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As COVID-19 cases have skyrocketed across all islands in recent months, one of the most closely watched measures to assess whether to keep schools open for in-person learning, among other policies, has been been the incidence of serious illness in children.
But state data on pediatric hospitalizations appears to be inflated due to the way it is collected, making it difficult to get a clear picture of the situation for children.
The Centers for Disease Control and Prevention said the risk of complications or serious illness in children infected with COVID-19 is actually lower than that of the flu, which has brought some comfort to parents and healthcare professionals. health anxious.
But as the highly contagious delta variant has taken hold across the country this summer, doctors in other states have reported an alarming increase in pediatric hospitalizations.
Children under 12 are still not eligible for vaccines, and as older children prepared to return to school this fall, only half of those aged 12 to 17 had received at least one injection, according to national figures.
At the New Orleans Children’s Hospital, doctors and nurses have reported a worrying increase in the number of children with COVID-19 hospitalized and having trouble breathing, in some extreme cases, put on ventilators in the hospital. aim to save their lives.
Other cities in the South, where vaccination rates are lower, have also reported a worrying increase in the number of pediatric patients.
In Hawaii, it’s clear that cases in children have skyrocketed since early July, when the delta variant began to spread aggressively. In the last week of August, cases in children 17 and under were 17 times higher than in early July.
In the week ending August 29, more than 800 new cases were reported in children across the islands. But when it comes to figuring out how many of these kids get so sick that they end up in the hospital, the picture is much bleaker.
Before the rapid spread of the delta variant, 47 children with COVID-19 had been hospitalized in Hawaii since the pandemic began in early 2020, according to data published on the Hawaii Department of Health website. In the past two months alone, that number has more than tripled to 147.
One hundred pediatric hospitalizations in just two months is a worrying figure. But health care officials at Kapiolani Medical Center for Women and Children, the state’s only hospital specializing in pediatric care, say those numbers seem high and do not reflect what they are seeing.
On August 27, hospital officials said they admitted fewer than a dozen children for COVID-19 in the past month and a half.
Kaiser Permanente has only treated three pediatric cases of COVID-19 since July, none of which required ventilators, according to Laura Lott, spokesperson for the health system.
State data indicates that only one child has died from COVID-19 in Hawaii since the start of the pandemic.
Hospitalizations
The Healthcare Association of Hawaii, a trade group for state hospitals, reports statewide hospitalization data to the Department of Health, which publishes it on its COVID-19 website under the results cases. The data is used to estimate the percentage of COVID-19 cases requiring hospitalization and is broken down by age group.
Amid questions about what is included in the data, a spokesperson for the hospital association said the figures include children who have been admitted due to COVID-19, as well as children who test positive for the virus but may have been admitted for other reasons.
“The data is currently being reported in aggregate form, and this may give the false impression that there are more children requiring hospital care primarily for COVID-19 than there actually are,” said Stacy Wong, spokesperson for the Healthcare Association of Hawaii, by email. “Some pediatric patients are admitted primarily for COVID treatment, while others are admitted for other reasons and test positive for COVID. “
According to a study published in May by researchers at Stanford University School of Medicine, aggregating data in this way can dramatically inflate the numbers on COVID-19 outcomes.
Amid the pandemic, hospitals across the country, including Hawaii, have started screening all hospital patients for COVID-19, whether the virus is suspected or not. For pediatric patients, they could have been admitted for various conditions unrelated to COVID-19, such as fractures or appendicitis.
This screening has been an important safety measure in hospitals, but the number of tests that come back positive can be misleading if the data is reported in a way that suggests the virus is the cause of all hospitalizations.
The study analyzed COVID-19 data from Stanford’s Lucile Packard Children’s Hospital between May 2020 and February 2021, and found that 117 hospitalized children tested positive for COVID-19 or were admitted for MIS-C , a serious multisystem inflammatory disease in children that can develop weeks after infection with COVID-19.
The study found that of the 117 patients, 39% had asymptomatic COVID-19 infections and 28% had mild to moderate illness. Only 20% of patients were critically or critically ill with COVID-19, while 12% had MIS-C.
The study authors concluded that 45% of pediatric patients were admitted for reasons unrelated to COVID-19, stressing the importance of distinguishing between patients who were admitted due to COVID-19 and those who tested positive on screening but were asymptomatic and admitted for other reasons.
The Honolulu Star-Advertiser has tried unsuccessfully for several weeks to get the data disaggregated only by children hospitalized with COVID-19. On Wednesday, Wong said the Healthcare Association of Hawaii and health officials were discussing the possibility of modifying the data in a way that gives a more accurate picture of how COVID-19 is affecting children. But she said it could go against patient privacy.
“Patient privacy must be considered before definitive action can be taken,” she said via email.
Wong did not respond to a follow-up question about why reporting the number of patients hospitalized due to COVID-19 could affect patient privacy.
Kristen Bonilla, spokesperson for Hawaii Pacific Health, which oversees the Kapiolani Medical Center for Women and Children, said hospital officials were discussing the issue with the Healthcare Association of Hawaii and “hoped that they or the DOH can make this distinction when presenting these moving figures forward to provide a clearer picture to the audience.
The Healthcare Association of Hawaii did not answer whether all of its hospitalization data, covering all age groups, is aggregated in the same way. These numbers are also being watched closely as the state’s healthcare resources, including oxygen supply and intensive care unit capacity, remain stretched.
Watch the data
Government leaders are ready to impose more public restrictions, such as curfews and additional limits on social gatherings, if hospitalizations increase.
Lt. Gov. Josh Green reported 320 hospital patients with COVID-19 statewide on Friday, with a downward trend in recent days.
But on July 7, the number of hospitalizations jumped to 473, according to state data, approaching dangerously close to the 500 threshold that Green cited as a tipping point. If the numbers get that high, Green, who also works as an emergency doctor, said he would recommend Governor David Ige to impose lockdown measures.
“If we get close to 500, you have to take some very strong action, some life-saving action, and that would probably come in the form of at least a temporary shutdown based on some standards,” Green told Star-Advertiser’s. Spotlight Hawaii shows live online on August 30. Green said that at this point hospitals could be so strained that they should start rationing intensive care.
When asked later if he was concerned that hospitalization data was inflated due to the way it is collected, Green said there were cases that could skew the numbers. For example, he said people can test positive for COVID-19 three or four months after contracting the disease even if they have no symptoms and have been admitted to the hospital for an illness unrelated to COVID- 19.
But Green said he didn’t think it was a major problem.
“On occasion, they may call at a slightly higher number. But it’s basically the numbers, ”he said.
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