Thread by @jeffgilchrist

COVID-19: Pediatric Hospital Admissions

I'm really hoping that anyone who doesn’t believe COVID-19 can be dangerous to children has seen what is going on in the USA now that schools have reopened with many jurisdictions are no longer requiring masks. 🧵1/

The USA continues to see spiking COVID-19 pediatric admissions to hospitals, now at 300 new children being admitted to hospitals each day and over 48,000 child admissions in the last year ( covid.cdc.gov/covid-data-tra… ). 2/

Mississippi had almost 6,000 students test positive for COVID-19 in the last 2 weeks and 4500 cases at 803 schools in the last week alone which resulted in more than 20,000 students being quarantined last week ( mississippifreepress.org/14927/mississi… ). 3/

Just a week into grade 8, Mkayla Robinson died of COVID-19 only hours after testing positive. "The Children’s of Mississippi, the state’s only pediatric hospital, is currently full of children sick with COVID-19, including several on ventilators for life support." 4/

In the US there are around 27,500 staff pediatric beds and 5,400 pediatric ICU (PICU) beds (

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

). Pediatric hospitals usually operate around 80% capacity with significant variation during the week and seasons. 5/

Since mask recommendations were lifted in many places, other viruses have an easier time spreading as well, RSV is already surging, well before the normal fall/winter appearance. 6/

There are additional RSV infected children in hospital now, on top of all the new COVID-19 patients they are dealing with. 7/

Pediatric beds cannot be easily staffed by adult-trained providers because children are not little adults, their normal vital signs are different and they have different fluid and medication requirements. Children get different diseases and complications. 8/

According to CDC data, from April to late July 2021 this year, children were being hospitalized at a rate of around 1% of infections. Of those children hospitalized, around a third (33%) got sick enough to require PICU care. 9/

With Delta, there are concerns it is making children even sicker which seems to have been confirmed in Canada where pediatric hospitalizations of children age 0-9 in Ontario are 2.7x higher with Delta compared to earlier strains (

https://twitter.com/DFisman/status/1426176810627305474

). 10/

Predictions for how Delta might spread in schools found that without mitigation 90% of elementary students will be infected by the end of the first semester, 80% within 2 months of schools opening, and the majority of cases within the first 30 days ( covsim.hosted-wordpress.oit.ncsu.edu/school-level-m… ).11/

They estimate that universal masking can reduce student infections up to 78% and biweekly testing along with masking reduces infections by another 50%. 12/

With 50 million school-aged children in the USA, and around 4 million who have already been infected with COVID-19, 8 million older children have been vaccinated. 13/

With asymptomatic infections they estimate another 8 million children were infected and have partial protection, that leaves 34 million susceptible school children. Note, the USA has almost as many susceptible school children as the entire population of Canada. 14/

If schools do not implement masking policies and 50% of the susceptible children are infected within the 30 days following the first two weeks of school that means an average of 570,000 children would be infected per day. 15/

If 1% of those are hospitalized, pediatric hospitals would need to care for 5700 new COVID admissions each day. But children don't usually stay just 1 day. 16/

The early variant in 2020 had an admission of 2.5 days on average which means 14,000 general pediatric beds and 4,300 PICU beds would be needed just for COVID patients. 17/

Reports from the field suggest this may be longer for Delta, and if the average stay increases to 4 days, that would increase to 23,000 general pediatric beds and 6,800 PICU beds which would overwhelm the pediatric capacities at hospitals. 18/

That doesn't even take into account beds required for all other reasons, including RSV outbreaks. Even if only 1% of children need hospitalization, a giant surge of pediatric cases needs to be prevented. 19/

This can be accomplished with universal mask wearing and improved ventilation and filtering in schools, regular rapid testing, and vaccinating those who are eligible. 20/