We need to talk about the pediatric bed situation in the USA.

Because things are going to get really bad, real fast, unless people doing things to stop it.

This is an important thread. Please share.

#delta #deltavariant #pediatric #covid #schoolreopening

🧵 1/n
Let’s start with the numbers:

In the last year that we have published data on (2018), there were 27,500 staffed pediatric beds and 5,400 pediatric ICU (PICU) beds in the USA.

pubmed.ncbi.nlm.nih.gov/34127553/ 2/n Image
Pediatric hospitals usually operate around 80% capacity, with significant variation during the week and season. They are used to small surges that are expected with seasonal changes in diseases, particularly RSV. ncbi.nlm.nih.gov/pmc/articles/P… 3/n Image
So they often have to operate at over 100% capacity. How? They have unused beds that they open up, ask staff to work extra shifts, and call in floating staff from elsewhere. The staff is really the key thing here – a bed without staff is no better than a bed in a hotel. 4/n
But that means that if there is RSV already surging, like it is now because of the ill-advised lifting of mask recommendations, they are already using their built-in surge capacity. 5/n
Pediatric beds cannot be staffed by adult-trained providers, because children are not little adults.

Their normal vital signs are different. They have different fluid and medication requirements (depending on weight or height). They get different diseases and complications. 6/n
So now lets talk about COVID. 7/n
Children who have tested positive for the coronavirus have a risk of being hospitalized on the order of 1%. downloads.aap.org/AAP/PDF/AAP%20… 8/n Image
Of the children hospitalized, 33% have been sick enough to require pediatric ICU (PICU) care. 9/n

There are concerns that delta is making children sicker, and now data from Canada seems to show that this is indeed the case – the risk of hospitalization with delta appears to be ~2.7 greater than with earlier strains. 10/n
Somewhere between 10-50% of infected children may be asymptomatic, at least with earlier strains.
cdc.gov/coronavirus/20… 11/n Image
Hence, it seems pretty safe to say that a child has a 1% risk of hospitalization when infected by delta, as it accounts for the asymptomatic cases. Remember, though, the risk may be even higher than 1%. 12/n
Now we can use these numbers get an idea if our pediatric healthcare system can sustain mass infection of schoolchildren (and their family members) this fall. 13/n
The COVSIM modeling project in North Carolina have created models of how the delta variant might spread through a school, and how different mitigation strategies could slow it down. Please check it out. 14/n
Without mitigation, they predict that 80% of elementary students will be infected within 2 months, with most cases within span of 30 days. 15/n Image
There are 50 million school-aged children in the US. A little over 4 million children have had confirmed COVID, childstats.gov/americaschildr… downloads.aap.org/AAP/PDF/AAP%20… 16/n
8 million have been vaccinated. Considering asymptomatic infections, we can guesstimate that approximately 8 million schoolchildren are relatively protected due to past infection.

This means that there are about 34 million susceptible schoolchildren. 17/n
If current mitigation strategies are ineffective, and 50% of these susceptible schoolchildren catch COVID in the 30 days staring two weeks after school opens (not an unreasonable prediction based on the COVSIM model), what would happen? 18/n
That means an average of 570,000 children would be infected per day.

If 1% of infected children are hospitalized, pediatric hospitals would need to care for 5700 new COVID admissions daily. 19/n
But children don’t usually stay just one day. With the original strain in 2020, it was 2.5 days on average, in which case we would need 14,000 general pediatrics beds and 4,300 PICU beds, just for COVID patients.

cdc.gov/mmwr/volumes/6… 20/n
But we don’t know what the average hospital stay for children with the delta variant will be.

If the average stay is actually 4 days (not unreasonable, based on anecdotal reports from the field), we would need 23,000 pediatric hospital beds and 6,800 PICU beds. 21/n
Recall that the USA only has about 27,500 pediatric beds and 4,500 PICU beds.

Either way, those sorts of numbers would vastly overwhelm our pediatric hospitals’ capacities. 22/n
The message here is that we just don’t have any wiggle room for mistakes.

We need to do everything in our power to prevent a giant surge of pediatric COVID cases, even if only 1% of children need hospitalization. 23/n
So them’s the numbers. 24/n
This is why we need to have absolute mask mandates, EVERYWHERE.

This is why we need mandatory vaccinations for everyone eligible who sets foot into a school. 25/n
And now it gets even worse….we aren’t sure if surgical masks can prevent even vaccinated people from spreading delta and being infected from it.

