Though the uptick in pediatric COVID hospitalizations is concerning, doctors stress the vast majority of children with the virus will have mild illness that can be treated at home.
Ontario hospitals are seeing more children sick with COVID-19 during the Omicron wave than at other points in the pandemic, though the highly transmissible variant does not appear to cause more severe illness, say doctors who spoke to the Star.
Data shows young children under the age of five and currently ineligible for COVID vaccines are being admitted in higher numbers than older children, a trend physicians say is similar to what hospitals experience with other viral respiratory infections.
Doctors are also reporting that Omicron seems to affect children differently than other forms of the virus. This variant appears to cause inflammation in the upper airways, which can lead to a dry, barking cough and breathing difficulties in some younger children.
Though the uptick in pediatric COVID hospitalizations is concerning, doctors stress the vast majority of children with the virus will have mild illness that can be treated at home. They also urge families to get vaccinated to protect themselves and their kids.
“We’re definitely seeing more children — starting in December, and now more in January — than we have seen in previous waves of COVID,” said Dr. Lindy Samson, chief of staff at CHEO (the Children’s Hospital of Eastern Ontario) in Ottawa. “But it’s important to know that it is still a relatively small number (who need hospital care) compared to the entire number of children who have been infected with COVID in the last month.”
Last week, CHEO took to social media to alert the community to the rise in cases, noting the hospital had so far seen 28 children with COVID admitted in January. Of those, three were admitted into the pediatric intensive care unit, Samson said.
The hospital is encouraging eligible residents to get vaccinated to protect those at greatest risk, including children under the age of five and those with complex medical conditions.
“The message is what can we do, not only as parents and families, but also the whole community to protect these kids,” Samson said. “Because any child who is admitted to hospital, that is really difficult for the child and the family.
“We want to avoid as many kids coming in as possible.”
According to Public Health Ontario, 137 kids under the age of 19 were admitted to hospital for COVID between Jan. 6 and Jan. 20, including 77 children under the age of five.
Among those under 19, the hospitalization rate is highest for this youngest age group at 10.6 per 100,000. During the same time period, 26 kids between the ages of 5 and 11 were hospitalized, a rate of 2.4 per 100,000. And 34 children aged 12 to 19 were admitted to hospital, a rate of 2.6 per 100,000, the data show.
Doctors who spoke to the Star report that older children who need hospital care are more likely to be unvaccinated or have underlying health conditions that make them more vulnerable to the virus.
Like CHEO, the Hospital for Sick Children has in recent weeks seen a rise in kids with COVID needing hospital care. On Sunday, there were 22 children admitted to the hospital with the virus.
Of those, about 40 per cent tested positive while receiving care for another condition or injury, said Dr. Upton Allen, Sick Kids’ division head of infectious diseases.
“These are incidental cases; they came into hospital for some other reason and are found to be COVID-positive,” he said.
Children who are admitted with COVID as their primary diagnosis are generally requiring supportive care, such as IV fluids, some oxygen support and electrolytes, rather than COVID-specific treatment, Allen said.
“The virus is bringing in kids with respiratory illness; it’s not too different than what we would see with RSV and influenza,” he said. Currently, there are fewer than five children with COVID in Sick Kids’ pediatric intensive care unit.
At previous points in the pandemic, including the spring Delta wave, Sick Kids on average had about five children admitted with COVID, said Allen, noting cases have fluctuated throughout the pandemic.
With Omicron, the rise in pediatric COVID hospitalizations is linked to the surge of cases in the community; given the vast number of cases in this wave, doctors expected pediatric cases to increase. But Allen said there are signs the uptick in kids with COVID needing hospital care is levelling out.
“We’ve been stable for the last week or so,” he said, noting the number of COVID in-patients at Sick Kids has been between 20 to 25 each day. “We’re hoping with cautious optimism that next week we won’t be reporting 20 to 25 (inpatients), but between 15 and 20.
“It’s suggestive there might be light at the end of the tunnel.”
Dr. Lorne Small, an infectious diseases specialist at Mississauga’s Trillium Health Partners, said children have represented a minority of COVID cases admitted to community hospitals throughout the pandemic.
On Friday, THP’s hospitals had about 300 COVID inpatients; only five of those cases were children. While recent modelling suggests cases in the community might be falling, Small said the return to in-person school could lead to another increase in pediatric hospitalizations.
Generally, COVID-positive children who need hospital care are not as sick as adults and typically require supportive care, such as IV fluids to help with dehydration, according to Small, THP’s medical director of infection prevention and control.
“By and large, they are not experiencing the devastating pneumonia that we see with adults,” said Small.
On a recent shift at Humber River Hospital, pediatrician Dr. Richard Hamat did not admit any COVID-positive children, and he said the number of pediatric inpatients with COVID-related illness at that hospital “remains low.”
However, he did see a large number of children coming to the emergency department with fevers and several COVID-positive mothers in hospital delivering babies.
In his outpatient clinic, “it seems everyone has it,” said Hamat, who is also a pediatrician at the Vaughan Pediatric Clinic in Woodbridge.
“We’re seeing a tremendous number of children … they have a several-day illness of fever, barking cough and other respiratory symptoms.” In the past week, about half of the families who called for an appointment had COVID-related illness, he said.
For the most part, families can treat their sick child’s COVID symptoms at home. Hamat advises parents to go to hospital if their child is finding it hard to breathe, there is a blue or white tinge to the skin or if there are signs of dehydration. Any infant under three months of age with a fever should be seen by a doctor, he said.
Dr. Stephen Freedman, a pediatric emergency medicine physician at the Alberta Children’s Hospital in Calgary and clinician-scientist at the hospital’s research institute, said the increase in children with COVID coming to hospital in the Omicron wave is a reflection of widespread community transmission.
Like other doctors, Freedman has seen more kids with COVID presenting like they have croup, a common childhood illness that causes a distinctive barking cough and can cause some children to have breathing difficulties. Although Omicron is causing different symptoms, the likelihood of a child getting severely ill is the same or lower than with other variants, he said.
And while most kids sick with the virus will have mild symptoms and recover at home, about 14 per cent of children admitted to hospital with COVID-related illness will have “severe outcomes,” said Freedman, pointing to data published this month in the medical journal JAMA Open Network. Freedman is co-lead of the international team that published the report investigating the outcomes of COVID-positive children presenting to emergency departments.
At Sick Kids, Allen said that despite the increase in the number of kids with COVID, there has not been a corresponding increase in MIS-C, or multi-system inflammatory syndrome in children.
The rare complication typically appears weeks after COVID infection and while most children with the syndrome will recover, some will need intensive care. A recent report from the U.S. Centers for Disease Control and Prevention found two doses of COVID vaccine was highly effective at protecting adolescents from MIS-C.
“We were all worried that with more Omicron cases, we were going to see more MIS-C cases; we haven’t seen that so far,” Allen said, noting more data is needed to understand fully whether COVID vaccines have prevented MIS-C cases.
He recommends parents vaccinate eligible children to protect them from all COVID complications. And those with young children not yet eligible for vaccines should vaccinate all family members, including older siblings.
“This builds a protective cocoon around the younger children.”
Article From: The Star
Author: Megan Ogilvie
