PHILADELPHIA – The current delta-driven COVID-19 surge is sending more children to hospitals locally and across the country, a sign, doctors said adults need to do a better job protecting children, especially children under 12 who are not vaccinated can be.
Children’s hospital admissions for COVID-19 increased 84% from 665 to 1,224 between July 10 and July 31, according to the U.S. Department of Health. In this region, the number of pediatric hospital admissions increased from four to 13 in New Jersey and from 20 to 28 in Pennsylvania between July 10 and July 31. Although they are increasing, hospitalization rates remain low; 1.1 per 100,000 children in Pennsylvania and 0.7 per 100,000 in New Jersey.
According to a report from the American Academy of Pediatrics (AAP) and the Children’s Hospital Association, only 0.1% to 1.9% of all known cases in children result in hospitalization. The real percentage is likely even lower as many infected children are not tested, said Sara Bode, director of school health services at Nationwide Children’s Hospital in Columbus, Ohio and chair of an AAP committee on school health.
But the trend affects experts.
Bode said children’s hospital admissions tend to rise along with adults in her community. In the past two weeks, she said the number of children who tested positive and those who had to be hospitalized had doubled in her hospital. Although the numbers remain small, “this is a major trend to watch out for,” she said. She fears that the situation will get worse in the fall, when the children go back to school, people spend more time indoors and the virus spreads more easily.
According to the AAP report, the number of children who tested positive for COVID-19 rose from their summer low of 8,447 on June 24 to 71,726 on July 29. At the height of the winter surge in mid-January, there were more than 211,000 cases in children.
According to the report, 358 children have died from COVID-19, including two in Delaware, seven in New Jersey and 15 in Pennsylvania. Pennsylvania includes everyone up to the age of 19 in its child case data, while New Jersey turns 17.
A study from the UK published this week in Lancet Child and Adolescent Health found that the average illness in children lasted six days and 98% made a full recovery within eight weeks. However, 4.4% had symptoms – fatigue was the most common – that lasted for more than a month. People aged 12 and over tended to have more symptoms and a slightly longer course than younger children.
Bode said most children hospitalized with COVID-19 only need a few days in the hospital, but some are sick enough to need an ICU stay.
Doctors at St. Christopher’s Hospital for Children in Philadelphia and UPMC Children’s Hospital in Pittsburgh both said more children test positive and need hospital treatment. The number with COVID-19 rose from four on June 20 to 10 on July 25 in St. Chris. The numbers are still single digits at UPMC, but the outpatient test positive rate rose dramatically from 1.9% to 7% in the past week, said John Williams, director of the pediatric infectious disease division. This is a sign of the spread of fellowship.
Jonathan Miller, chief of primary care at Nemours duPont Hospital for Children in Wilmington, said his hospital only had two patients who tested positive for COVID-19 on Wednesday morning and none were admitted for the virus. He said his area had not seen an increase in cases either. In July 20 children tested positive, the fewest since May 2020. The peak was January 2021 with 91 positive tests.
Williams said he was concerned because children under the age of 12 are still unable to get vaccines, the Delta variant is spreading quickly, and many people have taken fewer precautions.
“The only thing protecting these young children is the rest of us, and as a country we are doing a bad job protecting these young children right now,” he said. He said vaccination rates need to go up in older children and adults, and everyone, regardless of vaccination status, needs to wear masks more often.
Pediatricians at the local and national levels are also seeing an increase in other respiratory viruses that gave us a break while staying at home, social distancing and masking. The most serious of these are respiratory syncytial virus (RSV) and parainfluenza. Doctors said the common cold had spread further during the pandemic. RSV and parainfluenza usually appear in the fall and winter, but come on strongly early on. At St. Christopher’s, 76 children tested positive for RSV in June and 110 children in July. “It’s definitely an abnormal summer,” said Emily Souder, an infectious disease doctor there.
To date, doctors haven’t seen any evidence that Delta makes children sicker than previous versions of the virus or causes any other symptoms. Whether they can spread it more easily is unknown. Some children generally hospitalized for COVID-19 had health problems, but many were healthy before developing breathing problems or pneumonia. Some children infected with the virus can also develop MIS-C or multisystem inflammatory syndrome, a potentially serious condition. Souder said St. Christopher’s saw more than 30 children with MIS-C during the pandemic.
Doctors say the best way for parents to protect their children is to vaccinate themselves, vaccinate eligible older children, meet with other vaccinated people, and wear masks in public places. Souder says it is better to eat outside than inside with kids in restaurants.
The AAP recommends that everyone in schools wear masks. Souder believes that getting back to face-to-face learning is better for children and she wants it to work. Mitigation measures like masking worked last year. “It wasn’t the kids who had problems with it,” she said.
She called it a “real travesty” that some adults are battling steps to protect children, adult employees at risk, classmates with health problems, and poorly vaccinated communities. “It is really the responsibility of adults to keep encouraging this and to exemplify the use of these strategies for their own children,” she said.
If schools start without widespread masking, Bode said, “the consequence of that is that we’re going back to virtual learning again.” Her own children are vaccinated and she would still recommend masking oneself in school to make this “normative” for all children.
When asked which masks children should wear, Bode said “one that they will wear”. Miller said children’s masks with adjustable ear loops are “really useful”.
Whether masks and distancing will also work at Delta is still too early. “I think we have to consider that,” said Bode. “We have to follow the data.”
Miller says the virus should have taught us to be careful by now. “It’s probably worth being a little more conservative than you think,” he said, “because we as a society keep getting burned.”
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