Why Are Pediatric Hospitalizations for COVID-19 Increasing?

While the Omicron variant sweeps the nation, now making up 95% of new cases, troubling statistics are emerging about a rise in pediatric hospitalizations due to COVID-19. Before Christmas, there were approximately 2,000 children nationwide hospitalized for complications due to COVID-19. Just two weeks later, that number has jumped to 4,000. What is the cause for this surge in young patients with COVID-19? In today's post, we'll explore the leading theories and end with some predictions for the coming months.

Hospitalizations due to COVID-19 are a much more helpful metric than overall cases, so in this post we will focus on those cases that lead to hospitalization. Children represent 17.4% of all positive cases, but just 1.7%-4.1% of hospitalizations, so overall children are not showing poorer outcomes from the virus itself. So why are there so many more children being hospitalized?

Reason 1: The Omicron variant is causing an enormous surge in cases overall, resulting in more children being exposed. The more children exposed, the more children who could potentially develop complications requiring hospitalization.

Reason 2: A lower percentage of children are vaccinated than the adult vaccination rate, and those under 5 not eligible for vaccines. Overall, children eligible for the vaccine are lagging adult vaccination. Children 5-11 have been authorized for vaccines for far less time than adults. While 62% of the US population is vaccinated, just 23% of children aged 5-11 have received at least one dose. These percentages vary greatly by state, and are predicted to have an impact on pediatric hospitalizations by state. Nearly all hospitalized children are unvaccinated or under-vaccinated (only one shot of Moderna or Pfizer/BionTech).

Reason 3: Some children are at the hospital for another reason, and just happen to test positive for COVID. All hospital admissions these days include a COVID test. In one study, hospitalizations due to COVID represented 78% of pediatric admissions. This means that 22% of them are not being admitted for complications due to COVID.

Reason 4: This is the time of year when medically fragile children are at risk for complications due to many respiratory viruses. This year, COVID adds a new virus to the list of risky pathogens that could send an already ill (or immunosuppressed) child to the hospital. The increased speed of transmission seen with the Omicron variant means even more children will be exposed.

Reason 5: Delays in medical care mean some pediatric cases escalate more dramatically and require hospitalization. Some parents are waiting to take their children to the hospital due to extended waits at the medical facilities themselves or because families chose to wait and see. By the time the child receives care, the case may have progressed to the point where additional treatments are needed.

There are many predictions being made about the impacts the latest surge will have on children. Returning to school after travel and family gatherings has provided an opportunity for greater transmission, further complicated by wide-spread school staffing shortages. In order to help stem the surge, the CDC now recommends children age 12-17 get a vaccine booster 5 months after their second dose. Researchers are looking closely at reported data in order to track pediatric intubation and oxygen supplementation, as this metric gives an even better idea of how severely the disease may be impacting children. As for Omicron, it is anticipated to peak by the end of January, so these next few weeks will certainly be challenging. And our best recommendation? Everyone who can get vaccinated should get vaccinated. This helps the vaccinated individual as well as the vulnerable people, including children, with whom they come into contact.