This means that we need to urgently do some pilot studies on how to keep schoolchildren safe before we send them back. Children should do virtual learning until these are done.

It is entirely possible that they can’t go back safely until they are vaccinated. 27/n
And note that vaccination may not protect against long covid, so it behooves us to continue wearing masks until the pandemic is truly over.

We need to work together on this. 28/n
This isn’t about keeping any individual child from getting sick.

This is about taking care of lots of children who are counting on YOU to keep them safe. 29/n
So children with curable pediatric cancers continue to get their miraculous life-saving treatments.

So children with diabetes and asthma crises continue to get saved.

So children who have been injured in accidents can have their injuries treated. 30/n
So children with complex medical issues are supported and cherished for the wonderful and awe-inspiring sentient human beings that they are.
If we hold off on in-person school until all children get vaccinated, then all children will thrive.

Vaccinated children who get breakthrough infections will sleep in their own beds at home, surrounded by their family. 32/n
And their family should get vaccinated too, so they are there with the child, and not in the adult hospital getting treated for covid themselves. 33/n
If we fail to heed the warnings and allow our children and families to be harmed, we won’t be able to go back and fix it.

This is not a game.

35/n fin
People, call and go to your local boards of education.

The anti-vaxxers and anti-maskers are stalking all the meetings and protesting in front of their buildings.

You need to be a counter-influence. Kids need you to speak up/be loud.

Or so many children will suffer needlessly.
For good guidance on how to make the air in schools safe and how to protect yourself and your family from COVID19, here is a great thread by aerosol scientist @kprather88 , whom I also recommend you follow:

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More from @denise_dewald

15 Oct
Feeling jealous of people in the EU who can buy ventilating windows that also do heat exchanging for energy efficiency.

I feel like the USA is the backwater that it was in the 1800s.
People in the EU have access to such technological advancement because of -- here's the shocker -- laws to improve energy efficiency.

Here's an article on it: mag.ebmpapst.com/en/industries/…
Here they put little ventilation units into the window sill: siegenia.com/en/products/co…
Read 6 tweets
15 Oct
How a society treats its most vulnerable segments—its elderly and its children—is a good measure of its ethics and compassion.

Seems that nations made up of individualistic people are still the stinky barbarians.
Did you know that Native Mexicans had large fresh-smelling cities because they had plumbing and human waste collection? Europeans had poop in their streets. Yet Spanish conquistadors slaughtered the Natives like animals.

I am beginning to think that there is something profoundly wrong with the European cultural mindset that persists to this day across the world.
Read 6 tweets
10 Oct
Surgical masks are not PPE. Image
Source, modified for brevity: cdc.gov/niosh/npptl/pd…
If you create a good seal with a mask brace, so they fit tightly, surgical masks can serve decently as PPE. Image
Read 4 tweets
9 Oct
Imagine if German schools stopped teaching about the Holocaust because it made children feel uncomfortable about their past.

"Section 51, part 6 of the Tennessee law makes lesson plans illegal if students 'feel discomfort, guilt, or anguish.'"

"Teaching the subject of the Holocaust and the Nazi era is mandatory in German schools and in addition to the classroom curriculum, almost all students have either visited a concentration camp or a Holocaust memorial or museum." pbs.org/wgbh/pages/fro…
Unsurprisingly, the German far-right is going after history education in Germany.

One German nationalist leader characterized the Holocaust as a '“speck of bird poop” in Germany’s otherwise admirable history.' Another defends Holocaust deniers.
Read 6 tweets
7 Oct
This profile raises all sorts of red flags
If you go to urgent care and the doc puts cucumber slices on your face, you might as well stay home.
Read 5 tweets
4 Oct
Reading Florence Nightingale's book, Notes on Hospitals, published in 1859, is just blowing me away.

She made many calculations, including how much water vapor patients exhaled overnight, and how much ventilation would be needed. And raised hell about it not being done.
Her interventions - improving ventilation, decreasing crowding, admitting natural light, washing surfaces -- cut hospital deaths by 2/3. This was WITHOUT hand washing, which wasn't even mentioned in her book.
Old hospitals built according to her specifications, using cross-breezes from large windows for natural ventilation, have much better ventilation than modern hospitals.

ACH = air changes per hour
Read 4 tweets

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