Thread by @haus_ppl

We also need to talk about the pediatric bed situation in #BC.

While all hospital resources are limited, the number of pediatric beds cannot be rapidly increased b/c they need to be staffed by HCWs trained in pediatric care.

A thread.

1/

#COVIDBc #BCed #bcpoli

https://twitter.com/denise_dewald/status/1426318422808449029

According to Child Health BC, BC has 231 general pediatric beds and 27 (yes 27) pediatric ICU beds.

childhealthbc.ca/clinician-reso… from "Children's Medical Services Part 1 - July 2021"

2/

Per provincial data there are 570,634 children in BC under the age of 12. These children cannot yet be vaccinated.

Of these, 296,420 are school aged (6-11 years old).

bcstats.shinyapps.io/popApp/

/3

Unfortunately, some of these kids have already contracted #COVID, & likely have some immunity. Assuming even age distrib'n of cases w/i age bands, the most recent situation report shows 6,510 cases among kids aged 6-11.

Math: 40% of <10 + 20% of 10-19
bccdc.ca/Health-Info-Si…
/4

But, kids may have asymptomatic infection – up to 50% of infections.

BC only tests symptomatic folks, so let’s assume that 2x as many kids have been infected. That means 13,020 kids aged 6-11 have some immunity.

/5

In BC, 1% of pediatric cases have needed hospital care.

Recent evidence from ON shows that kids with delta have ~2.7x the odds of hospitalization.

So, it's reasonable to assume that 1% of all infections (asymp + symp) will be hospitalized. 1% may be an underestimate.

/6

Models of COVID infection in schools predict that up to 80% of kids will be infected in the first two months of school without mitigation (e.g. no masks).

covsim.hosted-wordpress.oit.ncsu.edu/school-level-m…

/7

#BC has not released it's full back to school plan, but the preliminary plan released June 17th emphasizes a return to "close-to-normal". Earlier this month, the PHO said she did not intend to change the plan.

bc.ctvnews.ca/no-plans-to-ch…

/8

Cohorts are not expected, and limited reference is made to ventilation. A big concern because as @FurnessColin points out #CovidIsAirborne. Masks are not addressed by the current guidance.

Read more about the evidence that covid is airborne: thelancet.com/article/S0140-…
/9

@FurnessColin So, considering immunity from prior infection, that leaves 283,400 children aged 6 to 11 at risk of COVID infection in schools who have an 80% risk of contracting COVID in the first 2 months of school, with the majority of new cases occurring in the first 30 days.

/10

Assuming a 60/40 split of infections between month 1 and month 2, we would expect 136,032 kids in BC to contract covid in the first 30 days of school, or 4,535 per day.

/11

If we expect 1% of cases to need hospital care, that means we can expect 46 new hospital admissions among those aged 6-11 each day.

/12

Using the weighted average ICU rates from BC, about 12% of kids age 6 to 11 hospitalized for COVID are admitted to pediatric intensive care.

/13

That means that BC could see 46 new hospital admissions, including 5 new pediatric ICU admissions *each day* among kids aged 6 to 11.

/14

But kids don’t stay in hospital for just 1 day. They stay on average for 2.5 days, which means BC would need 115 general beds and 13 PICU beds just to manage COVID cases.

Put another way, half of BC's pediatric hospital beds would be used for COVID in kids aged 6 to 11.

/15

It's reasonable to think that hospital stays might be longer with delta. If the average hospital stay is 4 days, BC would need 184 general beds and 20 PICU beds for COVID.

Put another way, 3/4ths of BC's pediatric hospital beds would be used for COVID in kids aged 6 to 11

/16

We don't have that many beds available. In 2018/2019 BC had 49 inpatient admissions per day.

We can't let preventable COVID overrun pediatric services and prevent us from caring for already sick kids.

childhealthbc.ca/clinician-reso… "Children's Medical Services Part 1, July/21"

/Fin

H/t to @jdmereweather for the idea.

I welcome any feedback!

@DFisman @emilygraymd_mph @NjbBari3 @DrZoeHyde
@lisa_iannattone @JHowardBrainMD @fitterhappierAJ
@rebekah_diamond @KatharineSmart @DGBassani
@AshTuite @CMA_Docs @DrScottLear @rdmorris

I hope these numbers will help impress upon people the importance of effective mitigation measures. Everyone wants schools to open but they need to open safely to protect and support the health and well-being of our teachers, students and communities.

/Real fin