DETROIT — Among the many alarming consequences of Michigan’s recent Covid-19 surge is one that has doctors particularly concerned: a record-breaking spike in child hospitalizations.
Data from the Michigan Health & Hospital Association shows that the number of children hospitalized with severe Covid-19 symptoms hit a high of 70 this week — twice as many as were hospitalized during the worst days of the wave that swept the state in November.
The numbers have public officials across the country watching Michigan, raising questions about why the B.1.1.7, or U.K., coronavirus variant behind the latest wave here is leading to more cases of children who are seriously ill.
“That’s the burning answer in my mind,” said Dr. Rosemary Olivero, an infectious disease pediatrician at the Helen DeVos Children’s Hospital in Grand Rapids, which is treating eight children with severe Covid-19 symptoms, including five who are in intensive care units.
“I can’t say that this variant is all of a sudden making children much sicker,” she said, noting that the increase in hospitalizations is more likely the result of more children getting infected “but we are experiencing a really severe surge.”
Children’s risk of dying from the virus remains very low in the United States. The latest report from the American Academy of Pediatrics and the Children's Hospital Association shows that while children account for 14 percent of Covid-19 infections since the pandemic began, they represent a tiny fraction of deaths.
But children now comprise a larger percentage of people getting infected than earlier in the pandemic. The American Academy of Pediatrics report shows that children accounted for 1 in 5 cases detected across the country during the second week of April. In Michigan, rates of child infections are now higher than they’ve been at any point in the pandemic. As of April 17, the 10-19 age group had the state's highest rate of new cases, averaging more than 1,150 cases per day during the previous week. For children younger than 10, the average was 400 new cases per day.
With vaccinations still not available for children younger than 16, that means more kids could be at risk.
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“We all know that it’s more severe in older adults, but it’s absolutely not correct to say that it’s benign in other people, and that's true for kids, too,” said Dr. Sean T. O’Leary, the vice chair of the committee on infectious diseases for the American Academy of Pediatrics.
He noted that the Covkid Project, which tracks child deaths from Covid-19 using government reports and news accounts, had documented 582 child deaths as of late March, which could make the disease one of the top 10 causes of death for children in the U.S.
Still, most children hospitalized for Covid-19 have a high likelihood of surviving, said Dr. Bishara Freij, the chief of pediatric infectious disease at Michigan’s Beaumont Hospital. The project has logged only 10 deaths of children or teens from Covid-19 in Michigan since the pandemic began.
“The vast majority will recover because we have learned a lot during this pandemic on how to manage these kids,” he said.
But the path to recovery can be difficult and distressing for children and their parents, he said.
“It was all really, really scary,” said Kari Barrows, of Hazel Park, Michigan, whose daughter Karissa, 16, just got home from a five-day stay at Beaumont Children’s Hospital. “I was panicking, crying a lot.”
The hospital’s Covid-19 safety rules meant Barrows was quarantined in her daughter’s room for her entire stay, unable to leave or take turns with her husband as her daughter struggled to breathe. “I’d go hide in the bathroom to cry because I didn’t want her to see me cry. I didn’t want to scare her.”
Karissa had Covid-19 pneumonia, which is the primary driver behind the current spike in child hospitalizations in Michigan, said Freij, who treated her.
Acute symptoms are similar to those in adults infected with severe forms of the virus. When Covid-19 pneumonia shows up in children, it’s more likely to affect adolescents with pre-existing conditions such as diabetes and obesity rather than younger and healthier children.
Michigan hospitals say they’re not seeing high numbers of children with multisystem inflammatory syndrome, a rare but dangerous Covid-19 complication that affects otherwise healthy children.
Doctors say they typically see these cases weeks after Covid-19 spikes because the syndrome is not caused by the virus itself but by the body’s immune response. So, even as Michigan this week is seeing its spring surge begin to slow, doctors are bracing for an uptick in cases of the rare inflammatory condition in the coming weeks.
Parents should be on alert, said Michelle Elkhoury, whose 4-year-old daughter, Juliana, spent nearly a week at Beaumont Children’s last month as the inflammatory syndrome battered her heart, kidneys and other organs.
“It was probably the worst week of our lives as parents,” she said. “We were in the hospital and we didn’t know what was going to happen.”
Elkhoury didn’t know anyone in her family had even had the virus until Juliana developed a high fever, bloodshot eyes and a telltale rash. The family had spent the past year worrying about keeping elderly loved ones safe. It never occurred to them to worry about their young daughters, she said.
That’s likely true of many people, said Dr. Arnold S. Monto, a public health and epidemiology professor at the University of Michigan and the acting chair of the Food and Drug Administration advisory panel considering emergency use applications from Pfizer and BioNTech to extend their Covid-19 vaccines to children as young as 12.
In the early days of the pandemic, when most people with the virus had a variant similar to the one that originated in Wuhan, China, in 2019, children and young adults were less likely than older people to be infected, he said.
Then the U.K. variant began sweeping across Michigan.
This variant is “very clearly more transmissible and therefore more likely to involve a wider age group,” Monto said. Since children were less likely to be infected last year, they were less likely to have natural antibodies to protect them from the virus. They’re also too young to get vaccinated.
Those facts, combined with school and restaurant reopenings and the resumption of youth sports, which have been linked to multiple Covid-19 outbreaks across Michigan, created conditions that seem to have increased children’s chances of getting infected, he said.
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Although a recently published study suggests the U.K. variant doesn’t make children sicker than other variants, that’s still a question scientists are trying to answer conclusively, he said.
What’s not in dispute, however, is the fact that more children are getting sick.
Children’s hospitalization rates increased 311 percent between Feb. 19 and April 20, said John Karasinski, the health and hospital association's communications director.
Adult hospitalization rates increased even faster — by 400 percent in the same period, he said — but the rate among children is sobering.
“We should definitely be worried about it,” said Dr. Kengo Inagaki, a pediatric infectious disease specialist at the University of Michigan’s C.S. Mott Children's Hospital. “We still have to be careful. We have to adhere to distancing and wearing masks and avoiding gatherings because that's the best way of preventing Covid, regardless of the strain.”
Now that vaccines are widely available for adults, some people might feel like the pandemic is over, but that’s not yet true, he said.
“We’re not anywhere close to the end of the pandemic.”