It was far from a quiet Monday for infectious disease specialist Dr. Adriana Cadilla who had to meet with patients, many of them just out of the hospital after being treated for Covid-19 at Nemours Children’s Hospital in Orlando.
“Clinics were packed,” Cadilla said. Her hospital has seen a significant increase in the number of children with Covid-19. They’re also managing an earlier than usual surge in other respiratory illnesses. Kids aren’t sicker with Covid-19, necessarily, there are just more of them, Cadilla said.
“We know how to treat a lot of these things, including Covid,” Cadilla said. “But this is a public health crisis because when you overload the system, we can’t do a lot of things well.”
It’s frustrating, she said, because while they can provide supportive care for children, treatments like monoclonal antibodies aren’t authorized for children under the age of 12, and neither are vaccines.
What’s even more frustrating to her is that some families of her patients tell her that they won’t get vaccinated, or they won’t get everyone vaccinated until after their child has been hospitalized.
“I saw one today who got the sibling vaccinated who was eligible, but it’s just a hard way to learn that vaccines work by having to see a loved one hospitalized,” Cadilla said. These hospital admissions, she said, are totally preventable.
With school starting, Cadilla is concerned if more people don’t get vaccinated, her hospital will get a lot busier.
“We are trying to prepare for the unimaginable,” Cadilla said.
Across the country, Covid-19 cases among children have been on the rise since early July after months of decline. Almost 94,000 cases among children were added in the past week, the American Academy of Pediatrics said in what the group described as a “continuing substantial increase.”
The vast majority of cases don’t end up in the hospital. Generally, the cumulative hospitalization rate for children with Covid-19 has remained steady at around 1% since December, according to the AAP, meaning hospitalization is still uncommon compared to the number of adults who have been hospitalized. Nearly 189,000 adults have been hospitalized since the start of the pandemic, according to the CDC.
Yet, as of Saturday, the number of children who were hospitalized increased week-over-week, according to the US Centers for Disease Control and Prevention.
Specifically, there was an average of 203 children with Covid-19 admitted to US hospitals every day over the past week, CDC data shows. That’s a more than 21% increase from the previous week in daily new hospitalizations among Covid-19 patients ages 0 to 17.
“I think most areas, we are nearing or exceeding pediatric intensive care capacity,” said Mark Wietecha, the CEO of the Children’s Hospital Association, an association that represents more than 220 children’s hospitals. Hot spots for child cases are pretty much everywhere the adult Covid-19 hotspots are, he said.
Wietecha said hospitals are also stretched thin managing other diseases, including respiratory syncytial virus (RSV) cases, which he said this year are much higher and much more “wicked.” He said these hospitals have also been managing severe spikes in pediatric behavioral health or mental health cases throughout the pandemic. That will likely increase too, as it usually does, when school starts back up.
“It’s been quite a few things adding up that have added all this pressure on beds,” Wietcha said. “We don’t have a great national surge capacity in pediatrics.”
“It’s a big problem and an immediate one.”
As of Monday, there have also been at least 542 pediatric deaths related to Covid-19, according to the CDC. Deaths among children are still considered rare, and seven states in the US have had no reported child deaths. While that might not sound like a lot, given the more than 614,000 deaths in the US overall, the death of a child from any disease is typically incredibly rare.
When asked if children really should get vaccines, CDC director Dr. Rochelle Walensky put these deaths in perspective in a hearing for the US Senate Committee on Health, Education, Labor and Pensions at the end of July.
“One thing just I want to note with the children is: I think we fall into this flawed thinking of saying that only 400 of these 600,000 deaths from COVID-19 have been in children. Children are not supposed to die, so 400 is a huge amount,” Walensky said.
‘Things are moving a little bit too quickly’
Justin Senior, the CEO of Safety Net Hospital Alliance of Florida, which represents several children’s hospitals in Florida, said they are seeing about a 1 to 2% overall hospitalization among pediatric patients and that’s been pretty consistent throughout the pandemic. Nicklaus Children’s Hospital in Miami has 24 patients, with seven in the ICU, for a total of 39 patients. At Johns Hopkins All Children’s in the Tampa Bay area there are 15 children in the ICU.
“These recent surges are a really dark cloud, just very, very bad,” said Senior. “But at the same time there are a couple of silver linings and one is that this virus — knock on wood — still does not seem to impact children anywhere near to the extent that it impacts adults and that’s a good thing.”
In the Miami area, Dr. Aileen Marty, an infectious disease expert at Florida International University said the children’s hospitals there have been overwhelmed.
“Our pediatricians, the nursing, the staff are exhausted. And the children are suffering,” Marty said. “It is absolutely devastating … We’ve never seen numbers like this before.”
Experts say it’s still not clear if the Delta variant is causing more severe disease with kids, though it is more transmissible.
Dr. Amy Edwards, an infectious disease specialist at UH Rainbow Babies & Children’s Hospital in Cleveland, said it’s clear from the data that Covid-19 is now sending more children to the hospital.
What’s unclear, she said, is whether that’s because more kids are catching the virus, or the virus is somehow making the kids who do catch it more ill than before, requiring treatment at a hospital.
“Things are moving a little bit too quickly, and we know perfectly well that, especially with children, we’re not testing enough to really understand exactly what’s going on,” she said.
Edwards said her hospital is not inundated yet, but she expects they’ll see more cases in a few weeks. Children’s National Hospital in Washington, D.C. may be on the same trajectory. It has seen a slight increase in children testing positive for Covid-19, but said this increase has not yet impacted much the number of hospital admissions. Lurie Children’s Hospital of Chicago is also watching the cases closely.
“We expect Covid-19 activity to increase over the next several weeks,” said Dr. Larry Kociolek, the associate medical director of infection prevention and control at Lurie Children’s Hospital of Chicago.
Wietecha, with the Children’s Hospital Association, said people need to be careful in their thinking that children have escaped Covid-19.
“I think the idea that kids are pretty much healthy and fine is a unicorn,” Wietecha said.
Kids are not immortal, he said, and it should be very rare that a child would ever need to go to the hospital. The fact that even a few hundred have, is too many.
“I think a lot of parents view that their kids are kind of safe and unfortunately, we’re finding out otherwise,” Wietecha said.
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