Thread by @heather_haq

We are officially back to getting crushed by #COVID, and for #pediatricians this wave feels *worse* in many ways. And as a pediatric hospitalist who has been a front-line COVID doctor for the entire pandemic, I’m going to share what I’ve seen the last 8 days on service. 1/

After many months of zero or few pediatric COVID cases, we are seeing infants, children, and teens with COVID pouring back into the hospital, more and more each day. These patients ranged in age from 2 weeks old to 17 years.

COVID admissions in our medical center are up 500% and currently 80% of cases in our hospital are due to the highly contagious Delta variant. I worry that the Delta variant, in addition to being more contagious, *may* also be more virulent in children.

This time around I’m seeing more COVID pneumonia in younger children (previously was seeing COVID pneumonia mainly in tweens and up), now seeing in neonates to preschoolers.

So we are on the front end of a huge COVID surge. But the difference this time compared to previous surges is we are simultaneously dealing with an unheard of summertime #RSV surge—creating a “surge upon surge” situation.

This year the virus made a resurgence in the summertime, when children’s hospitals have lighter staffing. We are now having winter-level patient volumes of acutely ill infants/toddlers with RSV and I worry that we will run out of beds and staff to handle the surge upon surge.

To help handle the predicted sustained increased patient volume and high acuity of cases, my pediatric colleagues and I are all being called to work mandatory overtime shifts in the coming months.

Some children admitted this time have co-infection with COVID plus other viruses such as RSV which could definitely make them sicker, we didn’t see much COVID/RSV co-infection during prior waves and we worry what this combination of viruses could look like.

We know from prior waves that MIS-C typically lags behind the acute COVID cases by a few weeks. Children who have mild/asymptomatic COVID absolutely can and do go on to later develop MIS-C. When the #MISC cases start coming they will add to the high volume/high acuity situation.

We continue to see sustained high volume of pediatric mental health crisis admissions, further contributing to the high patient volumes as psychiatric hospitals that accept children remain full.

All pediatric COVID patients I cared for this week were unvaccinated, some because they are not yet eligible due to age and some were eligible to receive it but had not been vaccinated yet. All family members >12 should vaccinate to protect younger family members.

I worry as kids go back to school with the Delta circulating, we will see huge school outbreaks that we didn’t see in prior waves, disproportionately affecting kids <12 since they’re not vaccine-eligible yet. We’ve already seen big camp and daycare outbreaks all summer with delta

I’ve cared for hospitalized pediatric patients with COVID throughout the pandemic, but this time with unvaccinated, susceptible children plus Delta variant, we will see more pediatric COVID admissions, and possibly sicker/younger COVID cases (as adult colleagues are reporting.)

Our children’s hospitals will be busier than prior waves with less beds and staff to care for more patients and sicker patients. What are my other #tweetiatrician and #PedsHM colleagues seeing across the country? /end

Reading more accounts from pediatricians, many sharing they are seeing respiratory complications in younger and younger children, including neonates.

https://twitter.com/johndanielmd/status/1420217996614766594

What can you do to protect your children?
⁃Vaccinate. Everyone in household over 12 should be vaccinated to help protect those family members not yet old enough to be vaccinated.

⁃Mask up. Yes, even those of us who are fully vaccinated. We know (unfortunately) that vaccinated people can get and pass on COVID even if they are personally protected against severe disease.

⁃Follow public health guidance including updated @CDCgov guidance and @AmerAcadPeds guidance for schools. Even if it feels like we are going backwards—it is necessary to adapt to this new stronger, more contagious variant.

⁃Don’t visit newborns at this time unless necessary. I saw many infants <2 months old in hospital this week, requiring high flow oxygen/respiratory support for both RSV and/or COVID. Both viruses are circulating way too high right now, so please postpone visits to tiny babies.

⁃If you are symptomatic, get tested. Even if you’re vaccinated, please test so you can help prevent onward transmission. /end

Adding I am #Houston, #Texas. Currently there is regional variance in RSV & COVID circulation so not all regions are feeling this “surge upon surge”…yet. South seems to be worst hit right now, hearing accounts from #BatonRouge, #NewOrleans, #Galveston cnn.com/2021/07/30/us/…

#Texas #RSV positivity rates on PCR tests is currently >30% - it’s rampant here. Other states like California have RSV positivity rates <3% currently. Surveillance data from @CDCgov cdc.gov/surveillance/n…