Prevalence and severity of COVID-19 among children and adolescents with autism spectrum disorders in the Republic of Korea

Autism spectrum disorder is considered a vulnerability for many diseases including coronavirus disease 2019. This study investigated trends in coronavirus disease 2019 among children and adolescents with and without autism spectrum disorder and to evaluate whether there are differences in the prevalence, severity, and case fatality rate. We used data from the National Health Insurance Service for all people ?19 years of age. Among 9,187,211 children and adolescents ?19 years of age, 402,499 (4.4%) were coronavirus disease 2019-positive. Of the total population, 63,054 (0.7%) were diagnosed with autism spectrum disorder, among whom 2557 (4.1%) were coronavirus disease 2019-positive. The coronavirus disease 2019 prevalence was lower among children and adolescents with autism spectrum disorder, with 4055 per 100,000 versus 4383 per 100,000 without autism spectrum disorder (p<0.001). However, children and adolescents with autism spectrum disorder exhibited a higher proportion of hospitalization (24.8% vs 21.5%) and severe disease (0.2% vs 0.01%) than those without autism spectrum disorder (p<0.001); the length of hospital stay among inpatients was not different between the two groups (9.5 vs 9.4 days, respectively; p = 0.48). There were six deaths in total, with no deaths among children and adolescents with autism spectrum disorder. The quarantine policies have played a great role in sustaining low prevalence and higher hospitalization rates among children and adolescents with autism spectrum disorder.