The current surge in COVID-19 infections is hospitalizing children and adolescents at unprecedented rates. In the early stages of the pandemic, parents were assured that children primarily experience mild flu-like symptoms. Innate immune protection against the COVID-19 virus largely spared young children from contracting previous variants. However, as the predominant variant of COVID-19, Omicron has unique adaptations that penetrate natural immunity, leading to increased infection and hospitalization among children as young as infants.
Although rare, multisystem inflammatory syndrome in children (MIS-C) can manifest in pediatric patients vulnerable to severe COVID-19 related complications. Coinciding with positive COVID-19 symptoms, MIS-C is characterized by inflammation of organs and tissues, including the skin, brain, heart, blood vessels, lungs, digestive systems or kidneys. Most children recover from MIS-C with medical care, but for some, symptoms worsen quickly.
Clinical data from previous surges related to the Delta variant reveal that unvaccinated children are particularly vulnerable to developing severe COVID-19- related complications. The CDC COVID-19 Response Team recently released a report, tracking the clinical outcomes of 915 children and adolescents hospitalized for COVID-19 across six children’s hospitals during July to August 2021. A disproportionate number of these children were Black or Hispanic, consistent with previous reports on how COVID-19 is exacerbating racial health disparities.
713 patients, or 77.9%, reported COVID-19 as their primary reason for hospitalization, while asymptomatic patients hospitalized for unrelated reasons and those with MIS-C respectively made up 19.3% and 2.7% of the study’s sample. Among the pediatric patients hospitalized primarily by COVID-19, as few as 0.9% of children were fully vaccinated, even though 37.7%, aged 12 to 17, would have been eligible as of May 12, 2021. Children five years old and younger, who remain ineligible for vaccination, accounted for the second largest proportion of identified patients, following adolescents aged 12 years and older.
Approximately two thirds of these pediatric patients had at least one underlying medical condition, with the most common being obesity. In particular, 61.4% of patients aged 12 to 17 were diagnosed with obesity. These patients were admitted to the ICU and required oxygen support at higher rates, compared to those without obesity. In contrast to other age groups, adolescent patients were resultingly more likely to be admitted to the ICU for a longer duration and require higher levels of oxygen support.
Across all age groups, approximately 1% of hospitalized pediatric patients died of COVID-19 related complications. However, even for the children that were able to return home, the experience of being hospitalized puts tremendous strain on the family. Parents are often forced to take time from work to oversee their child’s hospital stay, which creates a great deal of emotional and financial stress.
Though a vast majority of children and adults recover from COVID-19 with mild symptoms, the spread of infection continues to disrupt our social systems. Home quarantines and COVID-19-realated school closures have become a regular occurrence for school-aged children across the country. However, few parents have the flexibility in their work schedules to respond to the routine shifts between virtual and in-person schooling. In addition to the fear of contracting the virus themselves, the pandemic is forcing parents to decide whether going to school is a necessary risk for their children.
Lessons from previous waves of the COVID-19 pandemic suggest that hospitalization rates rise as variants become more contagious, though not necessarily more deadly. With a particularly contagious variant such as Omicron, unvaccinated individuals are at the greatest risk of developing severe disease and being hospitalized. Consequently, every bed given to unvaccinated patients positive for COVID-19 limits the hospital’s capacity to take in patients with other severe diseases or injuries.
As we enter yet another year of this pandemic, reducing hospitalizations should be one of our highest priorities. It is particularly important to vaccine children at risk of severe disease. Although the FDA recently made booster shots available to children 12 years and older, the increase in child hospitalization demonstrates that vaccination eligibility needs to be extended to children below five years of age.