Rate of pediatric COVID-19 hospitalizations has increased
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An analysis of data from 22 U.S. states demonstrated a more than eightfold increase in the hospitalization rate of children with COVID-19 over the course of 6 months, according to a study published in JAMA Pediatrics.
“Unfortunately, the message of ‘lower risk’ in children was misinterpreted as ‘no risk’ by many until several children were diagnosed with multisystem inflammatory syndrome in children,” Pinar Karaca-Mandic, PhD, professor of health care risk management and academic director of the Medical Industry Leadership Institute at the University of Minnesota Carlson School of management, told Healio
“Unfortunately, testing among children has not been wide-scale and consistent to get a good understanding of prevalence of cases and infection rate among children,” Karaca-Mandic said. “Our study shows that children can get sick and hospitalized, while most children, fortunately, have less severe symptoms.”
According to data extracted from the Minnesota COVID-19 Hospitalization Tracking Project, there were 5,364 pediatric COVID-19 hospitalization from May 15 through Nov. 15, Karaca-Mandic and colleagues reported. During the study period, the average cumulative hospitalization rate rose from 2 per 100,000 children to 17.2 per 100,000 children, they reported.
The found large variations across the assessed states. Hawaii and Rhode Island shared the lowest pediatric hospitalization rate at the beginning of the study, with 0 cases per 100,000 children, whereas New Jersey and Colorado had the highest rates, with 5 and 4.4 per 100,000 children, respectively.
By November, at the end of the study period, Hawaii still had one of the lowest hospitalization rates with 4.3 per 100,000 children, only topping Rhode Island, which had 3.4 hospitalizations per 100,000 children, whereas South Dakota and Arizona led in hospitalizations, with 33.7 and 32.8 per 100,000, respectively.
The authors noted a significant variance in the magnitude of change from the beginning of the study period to the end of the 6-month analysis. Rates in Hawaii and New Hampshire increased by only 4.3 and 1 per 100,000 children compared with growing rates in Arizona and South Dakota, which had increasing rates of 32 and 31.2 per 100,000 children.
Several states had significant growth in 3 months, the authors reported. In Utah, hospitalization rates began at 0.3 per 100,000 children and increased to 15.5 per 100,000 children, a rate of increase of 5,067%.
“The take home for parents and clinicians is to understand that while children are much less likely to develop serious illness with COVID-19, some children will become very ill,” Karaca-Mandic said. “In our study, by Nov. 15, more than 17 children per 100,000 children had a COVID-19 hospitalization. [The corresponding] cumulative hospitalization rate for adults was 282 per 100,000 adults. Parents, in particular, should understand the symptoms of COVID, know early signs of deterioration and monitor their children closely until they fully recover.”
Perspective
Back to TopSamir S. Shah, MD, MSCE
The authors used data on COVID-19 hospitalizations from 22 states and combined those data with U.S. Census population estimates to determine the incidence of pediatric COVID-19 hospitalizations.
Not surprisingly, pediatric hospitalization rates varied by state. The rates of pediatric COVID-19 hospitalizations increased dramatically in some states between May and November but not in others. For example, the growth rate was greater than 1,000% in Arizona, Hawaii, South Dakota and Utah but less than double in Massachusetts and New Hampshire. These dramatic increases or lack thereof are likely attributable, in a large part, to the public health measures implemented at the state level. States with relatively small increases in COVID-19 hospitalizations often used early lockdowns, gradual reopenings, mask mandates and quarantine strategies for travelers or visitors in states. This study highlights the importance of a robust public health response to the pandemic as a way to protect children.
Additionally, changes in pediatric hospitalization rates tended to mirror changes in adult hospitalization rates. States with the highest adult hospitalization rates generally had the highest pediatric hospitalization rates. Children consistently accounted for 2% to 4% of all COVID-related hospitalizations during the latter phases of the pandemic in most states despite many states transitioning to remote learning to start the 2020-2021 school year. These findings, combined with other data, suggest that pediatric COVID-19 transmission often occurs outside of the school setting. We need to develop policies that focus on protecting children.
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