A trend facing neighboring states Wisconsin and Illinois is that children under the age of 5 are being significantly impacted in this latest surge of COVID-19. In the past 30 days, across Advocate Aurora Health, there’s been a threefold increase in hospitalizations at Advocate Children’s Hospital for COVID or COVID-related issues.
In a Zoom video press conference Thursday morning, four Advocate Aurora Health pediatric health experts shared updates on a dual pandemic crisis facing children and teens in the two states it serves: the surge in COVID-19 and mental health cases.
Amid the pandemic, there has been a skyrocketing in mental health issues in children and teens. Isolation is a driver of the issues. Vaccines can assure kids stay in the classroom and return to normal activities, the experts said.
First, get the shot
The pediatric experts encouraged everyone who is allowed to be vaccinated and boosted as soon as possible.
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“I think it’s the No. 1 primary way to combat severe illness,” said Advocate Children’s Hospital Chief Medical Officer Dr. Frank Belmonte. “Although omicron is very transmissible, and we’re seeing a lot of folks with break through, the folks that are vaccinating and boosting, really typically have mild symptoms … so we’re really encouraging parents to vaccinate their child when eligible.”
Medical Director of Aurora Children’s Health Dr. Kevin Dahlman said that even when people have already had the COVID illness, natural immunity can be unreliable, so everyone who can should still get vaccinated.
“It’s really key to keep our kids healthy and safe, especially those that can’t, or are not eligible to get the vaccine,” he said.
A threefold increase
Ninety-four percent of children hospitalized are unvaccinated, many of whom are coming from households where no one is vaccinated, according to data from Advocate Aurora Health.
Since mid-December, an uptick of roughly 25 to 38 children under the age of 18 are admitted to Advocate Children’s Hospital on an average daily basis.
A total of 25% of pediatric patients hospitalized currently are in the intensive care unit, and 49% of those hospitalized over the past month are 5 years old or younger. A total of 20% of all new COVID diagnoses in Wisconsin are children or teens. Seven of 10 school-aged children are testing positive in AAH Illinois outpatient offices; it was previously fewer than 2 out of 10.
Dahlman said those that are under the age of eligibility for the vaccine, ages 1-4, have seen the greatest increase in the number of cases — more than a threefold increase in less than a week.
“So pretty significant, rapid rate of rise in those that are in daycare and preschool age groups,” Dahlman said.
Serious COVID complications in children
COVID is not always mild in children and teens. Some are suffering serious complications. The long-term impact of COVID is also not yet fully known, the experts said.
Pediatric Critical Care Physician at Advocate Children’s Hospital Dr. Nekaiya “Kay” Jacobs said some of the increased amounts of children in the pediatric ICU for COVID or COVID-related issues were previously healthy and without prior risk factors.
Children who become infected with the COVID-19 virus can go on to develop MIS-C, or multi-system inflammatory syndrome. That’s when some organs and tissues — such as the heart, lungs, blood vessels, kidneys, digestive system, brain, skin or eyes — become severely inflamed. In the beginning, many of the COVID cases were associated with MIS-C, Jacobs said, and the organization is continuing to see those patients, but staffers are seeing more and more primary respiratory illnesses, even in infancy.
Some are presenting with upper airway issues like croup, or lower airway issues like COVID pneumonia. Some patients become very ill and require a ventilator to support their heart and lungs, and in the most severe cases, require extracorporeal membrane oxygenation, also known as extracorporeal life support, or heart and lung bypass.
This is also the time of year when all of the respiratory illnesses peak such as respiratory syncytial virus, rhinovirus and influenza, Jacobs said. Recently, people have tested positive for both the flu and the coronavirus.
“Having both of these viruses together could lead to severe illness,” Jacobs said. “There continues to be this misconception that COVID is always mild in children or teens, or that kids just don’t get sick. And we’re starting to see more and more patients of the pediatric age suffering from severe complications … There’s just so much to still learn and see and we just don’t know the implications that could occur in the future.”
Belmonte said despite all this, we should be doing everything in our power to keep kids in school safely.
“For the majority of kids, we have not seen major outbreaks in schools or in daycares,” Belmonte said. “If it’s possible, keep them in school.”
Mental health issues
Dr. Laura Yahr Nelson in pediatric psychiatry at Aurora Children’s Health spoke of underlying themes of the impact of isolation, the disruption of normal routines and the world of grief after losing loved ones.
There’s been a greater volume of patients with depression and anxiety, social anxiety leading to school avoidance and behavioral problems at school.
In addition, even though it’s rare, cases of COVID-induced psychosis have come up, which is an impaired sense of reality with neurological symptoms that occurs 1-2 months after a COVID infection.
Yahr Nelson’s message to parents to help with these issues is to check in with children, asking questions large and small, trying to connect and engage.
“Even if you ask and they don’t give the long answer you’d like, they’ve heard you. They’ve heard you tried,” Yahr Nelson said. “Really try to play games, ask to watch their favorite TikTok, go for a walk. It could be really simple.”
Yahr Nelson also said to try to foster connectedness outside the home because children need relationships: relationships with peers and support from adults.
Maintain normal sleep schedules and maintain a safe home, she said. Keep medications locked up and avoid having weapons. If there are firearms in the home, they should be kept in a safe.
Warning signs to watch for include increased isolation, declining grades or sleep changes. When concerned about a child, ask direct questions such as:
- “Have you hurt yourself?”
- “Are you thinking of hurting yourself?”
- “Are you thinking of suicide or harming anyone else?”
If it’s too much to manage at home, seek professional help. “We want kids to be in the least intensive level of care so they can continue to live well,” Yahr Nelson said.
Dahlman also encouraged parents to stay positive around their children and find unique activities to do to maintain a sense of normalcy.
“That rhythm, that routine can be really helpful and healthy for the families,” Dahlman said.
Dahlman said it’s “very important” to test children for COVID at the first sign of respiratory illness; however, he recognized all tests aren’t perfect and there may be some false negatives or positives. He encouraged seeking help from the child’s doctor if needed.
A phone call to a doctor can also help parents differentiate between when to take their children to a pediatrician, an urgent care clinic or the emergency room, he said.
“So easy to say, call us, because we got this,” Dahlman said. “Rest assured that we will talk you through even the most difficult and challenging cases.”
Jacobs said to take care of yourself and each other, love one another and be kind.
“We are all doing this together. Every day we wake up and we see more information on COVID there,” she said. “We’ve all lost loved ones and friends … so now it’s time for us to really just step it up and support each other and be there for each other.”
Yahr Nelson concluded: “We need to have a sense of normalcy wherever possible.”
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