.

If schools stay closed, parents of color are far more likely than white parents to say they are worried about losing income (65% vs. 41%) and their child not getting needed social services (52% vs. 32%). Many parents of color also are worried about not having the technology for online learning (49%) and their child not having enough to eat at home (44%). Few white parents worry about either situation (17% and 9%, respectively).

Majorities across Parties Want Congress to Prioritize Funding for COVID Testing, Tracing, and PPE

As Congress works on its next coronavirus relief package, news reports suggest the Trump administration is resisting allocating additional federal funds for testing, contract tracing and other preventive service – a position at odds with public opinion.

The poll finds that 72% of the public say increasing federal funding to limit the spread of coronavirus, including testing, contract tracing and personal protective equipment (PPE), should be a top priority for Congress, making it the highest-ranked priority in the poll, and the only one seen as a top priority by a majority of Democrats, Republicans, and independents.

Other high-ranking priorities for Congress include increasing federal funding to state and local governments to help schools reopen (55% say it should be a top priority), increasing government assistance to help Americans who do not get health insurance from their jobs pay for coverage (52%), and providing financial assistance for people who lost their jobs to purchase COBRA insurance through their former employers (49%).

Somewhat fewer cite a second round of stimulus checks to individuals (43%) and extending the increased unemployment benefit of $600 per week (39%) as top priorities for Congress.

Democrats are more likely than Republicans to cite each of the nine actions as top priorities for Congress, while independents tend to fall in between.

Most Americans are Pessimistic about COVID Pandemic and Say Their Mental Health is Suffering 

With cases and deaths rising across much of the country, the public is increasingly pessimistic about the pandemic. Most (60%) now say “the worst is yet to come,” three times the share (20%) who say “the worst is behind us.” The share saying the worst is yet to come is up 10 percentage points since May.

For the first time, most Americans (53%) now say that stress and worry related to the pandemic has had a negative impact on their mental health – an increase of 14 percentage points since May. This includes about one in four who say it has had a “major” negative impact.

Those most likely to report negative mental health effects include women, young adults, Blacks and people with difficulties affording household expenses due to coronavirus.

About half (52%) of the public also report experiencing at least one of six specific issues due to worry and stress related to the pandemic: sleep difficulties (36%), poor appetite or overeating (32%), difficulty controlling their temper (18%), frequent headaches or stomachaches (18%), increased alcohol or drug use (12%), and worsening chronic conditions like diabetes or high blood pressure (12%).

Other findings include:

• About half (48%) of the public rate the federal government response to the pandemic as “poor” while another 23% rate it “fair.” Smaller shares rate the federal response positively as “good” (20%) or excellent (7%). About half the public gives their state (46%) and local (48%) governments positive marks.
• With the country facing a double-digit unemployment rate, 40% of adults say someone in their household has had problems paying bills or affording medical care or basic expenses in the past three months, including 22% who say this was a direct result of coronavirus and its impact on their financial situation.

Designed and analyzed by public opinion researchers at KFF, the poll was conducted July 14-19 among a nationally representative random digit dial telephone sample of 1,313 adults including an oversample of parents of school-aged (5-17 year-old) children. Interviews were conducted in English and Spanish by landline (323) and cell phone (990). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.